Dynamic monitor of CT scan within short interval in invasive pulmonary aspergillosis for nonneutropenic patients: a retrospective analysis in two centers

Fei Chen,Huaqiong Huang,Huijie Wang,Yanbin Tan,Wen Hua,Hao Zhang,Yonghong Zhong,Na Li,Yanxiong Mao

doi:10.1186/s12890-021-01512-8

Fei Chen, Huaqiong Huang + Show 7 more

Open Access

https://doi.org/10.1186/s12890-021-01512-8

Copy DOI

Abstract

BackgroundIn nonneutropenic patients with underlying respiratory diseases (URD), invasive pulmonary aspergillosis (IPA) is a life-threatening disease. Yet establishing early diagnosis in those patients remains quite a challenge.MethodsA retrospective series of nonneutropenic patients with probable or proven IPA were reviewed from January 2014 to May 2018 in Department of Respiratory Medicine of two Chinese hospitals. Those patients were suspected of IPA and underwent lung computed tomography (CT) scans twice within 5–21 days. The items required for IPA diagnosis were assessed by their host factors, mycological findings and CT scans according to the European Organization for Research and Treatment of Cancer (EORTC) and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG) criteria (EORTC/MSG criteria).ResultsTogether with the risk factors, mycological findings and nonspecific radiological signs on first CT, ten patients were suspected of IPA. With the appearance of cavities on second CT scan in the following days, all patients met the criteria of probable or possible IPA. Except one patient who refused antifungal treatment, nine patients received timely antifungal treatment and recovered well. One of the nine treated IPA cases was further confirmed by pathology, one was confirmed by biopsy.ConclusionsDynamic monitor of CT scan provided specific image evidences for IPA diagnosis. This novel finding might provide a noninvasive and efficient strategy in IPA diagnosis with URD.

Highlights

Invasive pulmonary aspergillosis (IPA) is a fungal infection which is the most common form of invasive aspergillosis and a cause of mortality
We found that invasive pulmonary aspergillosis (IPA) in nonneutropenic patients showed a specific progressive deterioration in the computed tomography (CT) scan in a short interval, which promoted early diagnosis and timely antifungal therapy
We found there was no requirement for dynamic changes of clinical exacerbation, neither the CT scan nor mycological findings in the EORTC/ Mycoses Study Group (MSG) criteria

Summary

Introduction

Invasive pulmonary aspergillosis (IPA) is a fungal infection which is the most common form of invasive aspergillosis and a cause of mortality. Chen et al BMC Pulm Med (2021) 21:142 mortality rate of up to 30–40% in some risk groups [1, 2] Aside from those high-risk groups, the incidence of IPA in nonneutropenic patients with underlying respiratory diseases (URD) such as chronic obstructive pulmonary disease (COPD), asthma, lung cancer or autoimmune diseases with pulmonary involvement is increasing [3,4,5]. The mortality of IPA in URD patients has been found to be between 32% and 100% [6,7,8]. Patients with URD have similar symptoms, signs and radiology, which is likely to cause missed or misdiagnosed IPA in clinical diagnosis [2,3,4]. In nonneutropenic patients with underlying respiratory diseases (URD), invasive pulmonary aspergillosis (IPA) is a life-threatening disease. Establishing early diagnosis in those patients remains quite a challenge

Methods

Results

Discussion

Conclusion