[Diagnosis of aspergillosis and other invasive filamentous fungal infections in hematology].
OBJECTIVE
Invasive filamentous fungal infections (FFI) are difficult to diagnose in the department of hematology; a variety of arguments are necessary to confirm the fungal origin. Our study evaluated prospectively, in a large population in South Eastern France, the diagnostic techniques used ante and post mortem (mycology, anatomopathology, serology and aspergillosis antigens) to prove an FFI.


METHODS
Two hundred and twenty eight neutropenic patients with obvious, probable, highly probable or presumed FFI were selected. Since completion of this study, a new classification of aspergillosis, with 3 instead of 4 levels of diagnosis, has been defined by the ICAAC in San Francisco but has not yet been published. Mycological or histological examinations were been performed on broncho-alveolar washings (BAW), puncture liquids or biopsies. Serology used precipitation, hemagglutination, immunofluorescence or ELISA techniques. Aspergillosis antigens were researched using the Pastorex method (agglutination of latex particles), launched at the beginning of the study.


RESULTS
Invasive aspergillosis was diagnosed in 43.4% of patients, a non-aspergilla FFI in 6.5%, and no fungi was isolated in the cultures of 50% of patients. Ante mortem, 160 patients underwent BAW with a total of 175 samples. Among the latter, 41.7% mycological examinations were positive (presence of mycelium filaments and/or positive cultures) with 68.7% of Aspergillus fumigatus. Of the 48 puncture liquids, 25% of direct examinations and 29% of cultures were positive. Biopsies were taken from 59 patients and explored for mycology: 63.8% of direct examinations and 46.8% of cultures were positive; for those explored histologically, 76.7% revealed the presence of mycelium filaments. Post mortem, 17 patients out of 79 deceased underwent a total of 24 autopsy or biologic sampling. For 5 patients, FFI was diagnosed post mortem. Aspergillus serology and antigen explorations were conducted respectively in 202 and 182 patients and were positive in 31% and 33%. The presence of antibodies appears to be a good prognostic factor compared with the presence of antigens.


CONCLUSIONS
Biological diagnosis of FFI relies on the multiplicity of examinations and renewal of mycological sampling.
Gari-Toussaint
M
M
Laboratoire de Parasitologie-Mycologie, Hôpital Archet 2, BP 3079, F06202 Nice. gari-toussaint.m@chu-nice.fr
Piens
M A
MA
D000946:Antigens, Fungal / Q000097:blood; D001228:Aspergillosis / Q000175:diagnosis* / Q000473:pathology; D001344:Autopsy; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D003428:Cross Infection / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000473:pathology; D008297:Male; D016533:Mycological Typing Techniques; D009181:Mycoses / Q000175:diagnosis* / Q000473:pathology; D009503:Neutropenia / Q000175:diagnosis* / Q000473:pathology; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis
D000946:Antigens, Fungal