[Non-aggressive diagnostic approach to invasive pulmonary aspergillosis in a hematology unit. Retrospective analysis of a series of 16 cases].
OBJECTIVE
Among neutropenic patients, diagnosis of invasive pulmonary aspergillosis is difficult. Computed tomographic scan, bronchoalveolar lavage and histology are considered invasive procedures, because they represent an infectious risk for these immunocompromised patients.


METHODS
We describe the clinical and noninvasive paraclinical (X-rays, serology) signs of invasive pulmonary aspergillosis, from a retrospective study of 16 cases in a haematology unit.


RESULTS
Outside of fever and chills, cough and polypnea are the earliest signs, followed by chest pain, dyspnea, lung auscultation changes, and haemoptysis. The sensitivity of each sign is higher than 56%. Before the onset of lung auscultation changes, the chest X-ray shows mainly unilateral alveolar infiltrates. Sensitivity of serology is weak (25%), but contributed to early diagnosis in 16.6% of cases.


CONCLUSIONS
A better knowledge of the invasive pulmonary aspergillosis clinical, radiological and serological signs could help the practician to prescribe an 'invasive' investigation (computed tomographic scan, bronchoalveolar lavage) to confirm the diagnosis of this fungal infection.
Grandière-Perez
L
L
Service de maladies du sang-médecine interne, CHU, 4, rue Larrey, 49033 Angers, France. lucia.perez@infonie.fr
Penn
P
P
Gardembas
M
M
Boasson
M
M
D001228:Aspergillosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D001314:Auscultation; D001992:Bronchoalveolar Lavage Fluid; D005260:Female; D006801:Humans; D007938:Leukemia / Q000150:complications*; D015470:Leukemia, Myeloid, Acute / Q000150:complications; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications; D011379:Prognosis; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
Approche diagnostique non agressive de l'aspergillose pulmonaire invasive en hématologie. Analyse rétrospective d'une série de 16 cas.