title: Predictors of pulmonary zygomycosis versus invasive pulmonary aspergillosis in patients with cancer.
abstract: BACKGROUND
  Pulmonary zygomycosis (PZ), an emerging mycosis among patients with cancer, has a clinical manifestation similar to that of invasive pulmonary aspergillosis (IPA). Most cases of PZ in such patients develop as breakthrough infections if treatment with antifungal agents effective against Aspergillus species is administered. However, clinical criteria to differentiate PZ from IPA are lacking.
  
  
  METHODS
  We retrospectively reviewed the clinical characteristics and computed tomography (CT) findings for 16 patients with cancer and PZ and for 29 contemporaneous patients with cancer and IPA at the time of infection onset (2002-2004). Patients with mixed infections were excluded. Parameters predictive of PZ by univariate analysis were included in a logistic regression model.
  
  
  RESULTS
  Almost all patients with PZ (15 of 16) and IPA (28 of 29) had underlying hematological malignancies and typical risk factors for invasive mold infections. In logistic regression analysis of clinical characteristics, concomitant sinusitis (odds ratio [OR], 25.7; 95% confidence interval [CI], 1.47-448.15; P = .026) and voriconazole prophylaxis (OR, 7.76; 95% CI, 1.32-45.53; P = .023) were significantly associated with PZ. The presence of multiple (> or = 10) nodules (OR, 19.8; 95% CI, 1.94-202.29; P = .012) and pleural effusion (OR, 5.07; 95% CI, 1.06-24.23; P = .042) at the time that the patient underwent the initial CT were both independent predictors of PZ in the logistic regression analysis of radiological parameters. No difference occurred in the frequency of other CT findings suggestive of pulmonary mold infections (e.g., masses, cavities, halo sign, or air-crescent sign) between the 2 patient groups.
  
  
  CONCLUSIONS
  PZ in immunocompromised patients with cancer could potentially be distinguished from IPA on the basis of clinical and radiological parameters; prospective validation is needed.
authors.affiliation: Department of Infectious Diseases, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Georgios
authors.initials: G
authors.lastname: Chamilos
authors.forename: Edith M
authors.initials: EM
authors.lastname: Marom
authors.forename: Russell E
authors.initials: RE
authors.lastname: Lewis
authors.forename: Michail S
authors.initials: MS
authors.lastname: Lionakis
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
mesh_terms: D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D001230:Aspergillus / Q000145:classification / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009089:Mucor / Q000145:classification / Q000302:isolation & purification; D009091:Mucormycosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000382:microbiology; D009369:Neoplasms / Q000150:complications*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012233:Rhizopus / Q000145:classification / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed; D020096:Zygomycosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology