Clinical and radiologic predictors of invasive pulmonary aspergillosis in cancer patients: should the European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) criteria be revised?
BACKGROUND
Invasive pulmonary aspergillosis (IPA) is a life-threatening infection in immunocompromised patients. The outcome of such infections depends on early diagnosis and prompt initiation of therapy. The objective of the current study was to determine the significant predictive factors that characterize IPA in patients with cancer.


METHODS
The clinical characteristics and computed tomography (CT) findings for 47 cases with IPA were retrospectively reviewed and compared with 49 controls (patients diagnosed on autopsy with nonfungal pneumonias). Data from all 96 patients were modeled using multivariate logistic regression. Subgroups of patients with common characteristics and outcomes were identified.


RESULTS
Leukemia, neutropenia, cavitation, and nodular lesions occurred significantly more often among cases than controls (P = 0.04, 0.004, 0.04, and 0.02, respectively). A quantitative scoring system was developed that could be used to identify patients as being at low, medium, and high risk for IPA.


CONCLUSIONS
IPA should be highly suspected in leukemia patients with profound neutropenia, pleuritic chest pain, and cavitary or nodular lesions detected on CT scan. These predictive factors can be used to indicate when early prophylactic and therapeutic antifungal interventions should be initiated.
Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, 77030, USA. rhachem@mdanderson.org
Ray
R
Hachem
David
D
Sumoza
Hend
H
Hanna
Essam
E
Girgawy
Mark
M
Munsell
Issam
I
Raad
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D002637:Chest Pain; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007938:Leukemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009503:Neutropenia; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D000935:Antifungal Agents