Usefulness of the MSG/IFICG/EORTC diagnostic criteria of invasive pulmonary aspergillosis in the clinical management of patients with acute leukaemia developing pulmonary infiltrates.
Invasive pulmonary aspergillosis (IPA) is a frequently fatal complication in patients with acute leukaemia. Because diagnosis is still difficult, non-invasive diagnostic criteria were recently proposed by MSG/IFICG/EORTC for study purposes. We have analysed their usefulness in the clinical management of acute leukaemic patients with pulmonary infiltrates. Twenty-seven infiltrates developed during 174 chemotherapy cycles given to 50 consecutive patients. According to diagnostic criteria, IPA was diagnosed in 42% of patients and 77.8% of pulmonary infiltrates. AML diagnosis and the first induction cycle were significant risk factors. "Proven" IPA was rare, occurring in one patient (2%). The diagnosis of "probable" IPA was made in seven patients (14%) and was strongly supported by the significant association of characteristic radiological lesions ("major" clinical criterion) with the positivity of one microbiological criterion (P = 0.026). Conversely, "possible" IPA was frequent (26%) because its pertinent diagnostic criteria were fulfilled in 48.1% of pulmonary infiltrates. However, in 84.6% of cases, the diagnosis of "possible IPA" aspecifically derived from the association of two conditions, a new pulmonary infiltrate with symptoms of lower respiratory tract infection ("minor clinical criterion"), together with the definition of "susceptible" host, which applied to 100% of our leukaemic patients. We conclude that, according to MSG/IFICG/EORTC criteria, a high number of pulmonary infiltrates would be diagnosed as IPA, but only a diagnosis of "proven/probable" IPA should be considered reliable in the clinical management of suspected IPA.
Borlenghi
Erika
E
U.O. Ematologia, Spedali Civili, Piazzale Spedali Civili, Brescia, Italy. erika.ok@libero.it
Cattaneo
Chiara
C
Capucci
Maria Adele
MA
Pan
Angelo
A
Quaresmini
Giulia
G
Franco
Fabio
F
Grazioli
Luigi
L
Carosi
Gian Piero
GP
Rossi
Giuseppe
G
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D002939:Ciprofloxacin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D007938:Leukemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015242:Ofloxacin / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D016896:Treatment Outcome
D000935:Antifungal Agents; D017964:Itraconazole; D002939:Ciprofloxacin; D015242:Ofloxacin