Yield of diagnostic procedures for invasive fungal infections in neutropenic febrile patients with chest computed tomography abnormalities.
Haematological patients with neutropenic fever are frequently evaluated with chest computed tomography (CT) to rule out invasive fungal infections (IFI). We retrospectively analysed data from 100 consecutive patients with neutropenic fever and abnormal chest CT from 1998 to 2005 to evaluate their chest CT findings and the yield of diagnostic approaches employed. For their initial CTs, 79% had nodular opacities, with 24.1% associated with the halo sign. Other common CT abnormalities included pleural effusions (48%), ground glass opacities (37%) and consolidation (31%). The CT findings led to a change in antifungal therapy in 54% of the patients. Fifty-six patients received diagnostic procedures, including 46 bronchoscopies, 25 lung biopsies and seven sinus biopsies, with a diagnostic yield for IFI of 12.8%, 35.0% and 83.3%, respectively. In conclusion, chest CT plays an important role in the evaluation of haematological patients with febrile neutropenia and often leads to a change in antimicrobial therapy. Pulmonary nodules are the most common radiological abnormality. Sinus or lung biopsies have a high-diagnostic yield for IFI as compared to bronchoscopy. Patients with IFI may not have sinus/chest symptoms, and thus, clinicians should have a low threshold for performing sinus/chest imaging, and if indicated and safe, a biopsy of the abnormal areas.
Department of Medicine, Division of Infection Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305-5107, USA. doraywho@stanford.edu
Dora Y
DY
Ho
Margaret
M
Lin
Joanna
J
Schaenman
Fernando
F
Rosso
Ann N C
AN
Leung
Steven E
SE
Coutre
Ramachandra R
RR
Sista
Jose G
JG
Montoya
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019937:Diagnostic Techniques and Procedures; D005260:Female; D005334:Fever / Q000150:complications*; D005658:Fungi / Q000302:isolation & purification / Q000502:physiology; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000382:microbiology; D009503:Neutropenia / Q000150:complications*; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013909:Thorax / Q000002:abnormalities*; D014057:Tomography, X-Ray Computed; D055815:Young Adult