The strategy for the diagnosis of invasive pulmonary aspergillosis should depend on both the underlying condition and the leukocyte count of patients with hematologic malignancies.
The identification of the causative organism in invasive pulmonary aspergillosis (IPA) is recommended. We investigated whether a mycologic diagnostic strategy could be optimized based on patient characteristics. Fifty-five patients were enrolled in a prospective study. The presence of Aspergillus in respiratory samples occurred more frequently in non-acute leukemia (AL) patients than in AL patients (P = .0003), and in patients with leukocyte counts more than 100/mm(3) (P = .002). In a logistic regression model, these 2 factors appeared to be independent, with an adjusted odds ratio of 7.14 (95% confidence interval, 1.40-36.5) for non-AL patients and an adjusted odds ratio of 6.97 (95% confidence interval, 1.33-36.5) for patients with leukocyte counts more than 100/mm(3). A positive mycologic result was also more frequent among patients with lung CT scan signs of airway-invasive disease than among other patients (P = .043). Airway-invasive signs were more frequent among non-AL patients (P = .049), whereas angioinvasive disease was more frequent among both AL patients (P = .01) and patients with leukocyte counts less than 100/mm(3) (P = .001). A concomitant pulmonary infection was identified more frequently among non-AL patients (P = .005 vs allogeneic hematopoietic stem cell transplant and P = .048 vs others). Our results suggest that different strategies for diagnosing IPA should be considered based on the underlying condition.
Université Paris Diderot, Sorbonne Cité, Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Paris, France. anne.bergeron-lafaurie@sls.aphp.fr
Anne
A
Bergeron
Raphaël
R
Porcher
Annie
A
Sulahian
Cédric
C
de Bazelaire
Karine
K
Chagnon
Emmanuel
E
Raffoux
Anne
A
Vekhoff
Muriel
M
Cornet
Françoise
F
Isnard
Benoit
B
Brethon
Claire
C
Lacroix
Jean Louis
JL
Poirot
Claire
C
Bouges
Francis
F
Derouin
Abdellatif
A
Tazi
Patricia
P
Ribaud
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001230:Aspergillus / Q000302:isolation & purification*; D001999:Bronchoscopy; D002648:Child; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000628:therapy; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D007938:Leukemia / Q000150:complications / Q000628:therapy; D007958:Leukocyte Count; D016015:Logistic Models; D008168:Lung / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult