title: Computed tomography guided percutaneous lung biopsies and suspected fungal infections in pediatric cancer patients.
abstract: BACKGROUND
  The spectrum of potential fungal pathogens known to cause invasive pulmonary infections has grown as a result of intensified immunosuppressive therapy and the emergence of antifungal resistance.
  
  
  METHODS
  In a retrospective single center study, we investigated computed tomography guided percutaneous lung biopsies in 16 childhood patients with suspected fungal infections. Microbiological analysis consisted of microscopic examination, culture, and a broad-range fungal polymerase chain reaction for detection of either Aspergillus or Mucorales species.
  
  
  RESULTS
  In 14 patients (88%), invasive fungal infection with Aspergillus species including A. terreus, Mucormycetes, and Saccharomyces cerevisiae being the main pathogens was confirmed, including patients with a double infection (19%). In two cases, the most likely diagnosis of primary bronchiolitis obliterans organizing pneumonia was established based on the results of typical histopathologic features, negative culture results, and symptoms resolved after treatment with high-dose cortisone. Diagnosis of invasive fungal pneumonia led to an immediate interruption of antineoplastic treatment in 100%, reduction of antibiotic drugs in 76%, and change of empirical to targeted antifungal therapy in 63%. The safety of lung biopsy was guaranteed by lack of any complications, such as bleeding or pneumothorax.
  
  
  CONCLUSIONS
  The increased detection of rare fungal infections by computed tomography guided biopsy supports the need for a rapid and precise diagnosis, as most of the fungal pathogens are at least partially resistant to available antifungal therapy and proper treatment is essential for best practice in patient management.
authors.affiliation: Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Kropshofer
authors.forename: Adrian
authors.initials: A
authors.lastname: Kneer
authors.forename: Michael
authors.initials: M
authors.lastname: Edlinger
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meister
authors.forename: Christina
authors.initials: C
authors.lastname: Salvador
authors.forename: Cornelia
authors.initials: C
authors.lastname: Lass-Flörl
authors.forename: Martin
authors.initials: M
authors.lastname: Freund
authors.forename: Roman
authors.initials: R
authors.lastname: Crazzolara
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004271:DNA, Fungal / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D007223:Infant; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D016133:Polymerase Chain Reaction; D011379:Prognosis; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D004271:DNA, Fungal
keywords: biopsy; cancer; childhood; fungal