title: Invasive pulmonary aspergillosis in heart transplant recipients: two radiologic patterns with a different prognosis.
abstract: BACKGROUND
  Computed tomography (CT) findings can be used to classify invasive pulmonary aspergillosis (IPA) in 2 patterns: airway-invasive (AIR) or angioinvasive (ANG).
  
  
  METHODS
  AIR-IPA was considered when the CT revealed peribronchial consolidation or a tree-in-bud pattern and ANG-IPA when a nodule, cavity, halo sign, infarct-shaped, or mass-like consolidation was found. We evaluated the correlation among IPA patterns on CT and outcomes in heart transplant (HT) recipients.
  
  
  RESULTS
  The study included 27 HT recipients with a CT scan performed at the time of IPA diagnosis. The study interval was from 1988 to 2011. Ten AIR-IPA patients (37.1%) were compared with 17 ANG-IPA patients (62.9%). During the post-transplantation period before IPA developed, AIR patients required hemodialysis more frequently (40% vs 5.9%, p = 0.04). AIR patients also had more intercurrent bacterial pneumonia (23.5% vs 70%, p < 0.001), and IPA was diagnosed later after onset of symptoms (2.7 vs 8.5 d, p = 0.09). After diagnosis, AIR-IPA patients required more mechanical ventilation (23.5% vs 90%, p < 0.01) and had a higher related mortality rate (23.5% vs 70%, p = 0.04).
  
  
  CONCLUSIONS
  Our study shows that the AIR pattern represents 37% of IPA episodes in HT recipients and is associated with a more protracted clinical presentation, later diagnosis, and higher mortality rate.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Centros de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain. Electronic address: pmunoz@micro.hggm.es.
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vena
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Ines
authors.initials: I
authors.lastname: Cerón
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Maricela
authors.initials: M
authors.lastname: Valerio
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Palomo
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Guinea
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Escribano
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Martínez-Sellés
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Centros de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000382:microbiology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000401:mortality; D008168:Lung / Q000000981:diagnostic imaging* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D066027:Transplant Recipients
chemical_list: D000935:Antifungal Agents
keywords: Aspergillus spp; airway-invasive pattern; angio-invasive pattern; heart transplant; invasive aspergillosis