Invasive aspergillosis in cancer

• Published in: Mycoses 2002-11, Vol.45 (9-10), p.358-363
• Main Authors: Sridhar, H., Jayshree, R. S., Bapsy, P. P., Appaji, L., Navin Kumar, M., Shafiulla, M., VijayKumar, B. R.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Aspergillose; aspergillosis; Aspergillosis - etiology; Aspergillus; Biological and medical sciences; Female; Fever - etiology; haematologic disorders; Haematologische Erkrankungen; Humans; Investigative techniques, diagnostic techniques (general aspects); Krebs; Lung Diseases, Fungal - etiology; Male; malignancy; Mannans - isolation & purification; Medical sciences; Middle Aged; Neoplasms - complications; Neoplasms - therapy; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiography, Thoracic; Radiotherapy - adverse effects; Respiratory system; Retrospective Studies
• ISSN: 0933-7407; 1439-0507
• DOI: 10.1046/j.1439-0507.2002.00803.x

Ten confirmed cases of invasive aspergillosis (IA) in cancer patients were analysed retrospectively. Eight were pulmonary, one was sinonasal and one was cutaneous. The majority of patients had haematological malignancies (7), the remaining three were cases of solid tumours. Fever was present in all 10 cases. Cough and lung signs were present in all eight cases of invasive pulmonary aspergillosis. Haemoptysis was encountered in three of nine cases of pulmonary and sinonasal aspergillosis. Mortality was low (2%). While corticosteroids, antibiotics and anticancer chemotherapy/radiotherapy were factors predisposing the patients to IA, neutropenia was perhaps responsible for their mortality. Seven of the patients had other associated pathogens isolated in culture in addition to Aspergillus spp. Aspergillus fumigatus was the predominant species, followed by A. flavus, A. glaucus, A. nidulans and A. niger. Direct microscopic examination (in six of seven cases) and culture (six of seven cases) correlated well with radiographic and clinical findings in cases with lung involvement. Serology for anti‐Aspergillus antibodies performed by gel diffusion precipitin test was positive in one case of sinonasal aspergillosis, wherein only one precipitin band was observed. Correlation of clinical symptoms, consistent radiographic findings and microbiological work‐up (the latter including a triad of direct microscopy, culture and serology) are required to arrive at a diagnosis of IA, especially where histology cannot form the mainstay of diagnosis. Zusammenfassung.  Zehn gesicherte Fälle von invasiver Aspergillose (IA) bei Krebspatienten wurden retrospektiv analysiert. Acht waren Lungen‐ und je eine Nebenhöhlen‐ und Hautaspergillosen. Die Mehrzahl der Patienten hatte hämatologische Erkrankungen, die übrigen solide Tumoren. Husten und Lungensymptome wurden bei allen acht Lungenaspergillosen beobachtet. Dreimal wurden Hämoptysen beobachtet. Die Mortalität war niedrig (2). Als prädisponierende Faktoren für IA wurden Kortikosteroide, antibakterielle und antineoplastische Chemotherapie und Radiotherapie angesehen, während für die Mortalität wohl Neutropenie verantwortlich war. Bei sieben Patienten wurden noch weitere Erreger isoliert. Aspergillus fumigatus war der häufigste Aspergillose‐Erreger, gefolgt von A. flavus (2), A. glaucus (1) und A. nidulans and A. niger (1). Direkter mikroskopischer wie kultureller Nachweis korreierten gut mit radiologischen und klinischen Befunden bei d