Non-aggressive diagnostic approach to invasive pulmonary aspergillosis in a hematology unit. Retrospective analysis of a series of 16 cases

Among neutropenic patients, diagnosis of invasive pulmonary aspergillosis is difficult. Computed tomographic scan, bronchoalveolar lavage and histology are considered invasive procedures, because they represent an infectious risk for these immunocompromised patients. We describe the clinical and non...

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Bibliographic Details
Published in:La revue de medecine interne 2002-03, Vol.23 (3), p.259-266
Main Authors: Grandière-Perez, L, Penn, P, Gardembas, M, Boasson, M
Format: Article
Language:fre
Subjects:
Aspergillosis - diagnosis
Aspergillosis - diagnostic imaging
Auscultation
Bronchoalveolar Lavage Fluid
Female
Humans
Leukemia - complications
Leukemia, Myeloid, Acute - complications
Lung Diseases, Fungal - diagnosis
Lung Diseases, Fungal - diagnostic imaging
Male
Middle Aged
Neutropenia - complications
Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications
Prognosis
Radiography, Thoracic
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed
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Summary:Among neutropenic patients, diagnosis of invasive pulmonary aspergillosis is difficult. Computed tomographic scan, bronchoalveolar lavage and histology are considered invasive procedures, because they represent an infectious risk for these immunocompromised patients. We describe the clinical and noninvasive paraclinical (X-rays, serology) signs of invasive pulmonary aspergillosis, from a retrospective study of 16 cases in a haematology unit. Outside of fever and chills, cough and polypnea are the earliest signs, followed by chest pain, dyspnea, lung auscultation changes, and haemoptysis. The sensitivity of each sign is higher than 56%. Before the onset of lung auscultation changes, the chest X-ray shows mainly unilateral alveolar infiltrates. Sensitivity of serology is weak (25%), but contributed to early diagnosis in 16.6% of cases. A better knowledge of the invasive pulmonary aspergillosis clinical, radiological and serological signs could help the practician to prescribe an 'invasive' investigation (computed tomographic scan, bronchoalveolar lavage) to confirm the diagnosis of this fungal infection.
ISSN:0248-8663