Patricia Muñoz1, Antonio Vena2, Ines Cerón2, Maricela Valerio2, Jesús Palomo3, Jesús Guinea2, Pilar Escribano2, Manuel Martínez-Sellés4, Emilio Bouza5. 1. 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. 2. Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. 3. Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 4. Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain. 5. 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.
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.
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: A Oliva; G Ceccarelli; C Borrazzo; M Ridolfi; G D 'Ettorre; F Alessandri; F Ruberto; F Pugliese; G M Raponi; A Russo; A Falletta; C M Mastroianni; M Venditti Journal: Infection Date: 2021-05-26 Impact factor: 3.553