TABLE 2.
Clinical characteristics of patients with IPA
| Patient (age [yr], sex) | Transplant statusa | Reason(s) for BAL | CXR/CT scan | Antibiotic(s) prior to or at the time of BALb | BAL GM resultc | Serum GM resultd | Cytology result | Transbronchial biopsy of BAL fluid result | BAL fluid culture result | Diagnosis | Treatmente | Outcome, follow-up period |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 (54, male) | 3rd liver transplant; 3 wk; Sol (10 mg/day), FK506 | Fever, sepsis | Multifocal consolidations | AmBLC (3 wk), Lvx, Van | 8.83* | 0.07* | ND | ND | No fungus | Proven IPA (disseminated aspergillosis by brain and thyroid biopsies) | Vrc added to AmBLC after BAL result (treated for 1 yr); resection of the brain and thyroid lesions | Survived, 1.2 yr |
| 2 (40, male) | Kidney; 5 yr; Pred (60 mg/day) | Cough, pleurisy, hemoptysis | Multiple bilateral cavities with surrounding ground glass opacities | Tim, Azm | 2.58† | 0.04† | Acute inflammation; no hyphae | Acute inflammation; no hyphae | Negative | Proven IPA (culture of pleural fluid, A. fumigatus) | Vrc (8 mo) | Survived, 2 yr |
| 3 (64, male) | Heart; 2 yr; Siro, Pred (10 mg/day) | Fever | Cavity with surrounding infiltrates | Mxf | 2.1 | ND | Inflammation and hyphae | Necrotic tissues with hyphae | Candida sp. | Probable IPA | AmBLC plus Vrc immediately after BAL, then Vrc after GM result (6 mo) | Survived, 10 mo |
| 4 (58, male) | Kidney; 3 mo; ATG, FK506, Myco, Pred (10 mg/day) | Fever, chest pain | Multiple bilateral cavities/nodules | Cro, Azm, Sxt | 10.12 | 0.93‡ | Inflammation; hyphae | Acute and chronic inflammation; no hyphae | A. fumigatus, A. flavus | Probable IPA | AmBLC immediately after BAL, then Vrc after GM result (3 mo) | Survived, 1.3 yr |
| 5 (42, male) | 3rd kidney transplant; 5.3 yr; FK506, Myco, Pred (10 mg/day) | Fever, cough | Multiple bilateral cavities and nodular densities | None | 3.77 | 0.13 | No hyphae | Focal acute/chronic inflammation; no hyphae | Penicillium sp., A. fumigatus | Probable IPA | Vrc (1.25 yr) | Survived, 1.25 yr |
Transplant status: transplanted organ; time from last transplant to BAL; immunosuppressive regimen. Abbreviations: Sol, methylprednisolone (Solu-Medrol); FK506, tacrolimus; Pred, prednisone; Siro, sirolimus; ATG, anti-thymocyte globulin; Myco, mycophenolate.
Abbreviations: AmBLC, amphotericin B lipid complex; Lvx, levofloxacin; Van, vancomycin; Tim, ticarcillin-clavulanic acid (Timentin); Azm, azithromycin; Mxf, moxifloxacin; Cro, ceftriaxone; Sxt, trimethoprim-sulfamethoxazole.
Symbols: *, follow-up BAL GM results during antifungal therapy, 7.72 (21 days), 0.19 (5 months), 0.26 (9 months); †, follow-up BAL GM results during antifungal therapy, 0.13 (2 months), 0.23 (9 months).
Symbols: *, follow-up serum GM results over the next 4 days, 0.07, 0.07, 0.06; †, follow-up serum GM results over the next 6 days, 0.44, 0.06, 0.06, 0.12; ‡, follow-up serum GM results during antifungal therapy, 0.11 (4 days), 0.06 (1 month), 0.07 (1 month), 0.07 (2 months). ND, not done.
Abbreviations: Vrc, voriconazole; AmBLC, amphotericin B lipid complex.