TABLE 3.
Clinical characteristics of patients without IPA but with BAL GM results of >0.5
| 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 result | Serum GM resultc | Cytology result | Transbronchial biopsy of BAL fluid result | BAL fluid culture result | Diagnosis | Treatmentd | Outcome, follow-up period (cause of death) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 (57, male) | Heart; 2.5 yr; Pred (10 mg/day), FK506 | Fever, cough, wt loss, diabetic ketoacidosis | Large nodular mass extending to chest wall; mediastinal adenopathy | Fep, Van | 0.55 | 0.1 | No hyphae | Focal lymphocytic inflammation; yeast but no hyphae | C. albicans | Pneumonia due to Rhodococcus equi | No antifungal | Survived, 1.5 yr |
| 2 (40, male) | 3rd liver transplant; 3 wk; Sol (20 mg/day), FK506 | Hypotension, multisystem organ failure | Multiple bilateral nodules | Flc, Fep, Metro | 0.56 | 0.1, 0.33 | No hyphae (+) yeast | ND | C. glabrata | Bacteremia and pneumonia due to Pseudomonas aeruginosa | AmBLC (2 days), then Vrc (3 wk) (until death) | Died, 3 wk (bowel perforation and multisystem organ failure) |
| 3 (48, female) | Single lung; 5.5 yr; CyA, Aza, Pred (10 mg/day) | Fever, shortness of breath, cough | Focal mild consolidation | Sxt, Fep | 0.63 | ND | No hyphae | Mild acute cellular rejection | Candida | Rejection | No antifungal | Survived, 1.3 yr |
| 4 | Bilateral lung; 4 yr; FK506, Siro, Pred (5 mg/day) | Fever, hypoxemia | Ground glass opacification (diffuse) | Sxt | 0.86 | 0.2 | PCP | Interstitial lymphocytic infiltrate | No fungus | Pneumocystis pneumonia | No antifungal | Survived, 4 mo |
| 5 (65, male) | Kidney; 4 yr; CyA, Myco, Pred (10 mg/day) | Fever, chills, rigors, weakness | Patchy airspace disease and ground glass opacity (focal) | Fep, Van | 0.96 | 0.06 | No hyphae; normal cells | Mild interstitial edema; no hyphae | No fungus | Community-acquired pneumonia | No antifungal | Survived, 1.1 yr |
| 6 (63, female) | Heart; 1.5 mo; Sol (50 mg/day), FK506 | Septic shock | Consolidation (multifocal) | Fep | 1.09 | 0.11, 0.24 | ND | ND | No fungus | Refractory pulmonary valve endocarditis due to Enterococcus faecalis | Vrc (2.5 days) (until death) | Died, 3 wk (multisystem organ failure and refractory enterococcal bacteremia) |
| 7 (55, male) | Kidney; 10 yr; CyA, Myco, Pred (10 mg/day) | Fever, chills, shortness of breath, weak | Consolidation (focal); hilar adenopathy | None | 1.62, 0.10 (2 days later) | ND | No hyphae | Squamous cell cancer; no hyphae | Penicillium | Lung cancer with postobstructive pneumonia | No antifungal | Survived, 4 mo |
| 8 (51, female) | Bilateral lung; 5 wk; FK506, Aza, Pred (10 mg/day) | Bronchial stenosis due to lung reperfusion lung injury | Focal consolidation | Van, Gat, Dapsone | 3.04, 1.5 (7 days later) | ND | Acute inflammation cells; hyphae | ND | A. terreus | Bacterial pneumonia | Inhaled AmB (3 days) (to “eradicate colonization”) | Survived, 1.4 yr |
| 9 (55, male) | Heart; 3 wk; OKT3, FK506, Myco, Sol (100 mg/day) | Post-transplant sepsis | Extensive focal consolidation; pleural effusion | Fep, Van | 3.35, 0.12 (2 days later), 0.13 (3 days later), 0.10 (4 days later) | 0.12, 0.13, 0.10 | ND | ND | No fungus | Nosocomial bacterial pneumonia due to Klebsiella pneumoniae | Vrc (2.25 mo) (until death) | Died, 2.25 mo (sepsis due to multidrug-resistant Acinetobacter; cardiopulmonary arrest) |
| 10 (60, male) | Heart; 2 mo; CyA, Myco, Sol (150 mg/day) | Fever, cough, hemoptysis | Focal consolidation with reticulonodular component | Fep, Van, Azm, Metro, Sxt | 5.57 | 0.11 | No hyphae; acid-fast organisms | ND | No fungus | Pneumonia due to Nocardia asteroides | Vrc (7 days) (until death) | Died, 8 days (multisystem organ failure, sepsis) |
| 11 (59, female) | Single lung; 2.5 mo; FK506, Aza, Pred (20 mg) | Fever, cough, chills | No infiltrates (X-ray only) | Sxt | 7.14 | ND | Acute inflammation; hyphae | Acute pneumonia; no hyphae | A. flavus, A. niger | Pneumonia due to Pseudomonas aeruginosa; mild rejection | No antifungal | Survived, 1.3 yr |
| 12 (33, female) | Single lung; 2 yr; FK506, Pred (10 mg/day) | Shortness of breath, nausea | Ground glass consolidation (focal) and pleural effusion | Sxt | 8.1 | ND | Many macrophages; (+) hyphae | Mild lymphocytic bronchitis with unattached hyphae | A. flavus | MRSA pneumonia | Itraconazole (1 wk) | Died, 2 mo (disseminated MRSA infection [autopsy]) |
a
Transplant status: transplanted organ; time from last transplant to BAL; immunosuppressive regimen. Abbreviations: Cya, cyclosporin A; Aza, azathioprine; OKT3, muromonab-CD3; Sol, methylprednisolone (Solu-Medrol); FK506, tacrolimus; Pred, prednisone; Siro, sirolimus; Myco, mycophenolate.
b
Abbreviations: Fep, cefepime; Van, vancomycin; Azm, azithromycin; Metro, metronidazole; Gat, gatifloxacin; Sxt, trimethoprim-sulfamethoxazole.
c
ND, not done.
d
Abbreviations: Vrc, voriconazole; AmBLC, amphotericin B lipid complex.