Table 1.
Radiological findings, results of GM and PCR assays, antifungal treatment, and outcomes for 26 patients with proven IA and probable IA
| Patient no. | Primary disease(s)a | Sexb | Age (yr) | Radiologic sign | No. of samples tested/positivef |
Mycological culture | I.v. antifungal(s)c | Outcome at day 90 after diagnosis | ||
|---|---|---|---|---|---|---|---|---|---|---|
| GM (index minimum-maximum) | PCRm (Cq minimum-maximum) | PCRr (Cq minimum-maximum) | ||||||||
| Proven IA (n = 4) | ||||||||||
| 1 | AML | F | 13 | Halo | 42/28 (0.5–5.5) | 28/2 (43–41) | 28/2 (40–41) | VOR, CAS, AMB | Survival | |
| 2 | AML, HSCT | F | 22 | Nodules | 30/21 (0.5–15.3) | 21/6 (34–40) | 21/none | A. flavus (palate biopsy) | AMB | Survival |
| 3 | AML | M | 38 | 26/7 (0.6–3.7) | 7/3 (41–43) | 7/none | A. flavus (palate biopsy) | AMB, CAS | Survival | |
| 4 | Aplastic anemia | M | 74 | Not done | 4/2 (0.4–0.5) | 2/2 (35–37) | 2/2 (34–34) | A. fumigatus, F. oxysporum (lung biopsy) | AMB, CAS | Death |
| Probable IA (n = 22) | ||||||||||
| 1 | AML | M | 50 | Nodules | 34/6 (0.5–0.8) | 6/none | 6/none | CAS, AMB | Survival | |
| 2 | AML, HSCT | F | 34 | Nodules | 7/4 (0.5–1) | 6/none | 6/none | Survival | ||
| 3 | CLL | M | 72 | Halo | 10/7d (1.1–6) | 7/2 (40–40) | 7/2 (38–38) | VOR, AMB | Survival | |
| 4 | Lymphoma | M | 46 | Nodules, halo | 3/3d(1.6–4.4) | 3/2(40–41) | 3/2(38–38) | AMB, VOR | Death | |
| 5 | AML | F | 54 | Nodules | 9/3d (1.6–5.4) | 3/2 (42–46) | 3/2 (40–42) | CAS, VOR | Survival | |
| 6 | CLL | M | 56 | Cerebral lesion | 3/3 (1.2–4.9) | 3/3 (38–45) | 3/3 (33–45) | CAS, AMB | Death | |
| 7 | AML, HSCT | M | 54 | Nodules | 19/4 (0.5–1.7) | 4/none | 4/none | VOR | Survival | |
| 8 | AML | F | 16 | Nodules, halo | 14/4 (0.5–0.6) | 4/none | 4/none | AMB | Survival | |
| 9 | CLL | M | 62 | Nodules | 8/3 (0.6–0.7) | 3/none | 3/none | VOR | Survival | |
| 10 | Sickle-cell anemia, HSCT | M | 16 | Air crescent sign | 16/5d (0.6–0.8) | 5/3 (41–45) | 5/none | VOR. CAS | Survival | |
| 11 | AML, HSCT | F | 36 | Nodules | 17/6 (0.6–4.7) | 6/2 (45–45) | 6/6 (39–41) | AMB, VOR, CAS | Death | |
| 12 | Lymphoma | M | 47 | Nodules | 4/2 (0.9–1) | 2/none | 2/none | Survival | ||
| 13 | ALL, HSCT | M | 22 | Halo | 4/2d (0.6–1.3) | 2/none | 2/none | VOR | Death | |
| 14 | AML, HSCT | F | 28 | Halo | 11/5d (0.5–3.2) | 5/none | 5/none | VOR, CAS, AMB | Death | |
| 15 | CLL | F | 52 | Nodules | 27/16d (0.6–6.8) | 16/3 (42–44) | 16/3 (41–42) | AMB, CAS | Survival | |
| 16 | AML | F | 57 | Nodules | 27/9d (0.5–1.3) | 9/3 (39–44) | 9/5 (40–45) | AMB, CAS | Survival | |
| 17 | CLL | M | 61 | Halo | 8/4 (0.5–1.5) | 4/none | 4/none | VOR | Survival | |
| 18 | AML | F | 59 | Nodules, halo | 8/6d (0.6–2.6) | 6/3 (39–43) | 6/none | AMB, VOR, CAS | Survival | |
| 19 | ALL | F | 39 | Halo | 11/3d (0.6–2) | 3/2 (41–43) | 2/2 (38–40) | VOR, AMB | Death | |
| 20 | AML | F | 28 | Nodules | 9/2 (0.5–3.4) | 2/1 (41) | 2/1 (40) | AMB | Survival | |
| 21 | CML, HSCT | F | 48 | Nodules | 13/2 (0.7–2.1) | 2/none | 2/2 (37–41) | Scopulariopsis sp. (BALe) | VOR | Death |
| 22 | AML, HSCT | M | 56 | Cerebral lesion | 6/6d (0.8–4.9) | 6/none | 6/3 (38–41) | Phanerochaete chrysosporium (sputum) | CAS, VOR, AMB | Death |
AML, acute myeloblastic leukemia; ALL, acute lymphoblastic leukemia; CML, chronic myeloid leukemia; CLL, chronic lymphocytic leukemia; HSCT, hematopoietic stem cell transplantation.
M, male; F, female.
AMB, liposomal amphotericine B; CAS, caspofungin; VOR, voriconazole. According to the guidelines for antifungal therapies used in our institution (which are quite similar to those of the Infectious Diseases Society of America [IDSA]), caspofungin or l-Amb was used as a first-line treatment for febrile neutropenia and l-Amb was used when physicians suspected mold infection. Voriconazole was the first-line treatment for invasive aspergillosis. A combination of antifungals was used for cerebral and/or sinusal aspergillosis, invasive aspergillosis with extrapulmonary foci, and bilateral IA with multiple nodules in highly immunocompromised patients.
Patient receiving piperacillin-tazobactam.
BAL, bronchoalveolar lavage.
PCRm, mitochondrial PCR; PCRr, ribosomal PCR.