Concurrent lung infections in patients with hematological malignancies and invasive pulmonary aspergillosis: how firm is the Aspergillus diagnosis?

J Infect. 2012 Sep;65(3):262-8. doi: 10.1016/j.jinf.2012.05.001. Epub 2012 May 9.

Abstract

Background: Immunocompromised patients with hematological malignancies and/or recipients of hematopoietic stem cell transplants are constantly exposed to several fungal, bacterial, and viral respiratory pathogens.

Methods: We retrospectively evaluated all patients with invasive pulmonary aspergillosis (IPA) and underlying hematological malignancies for the presence of concurrent, microbiologically documented pulmonary infections during a 5-year period (2005-2010).

Results: We found 126 such patients that frequently had coinfections (49%) with respiratory pathogens other than Aspergillus species, with a higher rate in patients with probable IPA (53%) than in those with proven IPA (29%; P=0.038).

Conclusions: As the majority of patients with IPA in daily practice have probable IPA, often according to only the combination of positivity for serological biomarkers and radiological findings, our data may raise skepticism about both the certainty of IPA diagnosis and the evaluation of response to antifungals in a subset of these patients.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antifungal Agents / therapeutic use
  • Chi-Square Distribution
  • Coinfection / diagnosis
  • Coinfection / drug therapy
  • Coinfection / immunology
  • Coinfection / microbiology*
  • Hematologic Neoplasms / immunology
  • Hematologic Neoplasms / microbiology*
  • Humans
  • Immunocompromised Host
  • Invasive Pulmonary Aspergillosis / complications
  • Invasive Pulmonary Aspergillosis / diagnosis*
  • Invasive Pulmonary Aspergillosis / drug therapy
  • Invasive Pulmonary Aspergillosis / microbiology
  • Male
  • Middle Aged
  • Retrospective Studies

Substances

  • Antifungal Agents