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J Heart Lung Transplant. 2014 Oct;33(10):1034-40. doi: 10.1016/j.healun.2014.05.003. Epub 2014 Jun 2.

Invasive pulmonary aspergillosis in heart transplant recipients: two radiologic patterns with a different prognosis.

Author information

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.

KEYWORDS:

Aspergillus spp; airway-invasive pattern; angio-invasive pattern; heart transplant; invasive aspergillosis

PMID:
25012980
DOI:
10.1016/j.healun.2014.05.003
[Indexed for MEDLINE]

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