Original Clinical ScienceInvasive pulmonary aspergillosis in heart transplant recipients: Two radiologic patterns with a different prognosis
Section snippets
Methods
This study was performed at a 1,750-bed tertiary center in Spain serving a population that ranged between 650,000 and 715,000 inhabitants during the study period. The transplant database was reviewed to identify all IPA episodes diagnosed from August 1988 to August 2011. Patients with an initial lung CT scan, defined as the first CT scan available whenever IPA was suspected, were included in the analysis. The Local Ethics Committee approved this study and determined that specific informed
Results
The analysis during study period included 27 HT patients diagnosed with IPA with an initial chest CT scan. Median age was 54 years (range, 35–66 years), and 23 (85.8%) were men. Median time of IPA diagnosis after HT was 54 days (range, 29–91), and IPA occurred within the first 3 months (early IPA) in 20 patients.
As noted on chest CT findings, the ANG pattern was found in 17 patients (62.9%) and the AIR pattern in 10 (37.1%). Both populations had similar epidemiologic characteristics (Table 1),
Discussion
In our series, AIR-IPA radiologic presentation accounted for 37% of IPA cases in HT recipients and was related with a significantly poorer prognosis. Although AIR-IPA patients had fewer underlying conditions, they required more hemodialysis after transplantation and presented more clinically insidious disease that took longer to be diagnosed and led to more respiratory failure and more need of mechanical ventilation. Consistently with previous studies, the overall mortality rate was 41%,9, 19,
Disclosure statement
The authors thank all of their colleagues from the Cardiology, Heart Surgery, Radiology, Clinical Microbiology, and Infectious Diseases Departments for their help. They also thank the heart transplant recipients for their continuous support and friendship.
This study was partially financed by the PROMULGA Project, Instituto de Investigación Carlos III, PI1002868.
None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented
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2021, Revista Portuguesa de CardiologiaCitation Excerpt :In this immunosuppressed population, Aspergillus species are opportunistic pathogens that can cause aggressive infections including sinusitis, tracheobronchitis, pneumonia, necrotizing cellulitis, brain abscess, and disseminated disease. In heart transplant (HT) recipients, Aspergillus spp. have been reported as the most common cause of invasive fungal infection and frequently causes pneumonia2 with a high attributable mortality, ranging from 53% to 78%.3–5 Although invasive pulmonary aspergillosis (IPA) is a serious disease in this population, little is known about its natural history.
CT of invasive pulmonary aspergillosis (IPA) in cases with hematologic malignancy: Comparison of CT features in the group classified by the severity of neutropenia and underlying disease
2020, European Journal of RadiologyCitation Excerpt :IPA has two phenotypes: the angio-invasive form and the airway-invasive form. The two forms show a different prognosis, with the prognosis of the airway-invasive form being worse than that of the angio-invasive form among patients who have undergone heart transplantation or HSCT [3,4]. In general, the incidence of the airway-invasive form (14–34%) is lower than that of the angio-invasive form [5].
CT Halo sign: A systematic review
2020, European Journal of RadiologyCitation Excerpt :When a study reported more than 50 % of the population as neutropenic, it was classified as a study on neutropenic patients, whereas when the population was <50 % it was classified as a mixed study with both neutropenic and non-neutropenic patients. Of the remaining 47 studies, 18 were on non-neutropenic patients, [10,11,27,51,53,62,69,70,100,105,123,124,153,162–165,172], 7 were on mixed group (neutropenic plus non neutropenic) [4,14,34,40,60,93,161] and in 22 studies the status of neutropenia was not specified.(7,17,26,36,38,43,50,76,88,107,122,126–128141,146,159,166–169171] There were 24 studies in immunocompetent individuals (175 patients) and 12 studies in mixed population (both IS + IC) with 597 patients.
Invasive pulmonary aspergillosis in heart transplant recipients: Is mortality decreasing?
2019, Revista Portuguesa de CardiologiaCitation Excerpt :In this immunosuppressed population, Aspergillus spp. – an opportunistic pathogen – can cause aggressive infections including sinusitis, tracheobronchitis, pneumonia, necrotizing cellulitis, brain abscess, or disseminated disease. In heart transplant (HT) recipients, Aspergillus spp. has been reported as the most common cause of invasive fungal infection and frequently causes pneumonia2 with a high attributable mortality, ranging from 53% to 78%.3–5 Although invasive pulmonary aspergillosis (IPA) is a serious disease in this population, little is known about its natural history.
Approach to Peribronchovascular Disease on CT
2019, Seminars in Ultrasound, CT and MRI