Computed tomography guided percutaneous lung biopsies and suspected fungal infections in pediatric cancer patients. Issue 9 (7th May 2014)

• Record Type: Journal Article
• Authors: Kropshofer, Gabriele; Kneer, Adrian; Edlinger, Michael; Meister, Bernhard; Salvador, Christina; Lass‐Flörl, Cornelia; Freund, Martin; Crazzolara, Roman
• Is Part Of: Pediatric blood & cancer. Volume 61:Issue 9(2014:Sep.)
• Page Start: 1620
• Page End: 1624
• Publication Date: 2014-05-07
• Subjects: Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.25091
• Languages: English
• ISSNs: 1545-5009

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="pbc25091-sec-0001" sec-type="section"> <title>Background</title> <p>The spectrum of potential fungal pathogens known to cause invasive pulmonary infections has grown as a result of intensified immunosuppressive therapy and the emergence of antifungal resistance.</p> </sec> <sec id="pbc25091-sec-0002" sec-type="section"> <title>Procedure</title> <p>In a retrospective single center study, we investigated computed tomography guided percutaneous lung biopsies in 16 childhood patients with suspected fungal infections. Microbiological analysis consisted of microscopic examination, culture, and a broad‐range fungal polymerase chain reaction for detection of either <italic>Aspergillus</italic> or <italic>Mucorales</italic> species.</p> </sec> <sec id="pbc25091-sec-0003" sec-type="section"> <title>Results</title> <p>In 14 patients (88%), invasive fungal infection with <italic>Aspergillus</italic> species including <italic>A. terreus</italic>, <italic>Mucormycetes</italic>, and <italic>Saccharomyces cerevisiae</italic> being the main pathogens was confirmed, including patients with a double infection (19%). In two cases, the most likely diagnosis of primary bronchiolitis obliterans organizing pneumonia was established based on the results of typical histopathologic features, negative culture results, and symptoms resolved after treatment with high‐dose cortisone. Diagnosis of invasive fungal pneumonia led to an immediate interruption of antineoplastic treatment in 100%, reduction of antibiotic drugs in 76%, and change of empirical to targeted antifungal therapy in 63%. The safety of lung biopsy was guaranteed by lack of any complications, such as bleeding or pneumothorax.</p> </sec> <sec id="pbc25091-sec-0004" sec-type="section"> <title>Conclusions</title> <p>The increased detection of rare fungal infections by computed tomography guided biopsy supports the need for a rapid and precise diagnosis, as most of the fungal pathogens are at least partially resistant to available antifungal therapy and proper treatment is essential for best practice in patient management. Pediatr Blood Cancer 2014;61:1620–1624. © 2014 Wiley Periodicals, Inc.</p> </sec> </abstract>