The DOI matches its Crossref record.
Improved management of invasive pulmonary aspergillosis in neutropenic patients using early thoracic computed tomographic scan and surgery.
Abstract
PURPOSE: The prognosis of invasive pulmonary aspergillosis (IPA) occurring in neutropenic patients remains poor. We studied whether new strategies for early diagnosis could improve outcome in these patients. PATIENTS AND METHODS: Twenty-three histologically proven and 14 highly probable IPAs in 37 hematologic patients (neutropenic in 36) were analyzed retrospectively. RESULTS: The most frequent clinical signs associated with IPA were cough (92%), chest pain (76%), and hemoptysis (54%). Bronchoalveolar lavage (BAL) was positive in 22 of 32 cases. Aspergillus antigen test was positive in 83% of cases when tested on BAL fluid. Since October 1991, early thoracic computed tomographic (CT) scans were systematically performed in febrile neutropenic patients with pulmonary x-ray infiltrates. This approach allowed us to recognize suggestive CT halo signs in 92% of patients, compared with 13% before this date, and the mean time to IPA diagnosis was reduced dramatically from 7 to 1.9 days. Among 36 assessable patients, 10 failed to respond (amphotericin B [AmB] plus fluorocytosyne, n = 2; itraconazole + AmB, n = 8) and died of aspergillosis. Twenty-six patients were cured or improved by antifungal treatment (itraconazole with or without AmB, n = 22; voriconazole, n = 4). In 15 of 16 cases, surgical resection was combined successfully with medical treatment. Achievement of hematologic response, early diagnosis, unilateral pulmonary involvement, and highest level of fibrinogen value < 9 g/L were associated with better outcome. CONCLUSION: In febrile neutropenic patients, systematic CT scan allows earlier diagnosis of IPA. Early antifungal treatment, combined with surgical resection if necessary, improves IPA prognosis dramatically in these patients.
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Cited by
Freifeld, A. G., Bow, E. J., Sepkowitz, K. A., Boeckh, M. J., Ito, J. I., Mullen, C. A., Raad, I. I., Rolston, K. V., Young, J.-A. H., & Wingard, J. R. (2011) · Clinical Infectious Diseases · doi:10.1093/cid/cir073 · Cited by 3,463
Pappas, P. G., Kauffman, C. A., Andes, D., Benjamin, D. K., Calandra, T. F., Edwards, J. E., Filler, S. G., Fisher, J. F., Kullberg, B.-J., Zeichner, L. O., et al. (2009) · Clinical Infectious Diseases · doi:10.1086/596757 · Cited by 3,191
Patterson, T. F., Thompson, G. R., Denning, D. W., Fishman, J. A., Hadley, S., Herbrecht, R., Kontoyiannis, D. P., Marr, K. A., Morrison, V. A., Nguyen, M. H., et al. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/ciw326 · Cited by 2,926
Aspergillus fumigatus and Aspergillosis
Latgé, J.-P. (1999) · Clinical Microbiology Reviews · doi:10.1128/cmr.12.2.310 · Cited by 2,307
Ullmann, A. J., Aguado, J. M., Arikan-Akdagli, S., Denning, D. W., Groll, A. H., Lagrou, K., Lass-Flörl, C., Lewis, R. E., Munoz, P., Verweij, P. E., et al. (2018) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2018.01.002 · Cited by 1,556
Metadata
- Authors
- Caillot, D., Casasnovas, O., Bernard, A., Couaillier, J. F., Durand, C., Cuisenier, B., Solary, E., Piard, F., Petrella, T., Bonnin, A., Couillault, G., Dumas, M., & Guy, H.
- Venue
- Journal of Clinical Oncology
- Published
- 1997-01
- Volume
- 15
- Issue
- 1
- Pages
- 139-147
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2141436450
- Cited by
- 706
- References
- 0
- FWCI
- 25.25
- Type
- journal article
- Language
- en
- Open access
- closed
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- CoChat. (2026). Citation check: Improved management of invasive pulmonary aspergillosis in neutropenic patients using early thoracic computed tomographic scan and surgery. https://app.cochat.ai/papers/10.1200/jco.1997.15.1.139
- The paper
- Caillot, D., Casasnovas, O., Bernard, A., Couaillier, J. F., Durand, C., Cuisenier, B., Solary, E., Piard, F., Petrella, T., Bonnin, A., Couillault, G., Dumas, M., & Guy, H. (1997). Improved management of invasive pulmonary aspergillosis in neutropenic patients using early thoracic computed tomographic scan and surgery. Journal of Clinical Oncology. https://doi.org/10.1200/jco.1997.15.1.139
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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
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