Predictors of Pulmonary Zygomycosis versus Invasive Pulmonary Aspergillosis in Patients with Cancer
Author:
Georgios Chamilos, Edith M. Marom, Russell E. Lewis, Michail S. Lionakis, and Dimitrios P. Kontoyiannis
Date: 8 June 2005
Abstract:
Background. Pulmonary zygomycosis (PZ), an emerging mycosis among patients with cancer, has a clinicalmanifestation similar to that of invasive pulmonary aspergillosis (IPA). Most cases of PZ in such patients developas breakthrough infections if treatment with antifungal agents effective against Aspergillus species is administered.However, clinical criteria to differentiate PZ from IPA are lacking.Methods. We retrospectively reviewed the clinical characteristics and computed tomography (CT) findingsfor 16 patients with cancer and PZ and for 29 contemporaneous patients with cancer and IPA at the time ofinfection onset (2002-2004). Patients with mixed infections were excluded. Parameters predictive of PZ by univariateanalysis were included in a logistic regression model.Results. Almost all patients with PZ (15 of 16) and IPA (28 of 29) had underlying hematological malignanciesand typical risk factors for invasive mold infections. In logistic regression analysis of clinical characteristics,concomitant sinusitis (odds ratio [OR], 25.7; 95% confidence interval [CI], 1.47-448.15; ) and voricon- Pp.026azole prophylaxis (OR, 7.76; 95% CI, 1.32-45.53; ) were significantly associated with PZ. The presence Pp.023of multiple (10) nodules (OR, 19.8; 95% CI, 1.94-202.29; ) and pleural effusion (OR, 5.07; 95% CI, Pp.0121.06-24.23; ) at the time that the patient underwent the initial CT were both independent predictors of Pp.042PZ in the logistic regression analysis of radiological parameters. No difference occurred in the frequency of otherCT findings suggestive of pulmonary mold infections (e.g., masses, cavities, halo sign, or air-crescent sign) betweenthe 2 patient groups.Conclusions. PZ in immunocompromised patients with cancer could potentially be distinguished from IPAon the basis of clinical and radiological parameters; prospective validation is needed.
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