Diagnosis of invasive aspergillosis and mucormycosis guided by chest ct scan and PCR assays from bronchoalveolar lavage 64258; uid in allogenic stem cell recipients

Ref ID: 18548

Author:

H. Lellek (1), R. Bialek (2), H. Rohde (1), H. Baumann (1),
H. Klose (1), C. Langebrake (1), S. Kluge (1), N. Kröger (1)

Author address:

(1)University Hospital Hamburg-Eppendorf (Hamburg, DE);
(2)Labor Dr Krause (Kiel, DE)

Full conference title:

Annual Meeting of the EBMT, 38th

Abstract:

Patients face an increased risk of invasive mold infection,
especially of the lungs during allogeneic stem cell transplantation (SCT). Low-dose CT-scan is a sensitive tool to
detect lung lesions, and bronchoscopy with bronchoalveolar
lavage (BAL) is a standard procedure to identify pathogenic
microorganisms.
From April 2008 to August 2011 pulmonary infi ltrates were
detected by CT-scan in 64 adult patients (11,6% of all SCT
patients) during allogeneic SCT. The BAL was examined by culture for pathogenic bacteria and fungi. Additionally, DNA was
extracted and used in two semi-nested PCR assays target ing
the mitochondrial DNA of Aspergillus spp. and the 18S ribosomal DNA of Mucorales, respectively. PCR products were
characterised by sequencing.
In 28 (44%) out of the 64 patients fungal DNA was detected by
the PCR assays in the fi rst BAL. Sequencing revealed Aspergillus fumigatus specifi c DNA in 22 (78%) and A. fl avus in one
patient. Mucorales specifi c DNA was detected in 9 patients
(32%), and identifi ed as Rhizomucor spp in 6 and Rhizopus
spp in 3 patients. A mixed infection according to PCR caused by
A. fumigatus and Rhizomucor spp was found in 4 patients (14%
of all fungal PCR-positives).
A follow-up bronchoscopy was performed in 22 of 64 (34%)
patients. In the BAL of three previously PCR-negative patients
A. fumigatus DNA was detected, and in one Rhizomucor spp
[P462]S120
DNA was amplifi ed in addition. In another patient A. fumigatus
had been obtained in the fi rst BAL but DNA of Rhizomucor spp
was detected in the follow-up bal fl uid.
Overall the PCR assays were positive in 31 (48 %) cases.
Aspergillus spp. was detected in 20 (65%) patients, DNA
of Mucorales spp in 5 (16%) and both A. fumigatus and
Rhizomucor spp in 6 (19%) cases.
Out of 20 patients with detectable Aspergillus DNA 16
improved under antifungal treatment whereas 4 died. Out
of 5 patients with Mucorales spp DNA only two survived
whereas 3 out of 6 patients with a mixed infection survived,
i.e. 21 patients (68%) with invasive fungal disease survived.
In the fungal PCR-negative group consisting of 33 patients
23 (70%) survived.
In our hands the two PCR assays from BAL are a useful addition of the microbiological diagnostic armamentarium. It offers
the opportunity to detect DNA from agents of mucormycosis.
Pulmonary fungal infections are detected at an early stage in
order to increase the chance of a successful antifungal therapy.
Infi ltrates during SCT are associated with a high case fatality
rate and in many cases the etiology remains to be determined.

Abstract Number: P464

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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