Is Halo Sign the Earliest Sign of Pulmonary Invasive Aspergillosis (PIA)?

Ref ID: 18709

Author:

K. Kyo, MD (Doctor of Medicine) – Staff, T. Ochi, MD – Staff, T. Okatani, MD – Staff, M. Itagaki, MD – Staff, R. Imanaka, MD – Staff, Y. Katayama, MD – Staff, T. Kyo, MD – Chairman;

Author address:

Hiroshima Red Cross 65286; Atomic-bomb Survivors Hosp., Hiroshima, Japan.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: The mortality rate attributable to PIA has markedly decreased in recent years thanks to improved diagnostic procedures and anti-fungal drugs. The halo sign has been considered the earliest CT finding in PIA; however, almost no new CT imaging study of PIA has been conducted in the last decade. In this study we tried to capture infection signs before the halo sign was detected, by examining CT images obtained before the onset of infection.
Methods: From December 10, 2010 until December 3, 2011 we examined patients with acute leukemia without a history of PIA who received intensive chemotherapy in our hospital. Among them, data from 30 patients with provable PIA (serum galactomannan (GM) ≥ 0.5 and CT abnormalities suggesting PIA), were examined. GM was conducted twice a week. CT was performed at the time of admission and weekly during follow up. In addition, CT was repeated within 24 hours when pyrexia of ≥ 38.0°C occurred. If fever showed no improvement, CT was repeated every 3 days. GM ≥ 0.4 was also an indication for CT. As antifungal prophylaxis, Amphotericin-b syrup and an azole agent (itraconazole or voriconazole) were given to each patient. Treatment was started with voriconazole when GM was ≥ 0.5 or when CT abnormality was detected. Micafungin was added when no sufficient effect was observed.
Results: Data are presented as the median plus range. The age of patients was 74 y.o. (54-90), the number of days with an absolute neutrophil count <500 mm3 was 25 (17-116) and the frequency of CTs was 8 (2-18). Though an angina invasive pattern (AGIP) has a reputation for the characteristic and common CT pattern for PIA in neutropenic patient, in our investigation, all of 30 patients showed an air way invasive pattern(AWIP) as initial abnormal findings of CT. During follow up, only 4 (13%) patients developed AGIP: halo sign in 3 (10%), and cavity in 1 (3%). Of the remaining 26 patients, 8 (27%) showed signs of bronchitis and 18 (60%) of bronchopneumonia. None of the patients died. Conclusions: AWIP seems to be the first CT sign of PIA and prevention of angioinvasion may have contributted to the recent decrease of the mortality rate attributable to PIA.

Abstract Number: M-1226

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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