Diagnostic and therapeutic lung resection for invasive pulmonary aspergillosis following high dose chemotherapy and bone marrow transplantation

E Reichenberger, J. Habicht, E Bemet, R. Schldpfer, P. Stulz, A. Tichelli,A. Gratwohl, M. Tamm


Pulmonary invasive aspergillosis is a frequent complication following high dose chemotherapy (CH) and bone marrow transplantation BMT) and is associated with a high mortality. The diagnosis of invasive aspergillosis in neutropenic patients is usually based on antibiotic resistant fever, infiltrates with cavitation on X-ray/CT scan and fungal detection in bronchoalveolar lavage (BAL). However, the diagnostic yield of BAL varies considerably in the literature. We analysed all patients with haematologic disorders undergoing thoracic surgery for suspected or proven invasive aspergillosis.Patients: 25 patients; 18 male, 7 female; age 39.8 years. Underlying diseases: AML 11, CML 3, ALL 4, MDS 1, AA 6. Therapy: high dose chemotherapy 16, BMT 3, ALG/ATG 6. Clinical findings: fever 84% (12/25); platelet count 75,300 (5,000-354,000); leucocyte count 2200 (0.07-11950); fungal growth in BAL 2/14. Surgical treatment: 18 lobectomy, 1 bi-lobectomy, 6 segmentectomy.Histology: invasive fungal infection confirmed in 80% (20/25); 5 other diagnoses: lung infaretion 2, localised alveolitis 2, bacterial abscess 1.Complications: pneumothorax 2, haematothorax 1, dehiscence of anastomosis 1, revision of the wound 1, seroma 1, recurrent pulmonary fungal infectionl, renal aspergilloma 1 (nephrectomy).Follow up: Thirty-day mortality was 8% (2 deaths: sepsis and cerebral asgergilloma). Three months survival was 80% (3 additional deaths: recurrent fungal infection 1, cerebral haemorrhage 1, severe GVHD 1).Summary and Conclusion: the diagnostic yield of BAL for diagnosis of invasive aspergillosis was low. Clinically suspected fungal infection was confirmed by histology in 80% of cases. Surgical treatment of invasive fungal infection was associated with a low incidence of complications and an acceptable three- months survival. Surgical treatment for invasive pulmonary aspergillosis can therefore be recommended.

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7th European Respiratory Society Annual Conference
    • ERS 17th (2007)