Introduction: Invasive pulmonary aspergillosis (IPA) is increasingly recognised as a cause of acute respiratory failure (ARF) in high risk hospitalized patients (pts). While important for both prognosis and treatment (trt), its definitive diagnosis is often difficult since differentiation between colonisation and infection often requires invasive procedures such as lung tissue biopsy. Herein, we describe our experience on the interest of thorough inspection of the tracheobronchial tree associated with minimally invasive bronchial biopsy in confirming diagnosis in cases of suspected IPA.Case Reports: In the last 2 years, 6 pts (5 males; mean age: 62 y.o.) with ARF requiring mechanical ventilation were suspected of IPA because of consistent clinical and radiological findings and because of repeated isolation of Aspergillus Fumigatus (AF) from the sputum. Immune depression as a result of corticosteroid trt (n = 2), transplantation (n = 2), and hematologic malignancy (n = 1) was present in all but one pt. In each pt, tracheal (T) and/or bronchial (B) lesions were evidenced at endoscopy. These consisted of areas of erythema of the T or B mucosa associated with either patchy necrosis or non removable false membranes. In each case biopsy of these lesions demonstrated the presence of hyphae. AF was cultured in 5 cases. Subsequently, IPA was confirmed in each single patient by postmortem examination (n = 3), lung tissue biopsy (n = 1), or unequivocal clinical and radiological course (n = 2). All pts but one died.Meanwhile, bronchoscopy was performed during the Intensive Care stay in 7 other pts in which AF was recovered at culture. Although B or T erythema was evidenced in some pts, patchy tnucosal necrosis or false membranes were never found and none developed IPA. Conclusion:Thorough inspection of the tracheobronchial tree in conjunction with guided biopsies appears to be minimally invasive and effective in affirming diagnosis in critically ill pts suspected of IPA.
Full conference title:
7th European Respiratory Society Annual Conference
- ERS 17th (2007)