Pulmonary Lesions as First Computed-Tomography Presentation of Invasive Candidiasis in Neutropenic Patients

F. Tissot, F.L. Lamoth, S.S. Schmidt, L.S. Senn, V.E. Erard, J.B. Bille, B.D. Duvoisin, T.C. Calandra, O.M. Marchetti

Author address: 

Centre Hospitalier Universitaire Vaudois (CHUV), LAUSANNE, Switzerland

Abstract: 

Objectives : Whereas pulmonary lesions have been described in neutropenic patients with invasive aspergillosis (IA), invasive candidiasis (IC) is associated with typical hepatosplenic CT features detected after recovery from neutropenia. In contrast, pulmonary manifestations of IC are not well defined. The goal of the present study was to assess the CT presentation of IC pulmonary lesions in neutropenic patients. Methods : 29 neutropenic patients with possible, probable or proven IC or IA according to 2008 EORTC-MSG criteria were retrospectively studied. CT findings, size and number of lesions, as well as timing of appearance in IC and IA were compared. Results : Patients characteristics were: median age 58 years (range 28-77), males/females 76%/24%, acute myeloid/lymphoblastic leukemia 96.5%/3.5%, median duration of neutropenia 26 days (12-71). Invasive fungal infections included 15 IC (3 proven, 7 probable, 5 possible), 12 IA (5 proven, 7 probable) and 2 mixed IC/IA. Median number of CT per patient was 3 (1-6). Median time between start of fever and first CT was 2 days (0-31). In follow-up, the median interval between CTs was 10 days (4-83). Number and time sequence of CTs were similar for IC and IA. CT findings of IC and IA are summarized in the Table. Conclusions : In invasive candidiasis pulmonary signs are as frequent as and appear significantly earlier than hepatosplenic lesions, before recovery from neutropenia. Major signs classically associated with aspergillosis are also observed in one fourth of patients with candidiasis. Nodules are the most common pulmonary findings in candidiasis: smaller size and higher number differentiate lesions from those of aspergillosis. Lung CT may thus contribute to the early diagnosis of invasive candidiasis.
2009

abstract No: 

P.067

Full conference title: 

4th Trends in Medical Mycology
    • TIMM 4th (2012)