背景:肺毛霉菌病(PM)是一种危及生命的侵袭性霉菌感染。毛霉菌病的诊断具有挑战性,并且经常延迟,导致更高的死亡率。
目的:PM的疾病表现和诊断工具的贡献是否受患者潜在病情的影响?
方法:回顾性分析了2008年至2019年法国六家教学医院的所有PM病例。根据更新的欧洲癌症/真菌病研究和治疗组织研究组标准定义病例,增加糖尿病和创伤作为宿主因素,血清或组织PCR阳性作为真菌学证据。集中检查胸部CT扫描。
结果:共记录了114例PM,包括40%的传播形式。主要疾病为恶性血液病(49%),异基因造血干细胞移植(21%),和实体器官移植(17%)。传播时,主要传播部位是肝脏(48%),脾脏(48%),大脑(44%),和肾脏(37%)。放射学表现包括巩固(58%),胸腔积液(52%),反晕符号(26%),光环(24%),血管异常(26%),和空腔(23%)。53例患者中有42例(79%)血清定量聚合酶链反应(qPCR)阳性,96例患者中有46例(50%)BAL阳性。11例无贡献BAL患者中,有8例(73%)的经胸肺活检结果被诊断。总体90天死亡率为59%。中性粒细胞减少症患者更频繁地表现出血管侵袭性表现,包括逆转晕征和播散性疾病(P<0.05)。血清qPCR对中性粒细胞减少症患者的贡献更大(91%vs62%;P=0.02),非中性粒细胞减少症患者的BAL贡献更大(69%vs41%;P=0.02)。血清qPCR在>3cm主要病变的患者中更常见(91%vs62%;P=0.02)。总的来说,qPCR阳性与早期诊断(P=0.03)和治疗开始(P=0.01)相关。
结论:中性粒细胞减少症和放射学发现影响PM期间的疾病表现和诊断工具的贡献。血清qPCR对中性粒细胞减少症患者和非中性粒细胞减少症患者的BAL检查更有贡献。在无贡献BAL的情况下,肺活检的结果具有很高的贡献。
Pulmonary mucormycosis (PM) is a life-threatening invasive mold infection. Diagnosis of mucormycosis is challenging and often delayed, resulting in higher mortality.
Are the disease presentation of PM and contribution of diagnosis tools influenced by the patient\'s underlying condition?
All PM cases from six French teaching hospitals between 2008 and 2019 were retrospectively reviewed. Cases were defined according to updated European Organization for Research and Treatment of Cancer/Mycoses
Study Group criteria with the addition of diabetes and trauma as host factors and positive serum or tissue PCR as mycologic evidence. Thoracic CT scans were reviewed centrally.
A total of 114 cases of PM were recorded, including 40% with disseminated forms. Main underlying conditions were hematologic malignancy (49%), allogeneic hematopoietic stem cell transplantation (21%), and solid organ transplantation (17%). When disseminated, main dissemination sites were the liver (48%), spleen (48%), brain (44%), and kidneys (37%). Radiologic presentation included consolidation (58%), pleural effusion (52%), reversed halo sign (26%), halo sign (24%), vascular abnormalities (26%), and cavity (23%). Serum quantitative polymerase chain reaction (qPCR) was positive in 42 (79%) of 53 patients and BAL in 46 (50%) of 96 patients. Results of transthoracic lung biopsy were diagnostic in 8 (73%) of 11 patients with noncontributive BAL. Overall 90-day mortality was 59%. Patients with neutropenia more frequently displayed an angioinvasive presentation, including reversed halo sign and disseminated disease (P < .05). Serum qPCR was more contributive in patients with neutropenia (91% vs 62%; P = .02), and BAL was more contributive in patients without neutropenia (69% vs 41%; P = .02). Serum qPCR was more frequently positive in patients with a > 3 cm main lesion (91% vs 62%; P = .02). Overall, positive qPCR was associated with an early diagnosis (P = .03) and treatment onset (P = .01).
Neutropenia and radiologic findings influence disease presentation and contribution of diagnostic tools during PM. Serum qPCR is more contributive in patients with neutropenia and BAL examination in patients without neutropenia. Results of lung biopsies are highly contributive in cases of noncontributive BAL.