Journal Article

Predictors of Pulmonary Zygomycosis versus Invasive Pulmonary Aspergillosis in Patients with Cancer

Kontoyiannis, Dimitrios P., Lionakis, Michail S., Chamilos, Georgios, Lewis, Russell E., Marom, Edith M.

2005

Overview

Background. Pulmonary zygomycosis (PZ), an emerging mycosis among patients with cancer, has a clinical manifestation similar to that of invasive pulmonary aspergillosis (IPA). Most cases of PZ in such patients develop as breakthrough infections if treatment with antifungal agents effective against Aspergillus species is administered. However, clinical criteria to differentiate PZ from IPA are lacking. Methods. We retrospectively reviewed the clinical characteristics and computed tomography (CT) findings for 16 patients with cancer and PZ and for 29 contemporaneous patients with cancer and IPA at the time of infection onset (2002–2004). Patients with mixed infections were excluded. Parameters predictive of PZ by univariate analysis were included in a logistic regression model. Results. Almost all patients with PZ (15 of 16) and IPA (28 of 29) had underlying hematological malignancies and typical risk factors for invasive mold infections. In logistic regression analysis of clinical characteristics, concomitant sinusitis (odds ratio [OR], 25.7; 95% confidence interval [CI], 1.47–448.15; P = .026) and voriconazole prophylaxis (OR, 7.76; 95% CI, 1.32–45.53; P = .023) were significantly associated with PZ. The presence of multiple (⩾10) nodules (OR, 19.8; 95% CI, 1.94–202.29; P = .012) and pleural effusion (OR, 5.07; 95% CI, 1.06–24.23; P = .042) at the time that the patient underwent the initial CT were both independent predictors of PZ in the logistic regression analysis of radiological parameters. No difference occurred in the frequency of other CT findings suggestive of pulmonary mold infections (e.g., masses, cavities, halo sign, or air-crescent sign) between the 2 patient groups. Conclusions. PZ in immunocompromised patients with cancer could potentially be distinguished from IPA on the basis of clinical and radiological parameters; prospective validation is needed.

• Publisher: The University of Chicago Press,University of Chicago Press,Oxford University Press
• Subject: Adult / Aged / Antifungals / Aspergillosis - diagnostic imaging / Aspergillosis - epidemiology / Aspergillosis - microbiology / Aspergillosis - physiopathology / Aspergillus / Aspergillus - classification / Aspergillus - isolation & purification / Biological and medical sciences / Cancer / Computed tomography / Female / Fungi / Human mycoses / Humans / Infections / Infectious diseases / Lesions / Lung Diseases, Fungal - diagnostic imaging / Lung Diseases, Fungal - epidemiology / Lung Diseases, Fungal - microbiology / Lung Diseases, Fungal - physiopathology / Lungs / Major Articles / Male / Medical sciences / Medical treatment / Middle Aged / Mucor - classification / Mucor - isolation & purification / Mucormycosis - diagnostic imaging / Mucormycosis - epidemiology / Mucormycosis - microbiology / Mycoses / Mycoses of the respiratory system / Neoplasms - complications / Nodules / Non tumoral diseases / Operating rooms / Otorhinolaryngology (head neck, general aspects and miscellaneous) / Otorhinolaryngology. Stomatology / Phycomycoses / Pleural effusion / Predictive Value of Tests / Radiology / Respiratory diseases / Retrospective Studies / Rhizopus - classification / Rhizopus - isolation & purification / Risk factors / Tomography, X-Ray Computed / Tropical mycoses / Zygomycosis / Zygomycosis - diagnostic imaging / Zygomycosis - epidemiology / Zygomycosis - microbiology / Zygomycosis - physiopathology