Improving Diagnosis of Pulmonary Mucormycosis: Leads From a Contemporary National Study of 114 Cases.

Humans Mucormycosis / diagnosis Retrospective Studies Lung Diseases, Fungal / diagnosis Neutropenia
diagnostic strategy mucormycosis serum PCR pulmonary mucormycosis radiologic presentation underlying conditions

Journal

Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335

Informations de publication

Date de publication:
11 2023
Historique:
received: 24 03 2023
revised: 04 06 2023
accepted: 29 06 2023
medline: 13 11 2023
pubmed: 8 7 2023
entrez: 7 7 2023
Statut: ppublish

Résumé

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.

Sections du résumé

BACKGROUND
Pulmonary mucormycosis (PM) is a life-threatening invasive mold infection. Diagnosis of mucormycosis is challenging and often delayed, resulting in higher mortality.
RESEARCH QUESTION
Are the disease presentation of PM and contribution of diagnosis tools influenced by the patient's underlying condition?
STUDY DESIGN AND METHODS
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.
RESULTS
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).
INTERPRETATION
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.

Identifiants

DOI: 10.1016/j.chest.2023.06.039 PMID: 37419276
pubmed: 37419276
pii: S0012-3692(23)00946-7
doi: 10.1016/j.chest.2023.06.039
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1097-1107

Investigateurs

Nathalie Freymond (N)
Agathe Sénéchal (A)
Amine Belhabri (A)
Jean Menotti (J)
Florence Persat (F)

Informations de copyright

Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: A. Coste has received a travel grant from the association Marie-Bertille. O. L. has received speaker's fees from MSD, Gilead, Astellas, Pfizer, and F2G, and is consultant for Gilead. F. L. has received personal fees from Gilead, F2G and Pfizer. R. H. has received a grant from Gilead and personal honoraria from Pfizer, Gilead, and Mundipharma. L. M. has received travel grants from Gilead and Pfizer. F. D. has received personal fees from Gilead, outside the submitted work. None declared (A. Conrad, R. P., S. P., P. P., C. D., V. L.-B., F. M., T. G., M.-E. B., F. S., G. N., D. D., F. A., C. H.-D., S. D.-L., F. B., G. G., S. A., D. B., M.-P. L., J.-E. H., C. R., G. M., E. B., O. P., D. G.-H.).

Auteurs

Anne Coste (A)

Infectious Diseases Department, La Cavale Blanche Hospital, Brest University Hospital, Brest, France; UMR 1101, Laboratoire de Traitement de l'Information Médicale, Université de Bretagne Occidentale, Brest, France.

Anne Conrad (A)

Infectious Diseases Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France.

Raphaël Porcher (R)

Centre d'Epidémiologie Clinique, Hôtel-Dieu Hospital, AP-HP, Paris, France.

Sylvain Poirée (S)

Radiology Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France.

Pierre Peterlin (P)

Clinical Hematology Department, Nantes University Hospital, Nantes, France.

Claire Defrance (C)

Radiology Department, Nantes University Hospital, Nantes, France.

Valérie Letscher-Bru (V)

Parasitology and Medical Mycology Laboratory, Strasbourg University Hospital, Strasbourg, France; Institut de Parasitologie et Pathologie Tropicale, UR 7292, Strasbourg University, Strasbourg, France.

Florent Morio (F)

Parasitology and Mycology Laboratory, Nantes University Hospital, Nantes, France; UR 1155 IICiMed, Nantes University, Nantes, France.

Thomas Gastinne (T)

Clinical Hematology Department, Nantes University Hospital, Nantes, France.

Marie-Elisabeth Bougnoux (ME)

Mycology and Parasitology Laboratory, Necker-Enfants Malades Hospital, AP-HP, Paris, France; Unité Biologie et Pathogénicité Fongiques, Institut Pasteur, Paris, France.

Felipe Suarez (F)

Hematology Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France.

Gilles Nevez (G)

Mycology and Parasitology Department, La Cavale Blanche University Hospital, Brest, France.

Damien Dupont (D)

Medical Mycology and Parasitology Department, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France.

Florence Ader (F)

Infectious Diseases Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France.

Carine Halfon-Domenech (C)

Institut d'Hématologie et Oncologie Pédiatrique, Hospices Civils de Lyon, Lyon, France.

Sophie Ducastelle-Leprêtre (S)

Clinical Hematology Department, Hospices Civils de Lyon, Lyon, France.

Françoise Botterel (F)

Mycology and Parasitology Unit, Henri Mondor University Hospital, AP-HP, Créteil, France; EA DYNAMYC 1380, Université Paris-Est Créteil, Créteil, France.

Laurence Millon (L)

Mycology and Parasitology Laboratory, Besançon University Hospital, Besançon, France; UMR 6249, CNRS Chrono-Environnement, Université de Bourgonne Franche-Comté, Besançon, France.

Gaelle Guillerm (G)

Hematology Department, Morvan Hospital, Brest University Hospital, Brest, France.

Séverine Ansart (S)

Infectious Diseases Department, La Cavale Blanche Hospital, Brest University Hospital, Brest, France; UMR 1101, Laboratoire de Traitement de l'Information Médicale, Université de Bretagne Occidentale, Brest, France.

David Boutoille (D)

Infectious Diseases Department, Nantes University Hospital, Nantes, France; Centre d'Investigation Clinique, INSERM 1413, Nantes University Hospital, Nantes, France.

Marie-Pierre Ledoux (MP)

Hematology Department, European Strasbourg Cancer Institute, Strasbourg, France.

Jean-Etienne Herbrecht (JE)

Intensive Care Unit, Hautepierre University Hospital, Strasbourg, France.

Christine Robin (C)

Hematology Department, Henri Mondor Hospital, AP-HP, Créteil, France.

Giovanna Melica (G)

Infectious Diseases Department, Henri Mondor Hospital, AP-HP, Créteil, France.

François Danion (F)

Infectious Diseases Department, Strasbourg University Hospital, Strasbourg, France; UMR_S 1109, INSERM, ImmunoRhumatologie Moléculaire, Strasbourg University, Strasbourg, France.

Elodie Blanchard (E)

Pneumology Department, Bordeaux University Hospital, Bordeaux, France.

Olivier Paccoud (O)

Infectious Diseases Department, Necker-Enfants Malades Hospital, Paris-Cité University, AP-HP, Paris, France.

Dea Garcia-Hermoso (D)

Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France.

Olivier Lortholary (O)

Infectious Diseases Department, Necker-Enfants Malades Hospital, Paris-Cité University, AP-HP, Paris, France; Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France.

Raoul Herbrecht (R)

Hematology Department, European Strasbourg Cancer Institute, Strasbourg, France.

Fanny Lanternier (F)

Infectious Diseases Department, Necker-Enfants Malades Hospital, Paris-Cité University, AP-HP, Paris, France; Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France. Electronic address: fanny.lanternier@aphp.fr.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Improving Diagnosis of Pulmonary Mucormycosis:...
questionsmedicales.fr › Infection › Infections bactériennes et mycoses › Mycoses › Zygomycose › Mucormycose › Improving Diagnosis of Pulmonary Mucormycosis:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Improving Diagnosis of Pulmonary Mucormycosis:...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Mycoses pulmonaires › Improving Diagnosis of Pulmonary Mucormycosis:...
questionsmedicales.fr › Hémopathies et maladies lymphatiques › Hémopathies › Troubles leucocytaires › Leucopénie › Agranulocytose › Neutropénie › Improving Diagnosis of Pulmonary Mucormycosis:...