406. Computed Tomography (CT) Findings of Invasive Pulmonary Aspergillosis (IPA) in Solid Organ Transplant (SOT) Recipients
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Purpose: Characterize CT findings of IPA in SOT patients (pts) and correlate findings with outcome.
Methods: SOT pts diagnosed with IPA since 2006 at 5 centers were prospectively monitored over 6 months and records reviewed. Chest CT findings were characterized at 4 time points during treatment. Impact of baseline CT findings on outcome was investigated using Fisher’s exact test.
Results: Of 35 SOT (lung [19], kidney or kidney-pancreas [8], heart [5], liver [2], and pancreas [1]) pts with proven (11) or probable (24) IPA, the majority (31) were Caucasian and non-Hispanic (33). At diagnosis, 2 were neutropenic, 21 (60%) diabetic, and 10 (29%) had CMV disease. Within 30 days (d) prior to diagnosis, 12 (34%) had rejection and 19 (54%) pneumonia other than IPA. A. fumigatus was the most common infecting species (25) followed by A. terreus (5), A. flavus (2), A. niger (1), and multiple Aspergillus spp. (2). Five (14%) pts received mold active prophylaxis within 30d prior to diagnosis. Thirty-three pts were alive at diagnosis; 6 died within 3 months of diagnosis. CT findings (Table 1) at baseline were not predictive of outcome.
Table 1. CT findings in SOT recipients with IPA
FindingTime of Radiograph Post-IPA diagnosis
(N=Number of CTs reviewed at time point)
Baseline
N=34
1 Month
N=20
2 Months
N=19
4-6 Months
N=13
N (%) CTs with finding
Halo Sign10 (29)4 (20)1 (5)1 (8)
Air Crescent Sign1 (3)000
Consolidation14 (41)12 (60)6 (32)2 (15)
Interstitial Pattern1 (3)1 (5)00
Cavitary lesion10 (29)4 (20)6 (32)5 (38)
Bilateral nodules25 (74)14 (70)10 (53)6 (46)

Conclusions: This is the first prospective, multi-site assessment of serial CT findings in SOT pts with IPA. The most frequent manifestations of IPA were bilateral nodules and consolidation. The halo sign and cavitary lesions were also relatively common. The air crescent sign was rare. Findings on baseline CT were not predictive of survival.
Barbara Alexander, MD, MHS, FIDSA, Division of Infectious Diseases and Internal Medicine, Duke University, Durham, NC, David Andes, MD, University of Wisconsin, Madison, WI, John Baddley, MD, MSPH, Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, Erik Dubberke, MD, MSPh, Infectious Disease, Washington University School of Medicine, St. Louis, MO, J Harrison, MS-IV, University of Alabama, Birminghma, AL, Dimitrios Kontoyiannis, MD, ScD, FIDSA, The University of Texas M.D. Anderson Cancer Center, Houston, TX, Peter Pappas, MD, Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL and  B. D. Alexander,
Enzon Role(s): Grant Investigator, Received: Research Grant.
Astellas Role(s): Grant Investigator, Received: Research Grant.
Pfizer Role(s): Grant Investigator, Received: Research Grant.
Basilea Role(s): Consultant, Received: Consulting Fee.
Abbott Diagnostics Role(s): Consultant, Received: Consulting Fee.
D. R. Andes, None..
J. Harrison, None..
E. R. Dubberke, None. 
D. P. Kontoyiannis,
Merck Role(s): Consultant, Grant Investigator, Investigator, Research Contractor, Scientific Advisor (Review Panel or Advisory Committee), Speaker's Bureau, Received: Grant Recipient, Research Grant, Research Support, Speaker Honorarium, Consulting Fee.
Pfizer Role(s): Speaker's Bureau, Received: Speaker Honorarium.
Schering Plough Role(s): Consultant, Scientific Advisor (Review Panel or Advisory Committee), Received: Consulting Fee.
Enzon Role(s): Grant Investigator, Research Relationship, Speaker's Bureau, Received: Research Grant, Research Support, Speaker Honorarium.
Astellas Role(s): Grant Investigator, Research Relationship, Speaker's Bureau, Received: Grant Recipient, Research Support, Speaker Honorarium.
P. G. Pappas, None. 
J. W. Baddley,
Merck Role(s): Grant Investigator, Received: Research Grant.
Astellas Role(s): Research Relationship, Received: Research Grant.
Pfizer Role(s): Research Relationship, Received: Grant Recipient.
Enzon Role(s): Consultant, Received: Consulting Fee.