1047. Baseline And Bimonthly HRCT Imaging In The Early Detection And Treatment Of Nodular Pneumonia In Leukemic Patients With Prolonged Neutropenia
Session: Poster Abstract Session: Fungal Diagnosis
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Pulmonary mold infections (PMIs) are a common complication of prolonged severe neutropenia in leukemic patients. Mortality from these infections is as high as 80% in some series, but early detection and treatment has shown to be effective in reducing this mortality. In this study, we investigate the utility and effectiveness of baseline and serial bimonthly high-resolution computed tomography (HRCT) scans of the chest.

Methods: Medical records of 63 patients with a hematologic malignancy with prolonged (> 7 days) and profound neutropenia (ANC < 500) at the H. Lee Moffitt Cancer Center between June 2005 and January 2010 are retrospectively selected and reviewed. These patients have undergone baseline and serial CT imaging and are found to have new nodules assumed to be mold infections and are treated accordingly.

Results: Radiographic improvement was noted in 51 (81.0%) in an average of 27.2 days, and radiographic resolution was noted in 47 (74.6%) patients in an average of 58.5 days. The overall mortality rate of our subjects was 25.3% (16/67). This is considerably lower than in other series  wherein mortality reached mortalities upwards of 80%.Of the 16 deaths, only 3 deaths 3/63 (4.7%) were directly linked to the PMI. Other causes of death include refractory leukemia and chemotherapy failure and refractory thrombocytopenia leading to hemorrhage”.

Conclusion: Our findings suggest that baseline and serial chest HRCT may be assistive in the early detection and treatment of mold pneumonias and can contribute in a dramatic decrease of mortality in patients with hematologic malignancies associated with prolonged neutropenia diagnosed with pulmonary mold infections.  A randomized trial comparing outcome and cost effectiveness of fever-driven empirical therapy versus a baseline and bimonthly HRCT-driven preemptive treatment may be in order to confirm results.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Luis Rosas, MD1, Dexter Mendoza2, Elvis Castillo, MD3, Sally Alrabaa, MD2 and John Greene, MD2,4, (1)Infectious DIsease, University Of South Florida, Tampa, FL, (2)University of South Florida, Tampa, FL, (3)Division of Infectious Diseases and International Medicine, University of South Florida College of Medicine, Tampa, FL, (4)H. Lee Moffitt Cancer Center, Tampa, FL

Disclosures:

L. Rosas, None

D. Mendoza, None

E. Castillo, None

S. Alrabaa, None

J. Greene, None

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