956. Computed Tomography Comparison Of 3 Invasive Pulmonary Mold Infections In Neutropenic Patients: Aspergillus, Fusarium and Mucor
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Infections remain a leading cause of morbidity and mortality in neutropenic patients with hematologic malignancy undergoing chemotherapy and stem cell transplant. Invasive fungal disease, particularly invasive fungal pneumonia, continues to pose a diagnostic challenge.

Methods: We performed a retrospective analysis of culture proven infection episodes identified clinically as either fungal pneumonia or disseminated fungal disease in 101 neutropenic patients from a single center with emphasis on the radiologic description of the lung findings. We focused on the three most commonly identified molds (Aspergillus, Fusarium and Mucor) and compared their radiologic appearances.

Results: Of 101 neutropenic patients (69 men, 32 women) with a hematological malignancy and culture proven diagnosis of invasive fungal disease, 83 (82%) had a diagnosis of mold pneumonia. Of those, 28 (34%) had Aspergillus, 28 (34%) Fusarium and 27 (32%) Mucor. The most common CT finding was nodules found in 86% of Aspergillus cases, 100% of Fusarium and 82% of Mucor. Nodules were multiple in >50% of any fungal diagnosis, bilateral in 67% of Aspergillus cases, 55% of Fusarium and 73% of Mucor. Nodules were small (≤ 1 cm) in over 80% of Fusarium cases and large (> 1 cm) in over 70% of Aspergillus and Mucor cases with a peripheral, pleural based location in cases due to Aspergillus and Mucor (60%, 65%) and a central location for Fusarium (78%).  The halo sign was described most frequently in Aspergillus (75%) cases. The reverse halo sign was reported in 4(18%) cases of Mucor. Rate of nodular growth was fastest for Mucor.

Conclusion: Fungal pneumonia remains one of the most common and dangerous infections in neutropenic patients with high mortality and therefore early identification and treatment remains critical. Characteristic patterns on lung computed tomography (CT), when taken in context with the clinical findings, may allow early appropriate anti-mold therapy and may result in improvement of survival rates.


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

Elias Maroun, MD1, Ayesha Farooq, BS2, Sally Alrabaa, MD3, Ryan Murtagh, MD2, Asima Cheema, MD2 and John Greene, MD2, (1)Infectious DIsease, University Of South Florida, TAMPA, FL, (2)H. Lee Moffitt Cancer Center, Tampa, FL, (3)University of South Florida, Tampa, FL

Disclosures:

E. Maroun, None

A. Farooq, None

S. Alrabaa, None

R. Murtagh, None

A. Cheema, None

J. Greene, None

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