1 / 40

Other Fungal Diseases of the Lung

Other Fungal Diseases of the Lung. Ömrüm Uzun. DISCLOSURES. Consultant and speaker for, or grants from:. Basilea Erkim Gilead Janssen Cilag Merck Pfizer Schering Plough. Diagnostic Problems in Invasive Pulmonary Aspergillosis. Clinical symptoms are not characteristic.

maalik
Download Presentation

Other Fungal Diseases of the Lung

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Other Fungal Diseases of the Lung Ömrüm Uzun

  2. DISCLOSURES Consultant and speaker for, or grants from: • Basilea • Erkim • Gilead • Janssen Cilag • Merck • Pfizer • Schering Plough

  3. Diagnostic Problems in Invasive Pulmonary Aspergillosis Clinical symptoms are not characteristic. Clinical signs are rarely specific. Aspergilli could be the pathogen or colonizer, therefore: Superficial cultures Antigen tests, PCR surveys, methods for detection of antibody and/or metabolites should be carefully interpreted.

  4. GM Testing in Allo-HSCT Maertens et al. JID 2002;186:1297. Temporal association of antigenemia & other diagnostic tests + culture CT Chest X-ray GM 6 days 2 days 1 day

  5. GM Testing: “Cut-off Point“Maertens et al. JCM 1999, 37: 3223; Blood 2001, 97: 1604; Br J Haem 2004, 126: 852 ELISA Sensitivity: 60%-100% Specificity: 81%-98% Producing company 1.5 Static index 0.8 Dynamic index FDA Europe 0.5

  6. Systematic CT in Diagnosis of IPACaillot et al. J Clin Oncol 1997;15:139. SURVIVAL Systematic CT CT when indicated RETROSPECTIVE ANALYSIS n = 37 0 50 100 150 200 gün SYSTEMATIC BT BEFORE AFTER Days until diagnosis Since admission Since the first suspicion Halo sign before dx 31 ± 9 7 ± 5 1 / 8 21 ± 5 2 ± 1 23 / 25

  7. Course of CT Findings Caillot et al. J Clin Oncol 2001,19:253. Day0 24 100% - - 0 Day7 18 22% 50% 28% 900 Day14 16 19% 18% 63% 2,900 Day3 13 68% 31% 8% 0 CT(n) Typicalhalo Non-specific Typical“air-crescent” PMN/mm3 (median)

  8. 0 10 20 30 40 50 60 70 80 90 Day VRC vs. AmB-d in IA: SurvivalHerbrecht et al. NEJM 2002;347:408. 1.0 0.8 0.6 Probability of survival HR = 0.60 (95% CI 0.40 to 0.89), p=0.012 0.4 Amphotericin B -> OLATVoriconazole -> OLAT 0.2 0.0 Ben De Pauw’

  9. IA Treatment Guidelines of IDSA, 2008

  10. Risk Factors for Zygomycosis • Diabetic ketoacidosis • Iron overload • Desferrioxamine therapy • Neutropenia • GVHD • Corticosteroid therapy • IV drug use • Advanced AIDS • Disruption of skin integrity

  11. Problems in Diagnosis • Ubiquity in nature • Difficulty in obtaining tissue sample • Difficulty in microscopic differentiation • Delayed growth in culture • No serological surrogate marker • Difficulty in differentiating from other mould infections clinically

  12. Reversed Halo Sign Wahba H, et al. CID 2008;46:1733

  13. Causative Pathogens in Zygomycosis Roden MM, et al. CID 2005, 41: 634

  14. Zygomycosis: Review of Reported Cases Roden MM, et al. CID 2005, 41: 634

  15. The Impact of Underlying Disease on the Involvement Site Roden MM, et al. CID 2005, 41: 634

  16. Mortality in Zygomycosis Roden MM, et al. CID 2005, 41: 634

  17. Mortality in Zygomycosis Roden MM, et al. CID 2005, 41: 634

  18. Posaconazole

  19. PSC “Salvage” in Zygomycosis Greenberg RN et al, AAC 2006;50:126. 24 pts CR/PR 21% intolerant %80 (4/5) 79% refractory %79 (15/19) Hematological malignancy %63 Allo-BMT / PBSCT %46 Organ transplant recipient %17 DM %21

  20. 21 y.o. Relapsed ALL On chemo (Cortikosteroid+) Rapidly progressing dyspnea Hypoxia

  21. 1910 Antonio Carinii described in rat lung tissue • Protozoon (trophozoid & cyst forms, response to pentamidine) • 1988 Classified as fungus after sequencing of ribosomal RNA subunit • 2002 Pneumocystis infecting humans: Pathologist Jirovec

  22. Krajicek BJ, et al. Curr Opin Pul Med 2008:14:228.

  23. 494 pts. • Age • Subsequent attacks of PCP • Hb ↓ • Pulmonary Kaposi sarcoma 547 episodes 10.1% (1985-1989) mortality 16.9% (1990-1996) (1996-2006) 9.7%

  24. Treatment of PCP D’Avignon DC, et al. Semin Respir Crit Care 2008;29:132.

  25. “Salvage” Treatment of HIV-Related PCP Benfield T, et la. J Acquir Immune Defic Syndr 2008:48:63.

  26. Corticosteroids in the Treatment of PCP in HIV (+) Patients Briel M, et al. Cochrane, 2009

  27. Colonisation by Pneumocystis jiroveci Morris A et al. JID 2008;197:10.

  28. Pneumocystis jiroveci Kolonizasyonu: Morris A et al. JID 2008;197:10.

  29. Pneumocystis jiroveci Kolonizasyonu: Morris A et al. JID 2008;197:10.

  30. Pneumocystis jiroveci Kolonizasyonu: Morris A et al. JID 2008;197:10.

More Related