Universität zu Köln

Heinz, Werner J., Vehreschild, Jorg J. and Buchheidt, Dieter ORCID: 0000-0002-4425-6134 (2019). Diagnostic work up to assess early response indicators in invasive pulmonary aspergillosis in adult patients with haematologic malignancies. Mycoses, 62 (6). S. 486 - 494. HOBOKEN: WILEY. ISSN 1439-0507

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Abstract

In immunocompromised patients with acute leukaemia as well as in allogeneic hematopoietic stem cell transplant patients, pulmonary lesions are commonly seen. Existing guidelines provide useful algorithms for diagnostic procedures and treatment options, but they do not give recommendations on how to evaluate early success or failure and if or when it is best to change therapy. Here, we review the diagnostic techniques currently used in association with clinical findings and propose an approach using a combination of computer tomography, clinical and all available biomarkers and inflammation parameters, especially those positive at baseline, to assess early response in invasive pulmonary aspergillosis. Computed tomography scans should be carried out at regular intervals during early and long-term follow-up. Imaging on day seven, or even earlier in clinically unstable patients, combined with an additional testing of biomarkers and inflammatory markers in between, is needed for a reliable assessment at day 14. If no improvement is seen after 2 weeks of therapy or the clinical condition is deteriorating, a change of antifungal therapy should be considered. Alleged breakthrough infections or treatment failure should undergo early diagnostic workup, including tissue biopsies when possible, to retrieve fungal cultures for resistance testing.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Heinz, Werner J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Vehreschild, Jorg J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Buchheidt, Dieter UNSPECIFIED orcid.org/0000-0002-4425-6134 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-147384
DOI:	10.1111/myc.12860
Journal or Publication Title:	Mycoses
Volume:	62
Number:	6
Page Range:	S. 486 - 494
Date:	2019
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1439-0507
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LATERAL-FLOW DEVICE; BRONCHOALVEOLAR LAVAGE FLUID; CELL TRANSPLANT RECIPIENTS; C-REACTIVE PROTEIN; FUNGAL-INFECTIONS; MOLD INFECTIONS; ANTIFUNGAL TREATMENT; GALACTOMANNAN INDEX; F-18-FDG PET/CT; FOLLOW-UP Multiple languages Dermatology; Mycology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14738