INVASIVE PULMONARY ASPERGILLOSIS IN NEUTR OPENIC PATIENTS - A REPORT OF 36 CASES - ROLE OF THORACIC CT-SCAN AND ITRACONAZOL

In neutropenic patients, one way of improving invasive pulmonary asper gillosis (IPA) prognosis is an earlier initiation of the antifungal tr eatment. We report our experience with 36 cases of IPA in 35 patients with haematological malignancies. When aspergillosis nas diagnosed, al l but 2 patients were neutropenic (PMN < 500: median duration = 20 day s). The most frequent clinical signs were rough (100%), chest pain (78 %) and haemoptysis (58%). Before the diagnosis of IPA. Aspergillus ant ibody test was positive in 60% of cases. A thoracic CT-scan was perfor med in 23 patients and demonstrated highly suggestive images in 22 cas es (96%) with presence of CT halo sign (n = 13) or CT air-crescent sig n (n = 9). Moreover, Aspergillus antigen test was positive in 13 of 28 tested patients. IPA diagnosis nas determined to be definite in 23 ca ses and probable or possible in 13 cases. Thirty-five patients were tr eated: in 3 cases with amphotericin B (2 failures) and in 32 cases wit h itraconazole (7 failures and 25 successes or improvements). In 7 cas es (including 5 emergencies) surgical resection was successfully combi ned with the medical treatment. In neutropenic patient, with fever, He consider that thoracic CT-scan and repeated biological tests (Aspergi llus antibody and antigen tests) can be used to establish the diagnosi s of aspergillosis. Early treatment with itraconazole and surgical res ection appears to improve prognosis.