Role of early diagnosis and aggressive surgery in the management of invasive pulmonary aspergillosis in neutropenic patients

Invasive pulmonary aspergillosis (IPA) occurs mostly in immunocompromised h osts and especially in neutropenic patients. Improved prognosis for IPA req uires early diagnosis. We report our experience in the management of IPA in patients with hematological malignancies. In prolonged neutropenia (> 10 d ays), thoracic CT scanning seems to be the best choice for the diagnosis of IPA (with CT halo or air-crescent signs). Its systematic use allows a dram atic reduction in the time to achieve the diagnosis, if there is evidence o f a halo sign. The systematic screening for the detection of Aspergillus an tigenemia with an ELISA test is helpful for early diagnosis. The detection of Aspergillus antigen (with the less sensitive latex agglutination test) o n bronchoalveolar lavage (DAL) fluid may also he as useful. The treatment o f IPA relies on amphotericin B (or its lipid formulations) or on azole anti fungal agents. Pulmonary surgical resection should be considered either as an emergency procedure (despite persistent neutropenia) to avoid massive he moptysis. or as an elective or diagnostic procedure. This global strategy f or the management of IPA is associated with a 75-80% success rate in hemato logical patients. Nevertheless. the control of underlying: malignancy remai ns a major prognostic factor.