Surgical management of invasive pulmonary fungal infection in patients with hematologic diseases

Abstract

Abstract: Objective To investigate the efficacy and safety of surgical management in patients with hematology malignancies and suspected invasive pulmonary fungal infections.Methods A total of 10 patients with hematologic malignancies suspected of invasive pulmonary fungal infection and underwent pulmonary resection from April 2005 to June 2009 were recruited and analyzed.Postoperative complications and mortality were summarized to evaluate the efficiency and safty of surgery.Results All the surgery were performed under general anesthesia,including 5 thoracotomy surgery and 5 video-assisted thorascopic surgery.Three had wedge resections while seven had lobectomies.Postoperative histopathology proved invasive pulmonary fungal infection in 6 patients (60%),chronic bacterial infection in 1 patients.Postoperative complications occurred in 4 patients (40%),including pneumothorax (n=2) that absorded by itself,localized respiratory insufficiency (n=1),and hemothorax in 1 patients.Postoperative mortality within 30 d was 10%,while postoperative pulmonary IFI relapse rate was 16%.Until 31 August 2009,4 (40%) patients died with the mean follow-up period of 3.8 months (0.7-31.1 months).Conclusions Surgery is safe and helpful for diagnosis,lesion removement,prevention of IFI relapse and further immunosuppressive treatment.

Key words: invasive pulmanory fungal infection, surgey (IPFI), lung resection, hematologic malignancies

CLC Number:

R756.6

TANG Fei-fei, XU Lan-ping, LIU Dai-hong, LIU Kai-yan, CHEN Huan, HAN Wei, ZHANG Xiao-hui, CHEN Yu-hong, WANG Feng-rong, WANG Yu, HUANG Xiao-jun. Surgical management of invasive pulmonary fungal infection in patients with hematologic diseases[J]. Chinese Journal of Mycology, 2010, 5(2): 69-73.

References

[1] Thursky K,Byrnes G,Grigg A,et al.Risk factors for post-en-graftment invasive aspergillosis in allogeneic stem cell transplan-tation[J].Bone Marrow Transplant,2004,34(2):115-121.
[2] Pagano L,Caira M,Nosari A,et al.Fungal infections in recipients of hematopoietic stem cell transplants:results of the SEIFEM B-2004 study[J].Clin Infect Dis,2007,45 (9):1161-1170.
[3] Jantunen E,Ruutu P,Piilonen A,et al.Treatment and outcome of invasive Aspergillus infections in allogenic BMT recipients[J].Bone Marrow Transplant,2000,26(7):759-762.
[4] Caillot D,Casasnovas O,Bemurd A,et al.Improved management of invasive pulmonary aspergillosis in neutropenic patients using early thoracic computed tomographic scan and surgery[J].J Clin Oncol,1997,15 (1):139-147.
[5] Walsh TJ,Anaissie EJ,Denning DW,et al.Treatment of aspar-gillosis:clinical practice guidelines of the Infectious DiseasesSociety of America[J].Clin Infect Dis,2008,46 (3):327-360.
[6] 陈育红,黄晓军,郭乃榄,等.异基因造血干细胞移植后急性移植物抗宿主病的发生及其危险因素的探讨[J].中华血液学杂志,2003,24(2):61-63.
[7] 中华内科杂志编辑委员会.血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(修订版)[J].中华内科杂志,2007,46:607-611.
[8] 纪宇,刘代红,黄晓军,等.血清半乳甘露聚糖检测对造血干细胞移植后患者侵袭性曲霉菌感染的诊断价值[J].中华血液学杂志,2007,28(2):83-86.
[9] Pidhorecky I,Urschel J,Anderson T.Resection of invasive pulmonary aspergillosis in immunocompromised patients[J].Ann Surg Oncol,2000,7(4):312-317.
[10] Reichenberger F,Habicht JM,Grstwohl A,et al.Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenic patient[C].Eur Respir J,2002,19 (4):743 -755.
[11] Herbrecht R,Denning DW,Patterson TF,et al.Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis[J].N Engl J Med,2002,347(6):408-415.
[12] Habicht JM,Reichenberger F,Gratwohl A,et al.Surgical aspacts of resection for suspected invasive pulmonary fungal infection in neutropenic patients[J].Ann Thorac Surg,1999,68(2):321-325.
[13] Habicht JM,Matt P,Passweg JR,et al.Invasive pulmonary fungal infection in hematologic patients:is resection effective[J] ? Hematol J,2001,2 (4):250-256.
[14] Danner BC,Didilis V,D(o)rge H,et al.Surgical treatment of pulmonary aspergillosis/mycosis in immunocompromised patients[J].Interact Cardiovasc Thorac Surg,2008,7 (5):771-776.
[15] Denning DW.Therapeutic outcome in invasive aspergillosis[J].Clin Infect Dis,1996,23 (3):608-615.
[16] Pidhorecky I,Urschel J,Anderson T.Resection of invasive pulmonary aspargillosis in immunocompromised patients[J].Ann Surg Oncol,2000,7(4):312-317.
[17] Gossot D,Validire P,Vaillancourt R.Full thoracoscopic approach for surgical management of invasive pulmonary aspergillosis[J].Ann Thorac Surg,2002,73 (1):240-244.