[The value of the current diagnostic criteria of pulmonary invasive fungal infection after allogeneic hematopoietic stem cell transplantation].

ABSTRACT

OBJECTIVE: To analyze the practicality of current diagnostic criteria of invasive fungal infection (IFI) in patients with hematologic diseases/malignant tumors, so as to enhance the recognition of characteristics of pulmonary IFI after allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS: The clinical features of 51 cases with IFI after allo-HSCT were analyzed retrospectively. RESULTS: Pulmonary IFI accounted for 42.1% (51/121) of the whole infectious pneumonia diagnosed among the patients admitted during the study. One (2.0%) case was proven diagnosis; 24 (47.1%) were probable diagnosis and 26 (51.0%) were possible diagnosis. The using of immuno-suppressors and corticosteroids, and the presence of graft-versus-host disease (GVHD) were the main host factors. The patients with two or more host factors simultaneously accounted for 66.7% (34/51) of all pulmonary IFI patients. Totally 94.1% (48/51) of the patients with pulmonary IFI presented nodules and/or patches as the main features in high resolution computed tomography (HRCT) scanning. The positive rates of fungal antigen detection were 58.6% for G test and 33.3% for GM test, which were relatively high. Twenty patients (39.2%) showed decrease of arterial partial pressure of oxygen and hypoxia in blood-gas analysis. CONCLUSIONS: For the diagnosis of pulmonary IFI post allo-HSCT, the administration of immuno-suppressors and corticosteroids, and the presence of GVHD were the main host factors. Nodules and/or patches were the main features in HRCT image. Fungus antigen detection is the main tool to support clinical diagnosis.