A retrospective series of gut aspergillosis in haematology patients
Kazan, Eyad × Maertens, Johan Herbrecht, Raoul Weisser, Maja Gachot, Bertrand Vekhoff, Anne Caillot, Denis Raffoux, Emmanuel Fagot, Thierry Reman, Oumedaly Isnard, Francoise Thiebaut, Anne Bretagne, Stéphane Cordonnier, Catherine #
Clinical Microbiology and Infection vol:17 issue:4 pages:588-594
ABSTRACT Gut invasive aspergillosis is an extremely rare infection in immunocompromised patients. The goal of this retrospective multicentre study is to report on cases of gut aspergillosis in haematology patients, clinical presentation, risk factors, and outcome. Twenty one patients from 9 centers were identified. Eight were isolated gut aspergillosis, with no evidence of other infected sites, 13 were disseminated aspergillosis. Thirteen patients had acute leukaemia. Nine were allogeneic stem cell transplant recipients. Clinical symptoms and imaging were poorly specific. The galactomannan antigenemia was positive in 16/25 (64%) patients, including in 4 of the 8 cases of isolated gut aspergillosis. Five out of 21 patients had a dietary regimen rich in spices, suggesting that food could be in these cases the source of gut colonization, then of a primary gut aspergillus lesion. The diagnosis was made post-mortem in 6 patients. The mortality rate in the remaining patients at 12 weeks was 7/15 (47%). Gut aspergillosis is likely misdiagnosed and underestimated in haematology patients, due to the poor specificity of symptoms and imaging. Patients with a persistently positive galactomannan antigenemia unexplained by respiratory lesions should be suspected of gut aspergillosis in the presence of abdominal symptoms and quickly investigated. In the absence of severe abdominal complication leading to surgery and resection of the lesions, the optimal treatment is sofar not defined.