Limited index of clinical suspicion and under- diagnosis of histopathologically documented invasive mold infections

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ID Serval
serval:BIB_C2864AE3ED14
Type
Mémoire
Sous-type
(Mémoire de) maîtrise (master)
Collection
Publications
Institution
Titre
Limited index of clinical suspicion and under- diagnosis of histopathologically documented invasive mold infections
Auteur⸱e⸱s
DE CAUDRON DE COQUEREAUMONT G.
Directeur⸱rice⸱s
LAMOTH F.
Codirecteur⸱rice⸱s
ROTMAN S.
Détails de l'institution
Université de Lausanne, Faculté de biologie et médecine
Statut éditorial
Acceptée
Date de publication
2020
Langue
anglais
Nombre de pages
42
Résumé
Background
Invasive mold infections (IMI) are life-threatening complications for patients with severe immune defects, such as those with hematologic cancer or transplantation. Diagnosis of IMI is difficult because of the lack of specificity of clinical and radiological signs as well as the limited sensitivity of microbiological tools for the detection of molds in clinical specimens. As a consequence, diagnosis of IMI is often delayed or even missed, which results in high attributable mortality rates. In order to improve the diagnostic accuracy of IMI, an expert panel of the European Organization for Research and Treatment of Cancer (EORTC) and the Mycoses Study Group Education and Research Consortium (MSGERC) has established criteria for the definition of proven, probable and possible IMI. The aim of this study was to assess the adequacy of clinical appreciation and EORTC/MSGERC criteria for IMI diagnosis by confrontation to histopathology or autopsy results.
Methods
Histopathology and autopsy reports mentioning the presence of molds, mycelia or hyphal elements were retrospectively reviewed over a 10-year period (2010-2019). Cases fulfilling the criteria of angio-invasive mold infection were included in the analysis. These cases were classified as proven, probable, possible IMI or no IMI according to the EORTC/MSGERC criteria on the basis of clinical, radiologic and microbiological data preceding the histopathology sampling or autopsy. Clinical suspicion of IMI and initiation of antifungal treatment before histopathology/autopsy were also assessed.
Results
Of 107 histopathology/autopsy reports, 41 fulfilled the criteria of angio-invasive mold infection. Only 51% of these patients received antifungal therapy before histopathology/autopsy and, in 27% of cases, IMI was not suspected by the clinicians. The rate of missed diagnosis was particularly high (53%) among non-hematologic cancer patients. Applying the EORTC-MSGERC criteria, only 76% cases met the definitions of at least possible IMI.
Conclusions
This study suggests that up to one quarter of IMIs are missed by the clinicians. Increased awareness of this complication is warranted, especially among non-hematologic cancer immunocompromised patients at low-moderate risk of IMI.
Mots-clé
Invasive fungal infections, invasive mold infections, EORTC/MSGERC, aspergillosis, mucormycosis
Création de la notice
09/09/2021 8:27
Dernière modification de la notice
30/09/2022 5:39
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