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Invasive Fungal Infections: Imaging, Diagnosis, and Immunity Defects

This article discusses the relationship between specific immunity defects and various infections, particularly invasive fungal infections such as aspergillosis and candidiasis. It examines the role of phagocyte and T-cell abnormalities, alongside corticosteroid therapy, in increasing susceptibility to pathogens like Cryptococcus and Histoplasma. The imaging techniques, including chest X-ray and CT scans, are highlighted for diagnosing conditions such as invasive pulmonary aspergillosis and zygomycosis. Key findings like nodular opacities and the halo sign are emphasized, with recommendations for timely imaging in immunocompromised patients.

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Invasive Fungal Infections: Imaging, Diagnosis, and Immunity Defects

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  1. Dante LuizEscuissato

  2. Infections are related to specific immunity defects. • Phagocyte abnormalities and intravenous catheters: Aspergillus and Candida species. • T cell abnormalities and corticosteroid therapy: Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis, Pneumocystis jiroveci, andCandida species.

  3. Am J Roentgenol 2005;185:608-615

  4. Aspergillus sp Fusarium sp

  5. Pseudomonas sp.

  6. Infections • Fungal infections (invasive aspergillosis, candidiasis, zygomycosis, fusariosis) • Viral and bacterial infections • Neoplasia • Bronchoalveolar carcinoma • Kaposi sarcoma • Angiosarcoma metastasis • Vasculitis (Wegener granulomatosis) Br J Radiol 2005;78:862-865

  7. Invasive Pulmonary Aspergillosis • Chest X-ray: isolate or multiple nodular opacities, cavitate lesions, alveolar opacities. • CT: nodules and alveolar opacities, with or without the halo sign. Radiographics 2001;21:825-837 Braz J Infect Dis 2007;11:110-113

  8. Invasive Pulmonary Aspergillosis • Halo sign: 33-60%, disappears after one week (~75%) • Recommendation: CT scan performed not beyond 5th day after symptoms onset.

  9. Invasive Pulmonary Aspergillosis

  10. Invasive Pulmonary Aspergillosis

  11. Invasive Pulmonary Aspergillosis

  12. CT scan: nodules, consolidations, and ground-glass opacities. • Candidiais and IPA: similar CT findings in immunocompromised patients. • Halo sign and cavitation not helpful to differentiate fungal infections. Am J Roentgenol 2005;185:608-615 Radiology 2005;236:332-337

  13. Zygomycosis: imaging abnormalites are similar to IPA in immunocompromised patients. • Cryptococcosis:one or more nodules and masses (up 10cm in diameter), consolidations, and diffuse reticular a/o nodular opacities. Cavitations are seen in immunocompromised patients.

  14. Brodoefel et al.: • ~3 lesions (40 patients) • Lesions enlarges inicially (~ 9th day)  stabilization  regression (Am J Roentgenol 2006;187:404-413) • Cavitation: indicative of favorable evolution.

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  17. Chest X-ray: screening for lesions in patients with neutropenia and fever. • High-resolution CT scan shows abnormalities not seen in chest X-rays. • HRCT: differential diagnosis (infectious and not infectious lesions).

  18. Nodules >10mm and lesions with the halo sign associated to clinical context are enough to presume the diagnosis of pulmonary invasive fungal infection

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