Rapid Diagnosis Of Severe Invasive Pulmonary Aspergillosis In Patients With Non-hematological Diseases

Objective:To evaluate the value of chest CT imaging findings combined with bedside tracheoscopic changes in early diagnosis of severe invasive pulmonary aspergillosis(IPA).Methods:To analyze retrospectively the clinical data of non-hematological diseases' patients with IPA confirmed by pathology in the respiratory intensive care unit(RICU)of the First Affiliated Hospital of Xinjiang Medical University in recent 10 years.The diagnostic criteria were in accordance with the 2017 The European Society for Clinical Microbiology and Infectious Diseases/the European Confederation of Medical Mycology/the European Respiratory Society(ESCMID-ECMM-ERS)guidelines for the diagnosis and management of aspergillosis,based on the possible diagnosis made by the patient's initial chest CT imaging findings at day of admission to RICU combined with bedside tracheoscopic changes.Tracheoscopy was performed at the bedside of RICU to observe the changes of airway mucosa and the characteristics of secretion,and bronchoalveolar lavage fluid(BALF)was used to performed G test,smear and culture of pathogens suspected at the same time.Lung tissue samples were obtained by transbronchial lung biopsy(TBLB)or under the CT guidance for pathological examinations.Results:Twenty-six patients with non-hematological diseases were included in the study.The manifestations of CT as follows:ground glass opacity and interlobular septal thickening in 12 cases(46.2%),pulmonary infiltration shadow,consolidation and air bronchograms in 11 cases(42.3%),pulmonary nodules or cavities in8 cases(30.7%),other imaging findings in 2 cases(7.7%).Mucosal manifestations under the tracheoscope: mucosal leukoplakia and melanoplakia in 16 cases(61.5%),mucosal erosion,ulcer and pus in 11cases(42.3%),Mucosal hyperemia,edema and hemorrhage in 9csaes(34.6%).According to the chest CT findings combined with tracheoscopic changes,twenty cases were diagnosed correctly as IPA.The percentage of diagnostic concordance was 76.9%,with 95% confidence interval(95%CI)= 59.6%-94.3%.According to the pathological criteria,IPA was confirmed to occur in twenty-three cases.Draw fourfold tables,The sensitivity,the false negative rate,the specificity,the false positive rate,the positive predictive value,and the negative predictive value was 87.0%,13.0%,66.7%,33.3%,95.2%,40%,respectively.Conclusion:Chest CT imaging findings combined with bedside tracheoscopic changes can be used as a rapid and simple method for possible diagnosis of severe IPA in patients with non-hematological diseases,and provide a diagnostic clue for rapid empirical therapy of severe IPA.