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Baseline and Bimonthly High-Resolution Computed Tomographic Imaging of the Chest in the Early Detection and Treatment of Pulmonary Mold Infections in Patients With Leukemia With Prolonged Neutropenia

Mendoza, Dexter MD*; Castillo, Elvis MD; Alrabaa, Sally MD; Murtagh, Ryan MD, MBA; Velez, Ana Paula MD; Yacoub, Abraham T. MD§; Khwaja, Sara I. MD, MS§; Greene, John N. MD§

Infectious Diseases in Clinical Practice: July 2014 - Volume 22 - Issue 4 - p 210–215
doi: 10.1097/IPC.0000000000000111
Original Articles

Background Pulmonary mold infections are common complications of prolonged severe neutropenia in patients with leukemia. Mortality from these infections is high, but early detection and treatment have been shown to be effective in reducing this mortality. In this study, we investigate the use and effectiveness of baseline and serial bimonthly high-resolution computed tomographic (HRCT) scans of the chest in the early detection of mold pneumonias.

Methods Medical records of 63 patients with acute myeloid leukemia with prolonged (>7 days) and profound neutropenia (absolute neutrophil count, <500 cells/mm3) at the H. Lee Moffitt Cancer Center and Research Institute between June 2005 and January 2010 were retrospectively selected and reviewed. These patients have undergone baseline and serial HRCT imaging of the chest and were found to have new nodules suggestive of a probable mold infection and are treated accordingly.

Results Radiographic improvement was noted in 51 (81.0%) patients in an average of 27.2 days (SD, 16.7), and radiographic resolution was noted in 47 (74.6%) patients in an average of 58.5 days (SD, 33.79) after treatment. There was an overall mortality rate of 25.3%.

Conclusions Our findings suggest that baseline and serial chest HRCT is assistive in the early detection and treatment of mold pneumonias. A randomized controlled trial comparing outcome and cost effectiveness of fever-driven empirical antifungal therapy versus a baseline and bimonthly HRCT-driven preemptive antifungal treatment in patients with neutropenia was conducted to confirm results.

From the *College of Medicine, University of South Florida, and †Division of Infectious Diseases and International Medicine, College of Medicine, University of South Florida; ‡Department of Diagnostic Imaging, H. Lee Moffitt Cancer Center and Research Institute; and §H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.

Correspondence to: John N. Greene, MD, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB-3, Tampa, FL 33612-9497. E-mail:

The authors have no funding or conflicts of interest to disclose.

© 2014 by Lippincott Williams & Wilkins.