Universität zu Köln

Maschmeyer, G., Carratala, J., Buchheidt, D., Hamprecht, A., Heussel, C. P., Kahl, C., Lorenz, J., Neumann, S., Rieger, C., Ruhnke, M., Salwender, H., Schmidt-Hieber, M. and Azoulay, E. (2015). Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients (allogeneic SCT excluded): updated guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann. Oncol., 26 (1). S. 21 - 34. OXFORD: OXFORD UNIV PRESS. ISSN 1569-8041

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Abstract

Up to 25% of patients with profound neutropenia lasting for > 10 days develop lung infiltrates, which frequently do not respond to broad-spectrum antibacterial therapy. While a causative pathogen remains undetected in the majority of cases, Aspergillus spp., Pneumocystis jirovecii, multi-resistant Gram-negative pathogens, mycobacteria or respiratory viruses may be involved. In at-risk patients who have received trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis, filamentous fungal pathogens appear to be predominant, yet commonly not proven at the time of treatment initiation. Pathogens isolated from blood cultures, bronchoalveolar lavage (BAL) or respiratory secretions are not always relevant for the etiology of pulmonary infiltrates and should therefore be interpreted critically. Laboratory tests for detecting Aspergillus galactomannan, beta-d-glucan or DNA from blood, BAL or tissue samples may facilitate the diagnosis; however, most polymerase chain reaction assays are not yet standardized and validated. Apart from infectious agents, pulmonary side-effects from cytotoxic drugs, radiotherapy or pulmonary involvement by the underlying malignancy should be included into differential diagnosis and eventually be clarified by invasive diagnostic procedures. Pre-emptive treatment with mold-active systemic antifungal agents improves clinical outcome, while other microorganisms are preferably treated only when microbiologically documented. High-dose TMP/SMX is first choice for treatment of Pneumocystis pneumonia, while cytomegalovirus pneumonia is treated primarily with ganciclovir or foscarnet in most patients. In a considerable number of patients, clinical outcome may be favorable despite respiratory failure, so that intensive care should be unrestrictedly provided in patients whose prognosis is not desperate due to other reasons.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Maschmeyer, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Carratala, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Buchheidt, D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hamprecht, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Heussel, C. P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kahl, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lorenz, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Neumann, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rieger, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ruhnke, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Salwender, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt-Hieber, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Azoulay, E. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-418334
DOI:	10.1093/annonc/mdu192
Journal or Publication Title:	Ann. Oncol.
Volume:	26
Number:	1
Page Range:	S. 21 - 34
Date:	2015
Publisher:	OXFORD UNIV PRESS
Place of Publication:	OXFORD
ISSN:	1569-8041
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INVASIVE PULMONARY ASPERGILLOSIS; POLYMERASE-CHAIN-REACTION; STEM-CELL TRANSPLANT; PNEUMOCYSTIS-JIROVECI PNEUMONIA; RESOLUTION CT FINDINGS; INTENSIVE-CARE-UNIT; HIV IMMUNOCOMPROMISED PATIENTS; BRONCHOALVEOLAR LAVAGE FLUID; RESPIRATORY SYNCYTIAL VIRUS; BETA-LACTAM MONOTHERAPY Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/41833