Dante Luiz EscuissatoDante Luiz Escuissato

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, and Candida species.

Am J Roentgenol 2005;185:608-615

Fusarium sp

Aspergillus sp

Pseudomonas sp.

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

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;21:825-837Braz J Infect Dis 2007;11:110-113

Halo sign: 33-60%, disappears after one week (~75%)

Recommendation: CT scan performed not beyond 5th day after symptoms onset.

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

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.

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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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).

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