Clinical, laboratory, and radiologic findings suggestive of specific fungal diseases in patients with A-Leuk, shown according to presence or absence of myelosuppression
| Findings . | During aplasia . | After hematopoietic recovery . |
|---|---|---|
| Hematogenous dissemination: yeasts, mostly Candida species | ||
| Clinical | Hemodynamic instability may develop | Abdominal pain and nausea with CDC95 |
| Skin lesions: painless subcutaneous nodules, maculopapular, pustular, purpura fulminans–like, rarely ecthyma gangrenosum (ulcerative, necrotic) | Chorioretinal lesions, joint and bone pain infections Skin lesions and myalgia less conspicuous than during aplasia | |
| Rarely myalgia, muscular tenderness | ||
| Laboratory | Positive blood cultures, increased s-BDG86,87 | Increased serum alkaline phosphatase in patients with CDC |
| Increased s-BDG86,87,90 with persistent infection | ||
| Imaging | Lower yield during aplasia | Multiple lesions in liver, spleen, kidneys on CT scan, ultrasound, or MRI in patients with CDC95 |
| Angioinvasive molds, most commonly Aspergillus species | ||
| Clinical | Pneumonia: dry cough, pleuritic chest pain, pleural rub | Pneumonia: respiratory findings may worsen with neutrophil recovery9 |
| Sinusitis: facial pain, nasal discharge, hard palate ulceration | Skin lesions: less conspicuous than during aplasia | |
| Skin lesions: maculopapular, pustular, or ecthyma gangrenosum31 | ||
| Laboratory | Increased s-GMI ± s-BDG82,90 Positive blood cultures represent contamination31 | Increased s-GMI ± s-BDG86,87 in patients with persistent infection |
| Imaging | Chest CT: nodular or wedge-shaped infiltrates or halo sign93 | Larger nodules, air crescent sign, cavitation, other94 |
| Earlier nonspecific findings diagnostic if s-GMI is positive83 | Worsening pulmonary infiltrates with rapid neutrophil recovery94 | |
| Angioinvasive molds capable of hematogenous dissemination,31 most commonly Fusarium species | ||
| Clinical | Same as angioinvasive molds, but metastatic skin lesions more common, and target skin lesions may be present (Fusarium species)19 | Same as angioinvasive molds, plus chorioretinal lesions, joint and bone pain infections, similar to features of hematogenous dissemination above |
| Cellulitis at sites of skin breakdown: Fusarium species19 | ||
| Myalgia, muscular tenderness: Fusarium species19 | ||
| Laboratory | Same as angioinvasive molds, but blood cultures typically positive | Same as angioinvasive molds |
| Imaging | Same as angioinvasive molds | Same as angioinvasive molds |
| Findings . | During aplasia . | After hematopoietic recovery . |
|---|---|---|
| Hematogenous dissemination: yeasts, mostly Candida species | ||
| Clinical | Hemodynamic instability may develop | Abdominal pain and nausea with CDC95 |
| Skin lesions: painless subcutaneous nodules, maculopapular, pustular, purpura fulminans–like, rarely ecthyma gangrenosum (ulcerative, necrotic) | Chorioretinal lesions, joint and bone pain infections Skin lesions and myalgia less conspicuous than during aplasia | |
| Rarely myalgia, muscular tenderness | ||
| Laboratory | Positive blood cultures, increased s-BDG86,87 | Increased serum alkaline phosphatase in patients with CDC |
| Increased s-BDG86,87,90 with persistent infection | ||
| Imaging | Lower yield during aplasia | Multiple lesions in liver, spleen, kidneys on CT scan, ultrasound, or MRI in patients with CDC95 |
| Angioinvasive molds, most commonly Aspergillus species | ||
| Clinical | Pneumonia: dry cough, pleuritic chest pain, pleural rub | Pneumonia: respiratory findings may worsen with neutrophil recovery9 |
| Sinusitis: facial pain, nasal discharge, hard palate ulceration | Skin lesions: less conspicuous than during aplasia | |
| Skin lesions: maculopapular, pustular, or ecthyma gangrenosum31 | ||
| Laboratory | Increased s-GMI ± s-BDG82,90 Positive blood cultures represent contamination31 | Increased s-GMI ± s-BDG86,87 in patients with persistent infection |
| Imaging | Chest CT: nodular or wedge-shaped infiltrates or halo sign93 | Larger nodules, air crescent sign, cavitation, other94 |
| Earlier nonspecific findings diagnostic if s-GMI is positive83 | Worsening pulmonary infiltrates with rapid neutrophil recovery94 | |
| Angioinvasive molds capable of hematogenous dissemination,31 most commonly Fusarium species | ||
| Clinical | Same as angioinvasive molds, but metastatic skin lesions more common, and target skin lesions may be present (Fusarium species)19 | Same as angioinvasive molds, plus chorioretinal lesions, joint and bone pain infections, similar to features of hematogenous dissemination above |
| Cellulitis at sites of skin breakdown: Fusarium species19 | ||
| Myalgia, muscular tenderness: Fusarium species19 | ||
| Laboratory | Same as angioinvasive molds, but blood cultures typically positive | Same as angioinvasive molds |
| Imaging | Same as angioinvasive molds | Same as angioinvasive molds |
CDC, chronic disseminated candidiasis; MRI, magnetic resonance imaging.