Surgical resection for persistent localized pulmonary fungal infection prior to allogeneic hematopoietic stem cell transplantation: Analysis of six cases |
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| Affiliation: | 1. Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan;2. Department of General Thoracic Surgery, Saitama Medical Center, Jichi Medical University, Japan;1. The Research Committee of the Japanese Society of Chemotherapy and the Japanese Association for Infectious Diseases on Antimicrobial Stewardship in Clinics, Japan;2. AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan;3. Department of Pharmacy, Tokyo Medical University Hospital, Tokyo, Japan;4. Nakahama Clinic, Japan;5. Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan;6. Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan;7. Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo, Japan;8. Department of Infectious Diseases, International University of Health and Welfare, Chiba, Japan;9. Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan;1. Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, School of Medicine, University of Crete, 71110 Voutes, Heraklion, Crete, Greece;2. Department of Clinical Microbiology, University Hospital of Heraklion, School of Medicine, University of Crete, 71110 Voutes, Heraklion, Crete, Greece;3. National Reference Laboratory for Staphylococci, Department of Microbiology, School of Medicine, University of Patras, Patras, Greece;1. Eiju General Hospital, Taito-ku, Tokyo 110-8645, Japan;2. Kawasaki City Institute for Public Health, Kawasaki, Kanagawa 210-0834, Japan;3. Zama Children''s Clinic, Zama, Kanagawa 252-0023, Japan;4. Ichikawa Children''s Clinic, Isehara, Kanagawa 259-1133, Japan;5. Abe Children''s Clinic, Yokohama, Kanagawa, 223-0051, Japan;6. Yasumi Hospital, Morioka, Iwate 028-4125, Japan;7. Ichikawa Clinic, Fukushima-shi, Fukushima 960-0112, Japan;8. Futaba Children''s Clinic, Ushiku, Ibaraki 300-1207, Japan;9. Junseikai Yoshihara Clinic, Takasaki, Gunma 370-3524, Japan;10. Shiozaki Clinic, Wakayama, Wakayama 640-8482, Japan;11. Wakaayukai Baba Clinic, Nagaokakyou, Kyoto 617-0814, Japan;12. Kudo Clinic, Kakogawa, Hyogo 675-0018, Japan;13. Maebashi Kita Hospital, Maebashi, Gunma 371-0054, Japan;14. Jinjikai Takahashi Clinic, Bando, Ibaraki 306-0631, Japan;15. Yokohama City Institute of Public Health, Yokohama, Kanagawa 236-0051, Japan;1. Department of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Nishi 2-11, Inada-cho, Obihiro, Hokkaido, 080-8555, Japan;2. Diagnostic Center for Animal Health and Food Safety, Obihiro University of Agriculture and Veterinary Medicine, Nishi 2-11, Inada-cho, Obihiro, Hokkaido, 080-8555, Japan;3. Division of Clinical Research, Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8673, Japan;4. Department of Medical Technologist, Obihiro-Kosei General Hospital, West 14 South 10-1, Obihiro, Hokkaido, 080-0016, Japan;5. Department of Nutrition Science, University of Nagasaki, Nagasaki, Japan;6. Division of Bio-resources, Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8673, Japan;1. Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan;2. Department of General Internal Medicine, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan;3. Department of Pediatrics, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan;1. Infection Control Division, South Miyagi Medical Center, Aza-Nishi 38-1, Ogawara, Shibata-gun, Miyagi 989-1253, Japan;2. Department of Emergency and Critical Care Medicine, South Miyagi Medical Center, Aza-Nishi 38-1, Ogawara, Shibata-gun, Miyagi 989-1253, Japan |
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| Abstract: | ObjectiveAlthough invasive fungal disease (IFD) is an important complication in allogeneic hematopoietic stem cell transplantation (HSCT), the clinical significance of surgery, including the role of surgical resection for persistent pulmonary fungal disease prior to allogeneic HSCT in the current era with a variety of available antifungal agents, is controversial. We investigated the role of surgical resection.MethodsWe retrospectively investigated six patients who underwent surgical resection of suspected pulmonary fungal disease prior to allogeneic HSCT between April 2007 and June 2016 at our medical center.ResultsWe present six patients who underwent surgical resection of suspected pulmonary fungal disease prior to allogeneic HSCT. In our case series, three of four patients who were given a presurgical diagnosis of possible IFD were given a proven diagnosis after surgery, including two cases of invasive aspergillosis (IA) and one case of mucormycosis. All surgeries were performed by video-assisted thoracic surgery (VATS) for lobectomy without major complications. Recurrence of IFD was not observed after allogeneic HSCT in any of the six patients.ConclusionOur experience indicated that surgical resection of persistent localized pulmonary lesions of IFD before allogeneic HSCT was helpful for obtaining a definitive diagnosis and might be useful for reducing recurrence after HSCT. |
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| Keywords: | Surgical resection Pulmonary fungal infection Aspergillosis Mucormycosis Allogeneic hematopoietic stem cell transplantation |
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