• M Gari-Toussaint, M A Piens, and Groupe de Recherche sur les Infections Fongiques.
• Laboratoire de Parasitologie-Mycologie, Hôpital Archet 2, BP 3079, F06202 Nice. gari-toussaint.m@chu-nice.fr
• Presse Med. 2001 Dec 22;30(39-40 Pt 1):1912-7.

ObjectiveInvasive filamentous fungal infections (FFI) are difficult to diagnose in the department of hematology; a variety of arguments are necessary to confirm the fungal origin. Our study evaluated prospectively, in a large population in South Eastern France, the diagnostic techniques used ante and post mortem (mycology, anatomopathology, serology and aspergillosis antigens) to prove an FFI.MethodsTwo hundred and twenty eight neutropenic patients with obvious, probable, highly probable or presumed FFI were selected. Since completion of this study, a new classification of aspergillosis, with 3 instead of 4 levels of diagnosis, has been defined by the ICAAC in San Francisco but has not yet been published. Mycological or histological examinations were been performed on broncho-alveolar washings (BAW), puncture liquids or biopsies. Serology used precipitation, hemagglutination, immunofluorescence or ELISA techniques. Aspergillosis antigens were researched using the Pastorex method (agglutination of latex particles), launched at the beginning of the study.ResultsInvasive aspergillosis was diagnosed in 43.4% of patients, a non-aspergilla FFI in 6.5%, and no fungi was isolated in the cultures of 50% of patients. Ante mortem, 160 patients underwent BAW with a total of 175 samples. Among the latter, 41.7% mycological examinations were positive (presence of mycelium filaments and/or positive cultures) with 68.7% of Aspergillus fumigatus. Of the 48 puncture liquids, 25% of direct examinations and 29% of cultures were positive. Biopsies were taken from 59 patients and explored for mycology: 63.8% of direct examinations and 46.8% of cultures were positive; for those explored histologically, 76.7% revealed the presence of mycelium filaments. Post mortem, 17 patients out of 79 deceased underwent a total of 24 autopsy or biologic sampling. For 5 patients, FFI was diagnosed post mortem. Aspergillus serology and antigen explorations were conducted respectively in 202 and 182 patients and were positive in 31% and 33%. The presence of antibodies appears to be a good prognostic factor compared with the presence of antigens.ConclusionBiological diagnosis of FFI relies on the multiplicity of examinations and renewal of mycological sampling.

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