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reviews: Andrew F. Shorr, Gregory M. Susla, and Naomi P. O’Grady Pulmonary Infiltrates in the Non-HIV-Infected Immunocompromised Patient: Etiologies, Diagnostic Strategies, and Outcomes Chest 2004; 125: 260-271 [Abstract] [Full text] [PDF]

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Denis Caillot   (14 January 2004)

Untitled 14 January 2004
Denis Caillot, MD Hematology Unit CHU Dijon France Send letter to journal: Re: this article denis.caillot{at}chu-dijon.fr Denis Caillot	Sir, I have read the above paper from AF Shorr et al. The authors sate that:"The halo sign is neither sensitive nor specific for Aspergillus. First, many molds other than Aspergillus (eg, Fusarium) can cause a similar pattern on a CT scan. Second, the fact that the halo sign is a late finding coupled with the observation that Aspergillus causes such a wide spectrum of illness explains why the halo sign is absent in many cases. In one report (#9:Caillot et al) of definitive Aspergillus cases, the sensitivity was only 50%. In this paper cited as reference n°9, we have stated in the abstract that:"On d0 (first day of IPA diagnosis with early CT scan), a typical CT halo sign was observed in 24 of 25 patients." Moreover, in the same paper we said in the discussion section:"In the present series of surgically proven aspergillosis, it appears that when CT scan is systematically and promptly done in febrile neutropenic patients at risk of aspergillosis, its positive predictive value is quite 100%. Nevertheless, the duration of this halo sign is short. Three quarters of the initial CT halo signs disappeared within a week after IPA diagnosis." We think that if the presence of halo sign is not pathognomonic of aspergillosis, in the setting of neutropenia it is a very interesting tool to diagnose aspergillosis according to the frequence of aspergillus compared to other filamentous fungi. In conclusion, the CT halo sign remains probably the best way to achieve the diagnosis of invasive pulmonary aspergillosis in the setting of persistent neutropenia. However, the CT scan must be done very early in the evolution of the disease due to the the short duration of this halo sign. Sincerely Denis Caillot Cited reference: Increasing volume and changing characteristics of invasive pulmonary aspergillosis on sequential thoracic CT scans in neutropenic patients. D Caillot, J-F Couaillier, A Bernard et al. J Clin Oncol 2001; 19: 253-259