Patient selection: hematologic malignancy or hematopoietic stem cell transplant recipient
A patient at high risk for an invasive fungal pulmonary infection is monitored frequently with serum galactomannan (GM) levels and azole prophylaxis.
Triggers for further evaluation – one or more of the following:
(1) serum galactomannan index (GMI) >= 0.5
(2) unexplained fever that persists for more than 5 days
(3) clinical findings suggesting of an invasive fungal pulmonary infection
(4) new nodular pulmonary infiltrate on chest X-ray
(5) sinus boney destruction on skull X-ray
(6) presence of a mold in culture
(7) presence of a mold on histology
Objective findings for an invasive fungal pulmonary infection:
(1) nodular infiltrate on high resolution chest CT, especially if discrete, if has a halo or if cavitary
(2) positive fungal culture from BAL
(3) positive histopathology from bronchial biopsy or BAL cytology
(4) positive galactomannan antigen test on BAL
A patient may be treated with antifungal agents if one or more objective findings are present or if there is a high level of clinical suspicion.
