(1-3)--d-Glucan serum increase and small-airway-invasive radiological findings as early signs of pulmonary aspergillosis in high-risk hematologic patients in the posaconazole era: preliminary observations

Invasive pulmonary aspergillosis (IPA) is a severe complication in hematologic patients, including those with chemotherapy-induced profound neutropenia for acute myeloid leukemia (AML) remission induction [1]. The routine use of non-culture-based microbiological diagnostic tests and chest computed tomography (CT) scans has improved the diagnosis of IPA [2]. The integration of serum galactomannan index (s-GMI) levels and pre-specified pulmonary CT findings is crucial to categorizing suspected fungal infection episodes and starting targeted therapy [3-5]. However, these diagnostic features may vary according to several factors including moldactive antifungal prophylaxis with impairment of the performance of microbiological and radiological tests [6]. Among the different types of azoles that have been used over time, posaconazole, a next-generation of oral triazoles, has been recommended with the maximum level of evidence (A1) for IPA prophylaxis in several international guidelines [7]. With the intention of optimizing the yield of microbiological and radiological diagnostic work-up in hematological patients at very high risk of invasive fungal infection, we have determined if the 2008 European Organization for Research and Treatment