{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:42:38Z","timestamp":1790116958020,"version":"4.0.1"},"reference-count":6,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,12,26]],"date-time":"2017-12-26T00:00:00Z","timestamp":1514246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Delays in diagnosing pulmonary invasive aspergillosis (<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>), a significant cause of morbidity and mortality among heart transplant recipients (<jats:styled-content style=\"fixed-case\">HTR<\/jats:styled-content>s), may impact on successful treatment. The appropriate screening strategy for <jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content> in these patients remains undefined, particularly in the setting of nosocomial outbreaks. We describe our experience employing chest computed tomography (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>) scans as a screening method for <jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>. In addition, we comment on antimicrobial prophylaxis in <jats:styled-content style=\"fixed-case\">HTR<\/jats:styled-content>s in the setting of an outbreak.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Screening <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scans of the chest and serum galactomannan (<jats:styled-content style=\"fixed-case\">GM<\/jats:styled-content>) were performed in <jats:styled-content style=\"fixed-case\">HTR<\/jats:styled-content>s during an outbreak that followed the index case of <jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>. Abnormal <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> findings prompted a diagnostic workup. Antimicrobial prophylaxis for new transplants recipients included intravenous micafungin while hospitalized, followed by outpatient inhaled amphotericin B for up to 3\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During a 10\u2010month period, five cases of <jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content> were identified among <jats:styled-content style=\"fixed-case\">HTR<\/jats:styled-content>s. Two additional asymptomatic patients were diagnosed with <jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content> among 15 asymptomatic <jats:styled-content style=\"fixed-case\">HTR<\/jats:styled-content>s who underwent screening chest <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scans. Among the five cases of <jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content> in <jats:styled-content style=\"fixed-case\">HTR<\/jats:styled-content>s, two of five (40%) had a partial response and the other three failed voriconazole therapy. Complete response to voriconazole therapy assessed at 12\u00a0weeks was achieved in these two asymptomatic <jats:styled-content style=\"fixed-case\">HTRs<\/jats:styled-content> diagnosed via screening <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>s. Serum <jats:styled-content style=\"fixed-case\">GM<\/jats:styled-content> was positive only in one of the symptomatic cases. The negative predictive value of <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scans was 100% (95% confidence interval, 71.5%\u2010100%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In an outbreak setting, screening <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scans of the chest may aid in early detection of asymptomatic <jats:styled-content style=\"fixed-case\">HTR<\/jats:styled-content>s with <jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content> and improve outcome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.12808","type":"journal-article","created":{"date-parts":[[2017,11,10]],"date-time":"2017-11-10T14:52:38Z","timestamp":1510325558000},"source":"Crossref","is-referenced-by-count":12,"title":["Outbreak of invasive aspergillosis in heart transplant recipients: The role of screening computed tomography scans in asymptomatic patients and universal antifungal prophylaxis"],"prefix":"10.1111","volume":"20","author":[{"given":"Dima","family":"Kabbani","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases University of Toronto University Health Network Toronto General Hospital  Toronto ON Canada"},{"name":"Division of Infectious Diseases University of Alberta  Edmonton AB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livia","family":"Goldraich","sequence":"additional","affiliation":[{"name":"Division of Cardiology University Health Network University of Toronto  Toronto ON Canada"},{"name":"Division of Cardiology Hospital de Clinicas de Porto Alegre  Porto Alegre Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Ross","sequence":"additional","affiliation":[{"name":"Division of Cardiology University Health Network University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coleman","family":"Rotstein","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases University of Toronto University Health Network Toronto General Hospital  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahid","family":"Husain","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases University of Toronto University Health Network Toronto General Hospital  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,12,26]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2013.11.003"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1086\/444462"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2011.01.701"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1086\/588660"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1086\/590566"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1997.15.1.139"}],"container-title":["Transplant Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Ftid.12808","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.12808","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T12:57:54Z","timestamp":1695473874000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tid.12808"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,26]]},"references-count":6,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,2]]}},"alternative-id":["10.1111\/tid.12808"],"URL":"https:\/\/doi.org\/10.1111\/tid.12808","archive":["Portico"],"relation":{},"ISSN":["1398-2273","1399-3062"],"issn-type":[{"value":"1398-2273","type":"print"},{"value":"1399-3062","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,26]]},"article-number":"e12808"}}