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BACKGROUND: Aspergillus spp. are the leading cause of invasive fungal infection in lung transplant recipients. We investigated the relationship between the isolation of Aspergillus spp. from the respiratory tract of lung transplant recipients and their risk of mortality. METHODS: A retrospective, observational cohort study of all patients who received lung allografts between January 1999 and May 2011 at a single UK centre was performed. The time from transplantation to death was analysed using Cox regression models. Isolation of Aspergillus spp. from the respiratory tract was included as a covariate in the Cox regression model. RESULTS: Two hundred-thirteen patients were included. The median follow-up time was 5 years during which 102 patients (47.9%) died. Aspergillus was isolated from 74 (34.7%) patients. Twenty patients (27%) had Aspergillus isolated in the first 60 days post-transplant. Forty-one patients (55.4%) in the Aspergillus group and 61 patients (43.9%) in the non-Aspergillus group died during follow-up. A hazard ratio of 2.2 (95% CI 1.5-3.3; P < 0.001) for death following a positive Aspergillus sample was observed. CONCLUSION: Isolation of Aspergillus spp. from patients following lung transplantation is associated with a significant increase in mortality. Novel preventative strategies are required to minimise the impact of Aspergillus in lung transplant recipients.

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Idiopathic pulmonary fibrosis (IPF) has a poor prognosis and therapeutic options are limited with a 5-year survival of less than 50%. This report includes a case of histologically confirmed IPF in a patient whose native lung showed objective improvement as measured by high-resolution CT while he was receiving cyclosporine-based immunosuppressive therapy after single-lung transplantation.

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Histopathological findings in the liver in a series of autopsies on 110 patients suffering from leukaemia or lymphoma were reviewed. No treatment had been given to 23 patients, 50 had received chemotherapy alone, 23 chemo- and radiotherapy and 14 underwent bone marrow transplantation. The 23 untreated patients showed neoplastic infiltration in 10 (44%) and fibrosis in 16 cases (70%). The 14 bone marrow recipients showed mainly acute necrosis, zonal in six (43%) and focal in one (7%), and cholestasis in five (36%), together with marked siderosis in 11 (79%). Patients receiving chemotherapy or chemo-/radiotherapy showed similar changes consisting of neoplastic infiltration in 14 (28%) and in five (22%) cases respectively, and fibrosis in 31 (62%) and 17 (74%) cases respectively. Steatosis was seen in 70% of cases in the chemo-/radiotherapy group and in 50% of cases in the other groups. Infections were seen in all groups, particularly in the chemotherapy group (four fungal and two bacterial including one tuberculosis) and in the chemo-/radiotherapy group (one fungal and one bacterial). Cytomegalovirus infection was seen only in the bone marrow transplant group.

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The aim of this study was to determine the association between the histological diagnosis of tuberculosis and the microbiological findings and to indicate how these results affect treatment. Histopathology and microbiology records were examined retrospectively. 89 cases were identified between 1984 and 1988. 67% were diagnosed as tuberculosis (TB) by both methods, 97% were diagnosed as TB or 'compatible with TB' by histology. For 7% of these the final diagnosis was found to be other than TB. 48% of patients diagnosed as TB on the basis of histology alone were treated for TB. 70% were diagnosed as TB by microbiology and treated. When matched and appropriate specimens were sent to both departments there was a high level of agreement between histopathologists and microbiologists. There was a problem with inappropriate specimens sent to microbiology.

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Histopathological findings in the lungs in a series of autopsies on 87 patients suffering from various types of leukaemia or lymphoma who had received no treatment, or various combinations of radiotherapy, chemotherapy and bone marrow transplantation were reviewed. Thirteen untreated patients showed neoplastic infiltration (4), thromboembolism (4), infection (5) or amyloidosis (1). Seventy-two treated cases showed malignant infiltration (14), vascular damage (21), infections (32) and/or diffuse alveolar damage (47). One patient treated with local irradiation for myeloma had acute bronchopneumonia alone and another treated with [32P] for polycythaemia rubra vera had extensive thrombo-embolism of the large pulmonary vessels. Clinical and autopsy evidence of infection correlated very poorly. Non-infective pulmonary disease was a frequent finding. Bacterial, fungal or pneumocystis pneumonia particularly affected the chemotherapy and radiotherapy groups, while cytomegalovirus infection was seen only in the bone marrow transplant group. This study shows that diffuse alveolar damage is a common and important problem in patients treated with radiotherapy and chemotherapy.

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A method of testing for bacteriuria with multiple reagent strips for blood, nitrite, and leucocyte esterase was evaluated. Of 669 urine specimens tested, 267 were negative on the reagent strips and so would ordinarily be discarded, creating a reduction in the workload of culturing urine specimens of 40%. Thirteen of these were false negative results, however, which represented 10% of all the samples with definite bacteriuria. Additional time was required for the screening test which reduced potential savings in manpower. Overall, we found costs to be slightly increased. In our laboratory this screening test was not economic and would produce an unacceptable rate of false negative results.

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