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Schiraldi GF, Colombo MD, Harari S, Lo Cicero S, Ziglio G, Ferrarese M, Rossato D, Soresi E. Terbinafine in the treatment of non-immunocompromised compassionate cases of bronchopulmonary aspergillosis. Mycoses 1996; 39:5-12. [PMID: 8786758 DOI: 10.1111/j.1439-0507.1996.tb00077.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Conventional treatments of broncho-pulmonary aspergillosis are often ineffective and result in associated side-effects. Terbinafine (a new allylamine derivative), although as active against Aspergillus in vitro as amphotericin B and itraconazole, is less effective in rodent models because of a rapid hepatic first-pass effect. As terbinafine is metabolized differently in humans, the aim of this work was to evaluate this drug, for the first time, in the treatment of seven immunocompetent patients with lower respiratory tract mycotic infections unresponsive to the usual antimycotic drugs. Diagnosis was based on identification of fungal isolates, worsening of respiratory function tests, chest radiographs and computerized tomographic (CT) scan changes, positive skin test, aspergillin precipitins and clinical history. Terbinafine was administered at doses ranging from 5 to 15 mg kg-1 day-1 depending on the clinical severity of the disease, and was given for 90-270 days depending on clinical progress and compliance. In three patients A. fumigatus was suppressed with resolution of signs and symptoms; four patients showed transitory A. fumigatus suppression with marked clinical and radiological improvement. During relapses no resistance to terbinafine was observed. No significant side-effects were detected. Terbinafine appeared to be as effective as amphotericin B and itraconazole in the treatment of bronchopulmonary aspergillosis in nonimmunocompromised patients. These preliminary results suggest that controlled studies are warranted.
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102
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Kappe R, Schulze-Berge A, Sonntag HG. Evaluation of eight antibody tests and one antigen test for the diagnosis of invasive aspergillosis. Mycoses 1996; 39:13-23. [PMID: 8786752 DOI: 10.1111/j.1439-0507.1996.tb00078.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Eight Aspergillus antibody detection assays--three indirect haemagglutination assays (IHA-LD, IHA-Roche, IHA-Fumouze), three enzyme immunoassays (EIA-IgG, EIA-IgM, EIA-IgA, DDV) and two complement fixation tests (CF-metabolic and CF-somatic, Virion--and one latex agglutination test (LAT) for Aspergillus galactomannan antigen detection (Sanofi Pasteur) were evaluated in 14 patients with proven invasive aspergillosis (a total of 47 serum samples and one cerebrospinal fluid sample) and in 68 selected control individuals (one selected serum sample each). For the antibody tests, sensitivity ranged from 14% to 36% and specificity from 72% to 99%. The antigen detection test had a sensitivity of 36% and a specificity of 100%. Currently commercially available antibody detection assays for the serodiagnosis of invasive aspergillosis are inadequate. The antigen detection test appears to be highly specific, but lacks sufficient sensitivity.
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103
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Abstract
Aspergillosis comprises a spectrum of diseases caused by species of a ubiquitous saprophytic mold, Aspergillus, that usually live on decaying vegetation. Aspergillus organisms rarely behave as pathogens in an immunocompetent host. In the presence of immunosuppression, however, aspergillus may be invasive and take a fulminant course. Aspergillosis is the second most frequent opportunistic fungal infection surpassed only by candidiasis; therefore, early detection and treatment are essential to minimize morbidity and mortality. This article reviews the historical aspects, etiology, epidemiology, clinical manifestations, pathology, and treatment of this disease and focuses on the cutaneous aspects of species of Aspergillus known to infect humans.
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104
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Nenoff P, Horn LC, Mierzwa M, Lehmann I, Weidenbach H, Caffier P, Haustein UF. [Peracute, fatal Aspergillus sepsis as a complication of systemic lupus erythematosus and rheumatic diseases]. VERHANDLUNGEN DER DEUTSCHEN GESELLSCHAFT FUR PATHOLOGIE 1996; 80:332. [PMID: 9065047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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105
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Abstract
Aspergillus causes a variety of pulmonary diseases. For the most part, they can be divided into three groups: mycetoma, invasive aspergillosis, and allergic forms of aspergillosis. The mycetoma form of aspergillosis has no effective treatment other than surgery, which is reserved for the severely symptomatic patient, usually with massive hemoptysis. Invasive aspergillosis is a dangerous pulmonary infection seen in patients who are generally severely immunocompromised. It is treated with amphotericin B and success in treatment of this form of aspergillosis is limited. Two of the allergic forms of Aspergillus infection, allergic bronchopulmonary aspergillosis and bronchocentric granulomatosis, are treated with steroids. The third allergic type of reaction, hypersensitivity lung, is best treated by removal of the patient from exposure to the antigen. Although these are the characteristic forms of aspergillosis, there is occasional overlap of the different types of aspergillosis.
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106
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Klinjongol C, Chanyasawath S, Pakdirat B, Pakdirat P. One-stage surgical treatment of pulmonary aspergilloma with cavernostomy and muscle transposition flap: a case report. JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND = CHOTMAIHET THANGPHAET 1995; 78:692-6. [PMID: 8868015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 47-year-old female with cough and recurrent haemoptysis was admitted to Ratchaburi Hospital. Chest X-ray revealed a fungal ball in RUL. Aspergillus fumigatus was diagnosed by fungus culture from the material of the fungus ball. A one-stage cavernostomy was done and the fungus ball was then removed, obliteration of the cavity with intrathoracic transposition of extrathoracic skeletal muscle (latissimus dorsi) was performed. She recovered well, and haemoptysis disappeared. The body weight increased to 48 kgs in 4 postoperative months. (Fig. 6)
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Abstract
Invasive aspergillosis is seldomly described in systemic lupus erythematosus. We present two cases of aspergillosis and review 21 cases reported between 1957 and 1994. The typical clinical presentation is fever and cough in a hospitalized SLE patient previously treated with corticosteroids, immunosuppressors, and broad-spectrum antibiotics. Unlike aspergillosis in other conditions, granulocytopenia is uncommon. Chest radiographs show diffuse or patchy infiltration of lung fields. Diagnosis was suspected premortem in 2 patients. Aspergillus fumigatus was identified or isolated in sputum or parenchimal tissues in the majority of cases. Twenty-two patients died (95%). The finding of hyphae in the sputum of a systemic lupus erythematosus patient with a suggestive clinical picture should lead to bronchoscopy, bronchoalveolar lavage, and lung biopsy. Proof of diagnosis will come from the demonstration of hyphae in tissues and isolation of aspergillus from tissue cultures. Long-term therapy with amphotericin B alone or in combination with fluorocytosine or itraconazole may help improve survival.
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Abstract
The prolonged survival of profoundly immunocompromised patients with AIDS has contributed to the increasing recognition of aspergillus infections as an emerging problem. Nevertheless, many of these infections continue to be diagnosed only at autopsy. In this article we review details of 293 reported cases. Invasive aspergillosis occurs in advanced AIDS and most commonly affects the lungs, although brain involvement has also been frequently reported. The diagnosis is often difficult to make while the patient is alive, although examination of specimens obtained via bronchoalveolar lavage, percutaneous needle aspiration, or biopsy is often successful. Biopsy of the affected organ along with histologic examination and culture may be necessary for diagnosis. The dismal prognosis of invasive aspergillosis in patients with AIDS can be improved only with earlier diagnosis of disease and the availability of more-effective antifungal regimens.
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109
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Nakamura S, Vawter G, Sallan S, Chanock S. Fatal esophageal aspergilloma in a leukemic adolescent. Pediatr Infect Dis J 1992; 11:245-7. [PMID: 1565546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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110
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Imura Y, Ohtsuka T, Kobayashi T. [Cavernoplasty for pulmonary aspergillosis associated with restrictive ventilatory impairment]. KEKKAKU : [TUBERCULOSIS] 1992; 67:107-12. [PMID: 1552695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nine patients were diagnosed as suffering from localized pulmonary aspergillosis associated with restrictive ventilatory impairment. Eight cases reportedly received a combination of thoracoplasty and cavernoplasty, while one case received only cavernoplasty. The following postoperative courses were observed in these nine patients: of the eight patients having combined thoracoplasty and cavernoplasty, seven patients were cured as the result of successful cavity closures. Cavernotomy was required for the remaining patient whose cavity failed to close. An attempt was made to close the cavity of the one patient reported to have only cavernoplasty, but the cavity failed to close on the first attempt. The cavity was successfully closed in a later attempt using thoracoplasty. Although the application of thoracoplasty and cavernoplasty is useful and safe to the treatment of patients being unable to undergo resection and/or having pulmonary dysfunction, it is very important to reduce the number of ribs being resected because pulmonary function may be more worsened after operation. A combination of extraperiosteal detachment and cavernoplasty seems to be a useful alternative. A lower limitation of the postoperative ventilation function, evaluated as a ratio of FEV1.0/VCpr is thought to be 20%.
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111
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Elstad MR. Aspergillosis and lung defenses. SEMINARS IN RESPIRATORY INFECTIONS 1991; 6:27-36. [PMID: 1887164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aspergillosis refers to any of the illnesses caused by fungi that are members of the genus Aspergillus. The diseases range from allergic responses that occur in the absence of fungal growth (asthma, hypersensitivity pneumonitis), to colonization with or without an allergic component (allergic bronchopulmonary aspergillosis, aspergilloma, saprophytic involvement of infarcted tissue), to invasion and destruction of lung parenchyma (invasive aspergillosis, chronic necrotizing pulmonary aspergillosis). The development of lung infection and/or disease depends on interaction among three factors: the characteristics of the fungus (virulence factors), the status of host defense mechanisms, and the type of exposure. The purpose of this article is to review these factors and their relationship to the clinical syndromes of aspergillosis.
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112
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Hector RF, Yee E, Collins MS. Use of DBA/2N mice in models of systemic candidiasis and pulmonary and systemic aspergillosis. Infect Immun 1990; 58:1476-8. [PMID: 2323826 PMCID: PMC258651 DOI: 10.1128/iai.58.5.1476-1478.1990] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Mouse models of systemic candidiasis and pulmonary and systemic aspergillosis were established by using DBA/2N mice, which are known to be deficient in the C5 component of complement. In experiments comparing lethality in the respective models in DBA/2N versus outbred CFW mice, results showed that the 50% lethal dose values for the DBA/2N mice were 10- to 1,000-fold lower than those for the outbred mice, depending on the experiment. Additionally, onset of death was somewhat delayed for the DBA/2N mice. In the case of the pulmonary aspergillosis model, administration of cortisone acetate was necessary to ensure lethality after intranasal infection, but only a single dose was necessary.
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113
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Van Cutsem J, Janssen PA. Experimental aspergillosis. J Chemother 1989; 1:252-4. [PMID: 16312390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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114
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Dixon DM, Polak A, Walsh TJ. Fungus dose-dependent primary pulmonary aspergillosis in immunosuppressed mice. Infect Immun 1989; 57:1452-6. [PMID: 2651308 PMCID: PMC313298 DOI: 10.1128/iai.57.5.1452-1456.1989] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We report on a model of primary pulmonary aspergillosis occurring after intranasal instillation of concentrated suspensions of conidia of Aspergillus fumigatus in immunocompromised mice. Unconcentrated suspensions of inoculum contained ca. 2 x 10(7) conidia per ml (1x). These suspensions were concentrated by centrifugation, adjusted to give ca. 2 x 10(8) (10x) or 2 x 10(9) (100x) conidia per ml, and delivered in 30-microliters droplets to the nares of anesthetized mice. Mice were untreated or injected with cortisone acetate (CA) or cyclophosphamide (CY) in various dosage regimens. It was not possible to obtain mortality of more than 50% with sublethal immunosuppressive treatment and 1x fungus. In contrast, mortality followed a fungus dose response in mice receiving sublethal immunosuppression with either CA or CY. Mortality rates of up to 100% were obtained with 100x fungus and a single dose of CY (200 mg/kg) or CA (250 mg/kg) or three alternate doses (125 mg/kg per day) of CA prior to infection. This model is applicable to the study of acute, fatal primary pulmonary aspergillosis and chemotherapy trials.
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115
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Coman C, Stan A, Micu V, Dimitriu IM, Coman B. [Treatment of pulmonary aspergilloma]. REVISTA DE CHIRURGIE, ONCOLOGIE, RADIOLOGIE, O.R.L., OFTALMOLOGIE, STOMATOLOGIE. CHIRURGIE 1987; 36:363-71. [PMID: 2964063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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116
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Newburger PE, Luscinskas FW, Ryan T, Beard CJ, Wright J, Platt OS, Simons ER, Tauber AI. Variant chronic granulomatous disease: modulation of the neutrophil defect by severe infection. Blood 1986; 68:914-9. [PMID: 3019454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The present studies document the cellular and biochemical processes involved in granulocyte O2- production in three patients from two kindreds with variant chronic granulomatous disease (CGD). Rates of O2- production were 9% to 30% of normal, depending on the individual tested and the stimulus; the two brothers from one family responded to each stimulus with rates very similar to each other. Kinetic analysis of NADPH-dependent O2- production in subcellular fractions revealed all three to have NADPH oxidases with both diminished substrate affinity for NADPH (high Kmapp) and decreased maximal velocities of O2- production. Their granulocytes had normal lag times for activation of the respiratory burst but abnormal rates of stimulus-induced membrane depolarization. Cytochrome b was not found in granulocytes or subcellular fractions despite the use of a spectrophotometric assay sensitive enough to detect the cytochrome if its content were proportional to the residual rate of O2- generation. A striking finding in one patient from each kindred was a threefold to tenfold decrease in the rate of O2- production accompanying serious infection. The residual O2(-)-generating activity of CGD variants helps to explain their relative freedom from the recurrent infections of the classic disease. However, the marked decrease described in the present study indicates the potential for a vicious cycle in which an infection, once established, leads to increasing impairment of host defense.
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117
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Abstract
Six patients (five men and one woman, 19 to 57 years old) with laboratory-proven fungal corneal infections were successfully treated with topical ketoconazole, a synthetic imidazole derivative. No signs of progression of the corneal infection were seen after the antifungal therapy was initiated. The clinical signs of corneal infection disappeared after three (Aspergillus infections) to seven weeks (Fusarium infections) of ketoconazole therapy. In all cases, posttreatment visual acuities were better than pretreatment visual acuities. No significant biomicroscopic signs of ocular surface toxicity were noted.
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118
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Battaglini JW, Murray GF, Keagy BA, Starek PJ, Wilcox BR. Surgical management of symptomatic pulmonary aspergilloma. Ann Thorac Surg 1985; 39:512-6. [PMID: 3890782 DOI: 10.1016/s0003-4975(10)61986-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Pulmonary aspergilloma is a potentially life-threatening disease resulting from the colonization of lung cavities by the ubiquitous fungus Aspergillus fumigatus. Complex aspergilloma, characterized by thick-walled cavities with surrounding parenchymal inflammation, is a risk factor for increased morbidity and mortality. Fifteen patients with symptomatic aspergilloma underwent major thoracic procedures at North Carolina Memorial Hospital between January 1, 1972, and December 31, 1983. Twelve of the patients had hemoptysis; in 7 it was recurrent and in 5, life threatening. Tuberculosis and sarcoidosis were the most common underlying causes of lung disease, and more than half of the patients had other coexistent serious medical illness. Eleven of the 15 patients were seen with complex aspergilloma; all of the 4 major complications and the 2 deaths occurred in these patients. Bronchopleural fistula with persistent air space was the most common serious complication, and required thoracoplasty in 3 patients. Nine patients, including 5 with complex aspergilloma, had no postoperative complications, and there were no recurrent symptoms in any of the 13 operative survivors over a mean follow-up of five years. It is concluded that aggressive pulmonary resection can provide effective long-term palliation in critically ill patients with symptomatic pulmonary aspergilloma.
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119
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Ahmad M, Dar MA, Weinstein AJ, Mehta AC, Golish JA. Thoracic aspergillosis (Part II). Primary pulmonary aspergillosis, allergic bronchopulmonary aspergillosis, and related conditions. CLEVELAND CLINIC QUARTERLY 1984; 51:631-53. [PMID: 6525760 DOI: 10.3949/ccjm.51.4.631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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120
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Mehta AC, Dar MA, Ahmad M, Weinstein AJ, Golish JA. Thoracic aspergillosis (Part III). Invasive pulmonary and disseminated aspergillosis. CLEVELAND CLINIC QUARTERLY 1984; 51:655-65. [PMID: 6525761 DOI: 10.3949/ccjm.51.4.655] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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121
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Dar MA, Ahmad M, Weinstein AJ, Mehta AC, Golish JA. Thoracic aspergillosis (Part I). Overview and aspergilloma. CLEVELAND CLINIC QUARTERLY 1984; 51:615-30. [PMID: 6395992 DOI: 10.3949/ccjm.51.4.615] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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122
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Hawkins C, Armstrong D. Fungal infections in the immunocompromised host. CLINICS IN HAEMATOLOGY 1984; 13:599-630. [PMID: 6388935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Invasive fungal infections cause significant morbidity and mortality in patients with impaired immune defences. Defects in neutrophil function and neutropenia predispose to disseminated Candida, Aspergillus and Mucoraceae infections while altered T-lymphocyte mononuclear phagocyte function predisposes to infection with C. neoformans, Histoplasma and Coccidioides. Fungal infections in the immunocompromised host are difficult to diagnose and difficult to treat successfully. The diagnosis is often missed or delayed because of the non-specific clinical features, the failure to isolate or difficulty in interpreting the presence of the fungus from routine microbiological cultures, and the limited usefulness of available serological tests. The assay for cryptococcal antigen is the only currently available reliable serological test used to diagnose an invasive fungal infection. Definitive diagnosis is made by histopathological demonstration of the fungus in tissue or a positive culture from a sterile body site. Invasive procedures are often necessary to obtain adequate tissue for histology and culture. The treatment of invasive fungal infection in the immunocompromised host is amphotericin B with or without 5FC. The usual recommended dose is 1.5 to 3 g total amphotericin B over 6 to 12 weeks. The optimal dose and duration of therapy for each infection is not known. Treatment failures and relapses are common in patients who do not achieve remission of their underlying disease. Ketoconazole, a new broad-spectrum oral antifungal medication, does not appear to be effective therapy for invasive fungal infection in the immunocompromised patient based on results of small clinical trials. New diagnostic methods and therapeutic approaches are necessary to improve the outcome of these infections. Areas of current research include serological assays for fungal antigens and metabolites which may allow earlier diagnosis, treatment with combinations of antifungal agents, and the development of new antifungal agents.
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123
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Witlock DR, Wyatt RD, Anderson WI. Relationship between Eimeria adenoeides infection and aflatoxicosis in turkey poults. Poult Sci 1982; 61:1293-7. [PMID: 7134109 DOI: 10.3382/ps.0611293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Three-week-old turkey poults receiving 250 micrograms/kg of dietary aflatoxin displayed prolonged prothrombin times due to decreased fibrinogen levels and depressed activity of factor II. Decreased body weights and increased mortality were also evident. Poults experiencing an Eimeria adenoeides infection had slightly increased prothrombin times that were not corrected by the addition of specific clotting factors. These birds exhibited significant reductions in total plasma protein levels. The combination of E. adenoeides and aflatoxicosis resulted in a significant depression in body weight, altered prothrombin time, and decreased levels of plasma calcium, protein, and fibrinogen. Increased mortality was also observed. E. adenoeides did not affect the hemostatic system of the turkey as severely as does aflatoxin. Turkeys were shown to be highly susceptible to aflatoxin when compared to chickens.
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124
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Siccardi AG, Ugazio AG, Sacchi F, Jayakar SD. Use and results of neutrophil function testing in pediatric immunology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1982; 141:637-45. [PMID: 7090934 DOI: 10.1007/978-1-4684-8088-7_63] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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125
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García Gómez R, Valdespino Estrada A, López Ortiz R. [Aspergillus endocarditis. Report of a case treated surgically with success]. ARCHIVOS DEL INSTITUTO DE CARDIOLOGIA DE MEXICO 1981; 51:549-53. [PMID: 7034662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A 42 year old man without history of rheumatic heart disease was admitted to the hospital with severe aortic insufficiency and heart failure. There were no clinical data of an infectious disease. The bidimensional echocardiogram showed vegetations involving the aortic valve leaflets. With the diagnosis of acute aortic insufficiency caused by infective endocarditis the patient was submitted to surgery. During surgery the existence of endocarditis secondary to a mycotic agent was demonstrated. The fungus was latter identified as aspergillus fumigatus. The postoperative course was uneventful. The good results obtained in this case confirm recent reports advising an urgent surgical approach of cases of infective endocarditis secondary to mycotic agents, and support the view that echocardiography may be a valuable tool in the diagnosis of this entity.
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126
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Minsker OB, Novosil'tsev GI, Repina ES. [Primary acute aspergillosis of the lungs]. PROBLEMY TUBERKULEZA 1981:43-7. [PMID: 7255388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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127
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Malo JL, Inouye T, Hawkins R, Simon G, Turner-Warwick M, Pepys J. Studies in chronic allergic bronchopulmonary aspergillosis. 4. Comparison with a group of asthmatics. Thorax 1977; 32:275-80. [PMID: 882941 PMCID: PMC470597 DOI: 10.1136/thx.32.3.275] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A comparison is made of lung function tests and radiographic findings in 20 asthmatic patients with allergic bronchopulmonary aspergillosis paired in terms of sex, age, and duration of asthma with 20 other asthmatics in whom the diagnosis of aspergillosis was excluded in order to see if the aspergillosis causes more lung damage. One hundred per cent of the patients with aspergillosis and 75% of the patients with asthma alone showed a significantly reduced forced expiratory volume in one second (FEV1) before bronchodilator. All the patients in the two groups had a significantly reduced maximal expiratory flow at 50% vital capacity breathing air (V50air) but the severity of the reduction was statistically greater in the aspergillosis group. Reversibility in FEV1 of 15% and more was found in 50% of patients with asthma alone as against 31% of patients with aspergillosis. The degree of reversibility of FEV1 was also statistically greater in patients with asthma alone. Improvement of less than 20% of V50 after helium-oxygen breathing was found in 33% of the patients with asthma alone and in 75% of the patients with aspergillosis. Patients with aspergillosis also showed significantly (0-001 less than P less than 0-01) more reduced gas transfer factor. Radiological features of overinflation were as common in the two groups. Tubular and ring shadows were found in 95% and 60% respectively of patients with aspergillosis as against 45% and 15% of patients with asthma alone.
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128
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Malo JL, Hawkins R, Pepys J. Studies in chronic allergic bronchopulmonary aspergillosis. 1. Clinical and physiological findings. Thorax 1977; 32:254-61. [PMID: 882939 PMCID: PMC470593 DOI: 10.1136/thx.32.3.254] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This report outlines the clinical and physiological features in 50 asthmatic patients with chronic allergic bronchopulmonary aspergillosis in whom the diagnosis was made from 2 to 25 years ago (mean duration 10-9 years). From a questionnaire and analysis of the peak expiratory flow rate measurements it was found that they were worse in the winter months, corresponding to the maximal concentrations of Aspergillus fumigatus in the atmosphere. Nineteen patients reported daily sputum production of up to an eggcupful or more, and 24 had noticed sputum 'plugs' in the previous year. Reduction of vital capacity (VC) was found in 20 patients, of forced expiratory volume in one second (FEV1) in 38 patients, and of maximal expiratory flow at 50% VC breathing air (V50air) in 47 patients. Nine patients had significantly reduced gas transfer factor (DLCO). Significant improvement (more than 15%) in FEV1 after inhaled bronchodilator was shown by only 17 patients. There were statistically significant correlations between the degree of reduction in the physiological measurements of VC, FEV1, and V50air with the age of the patient at the time of the study and the later in life the diagnosis of aspergillosis was made, whereas the reduction in DLCO was also significantly related to the duration of aspergillosis. Prospective studies are needed for a proper assessment of any protective effect of treatment on the pathophysiological changes due to the disease over many years.
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129
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Bergmann L. [Stages of development of aspergillus-mycetom and their roentgenographic signs (author's transl)]. ZEITSCHRIFT FUR ERKRANKUNGEN DER ATMUNGSORGANE 1976; 146:318-27. [PMID: 799407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A series of 13 cases of aspergillus-infection in the respiratory tract are reviewed. A case of rapid development of an intrapleural aspergillus-mycetom is presented. A complete series of chest roentgenograms and operation-photos allowed to demonstrate like with a quick-motion apparatus 3 stages of development of an intrapleural aspergillus-myceton: I. Infection through Aspergilli of a residual intrapleural cavity by the bronchial way. Pleural thickening as reaction to the irritation. II. Development of fungus-lawn and mycotic layers on the cavity-wall. III. Scaling off from the wall and moulding to the fungus-ball through movement of human body. Each of the three stages can be coordinated to a roentgenographic sign. The detection in an early stage of development makes it possible to treat the aspergillus-mycetom also by conservative methods, f. i. with a Pimafucin-Suspension (Natamycin) by aerososl.
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130
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Kato T, Ozawa K, Yoshida F, Hiraki S, Iino S. [Acute myelogenous leukemia associated with systemic aspergillosis especially affecting the myocardium and resulting in ECG changes]. NIHON RINSHO. JAPANESE JOURNAL OF CLINICAL MEDICINE 1976; 34:1301-4. [PMID: 1067457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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131
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Chapnik JS, Bach MC. Bacterial and fungal infections of the maxillary sinus. Otolaryngol Clin North Am 1976; 9:43-54. [PMID: 1246433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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132
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133
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Safirstein BH, D'Souza MF, Simon G, Tai EH, Pepys J. Five-year follow-up of allergic bronchopulmonary aspergillosis. THE AMERICAN REVIEW OF RESPIRATORY DISEASE 1973; 108:450-9. [PMID: 4126802 DOI: 10.1164/arrd.1973.108.3.450] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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134
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Inkley SR, MacIntyre WJ. Measurement of regional area gas exchange by perfusion and clearance of 133 Xe from the lung. J Nucl Med 1973; 14:490-5. [PMID: 4711264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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135
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Biagi RW, Bapat BN. Pulmonary function in aspergillus-sensitive asthma patients. THE BRITISH JOURNAL OF CLINICAL PRACTICE 1970; 24:470-4. [PMID: 5492468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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136
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Scobie BA. Disturbed oesophageal manometric responses in patients with ankylosing spondylitis and pulmonary aspergilloma. AUSTRALASIAN ANNALS OF MEDICINE 1970; 19:131-4. [PMID: 5427445 DOI: 10.1111/imj.1970.19.2.131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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137
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Gernez-Rieux C, Voisin C. [Current problems of respiratory aspergillosis]. BULLETINS ET MEMOIRES DE LA SOCIETE MEDICALE DES HOPITAUX DE PARIS 1968; 119:773-784. [PMID: 5705155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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138
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Gernez-Rieux C, Voisin C, Aerts C, Wattel F, Gosselin B. [Experimental aspergillosis in the guinea pig. Dynamic study of the role of alveolar macrophages in the defense of the respiratory tract, after massive inhalation of Aspergillus fumigatus spores]. REVUE DE TUBERCULOSE ET DE PNEUMOLOGIE 1967; 31:705-25. [PMID: 4914810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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139
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