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Whittaker G, Taylor M, Chamula M, Granato F, Balata H, Kosmidis C. Chronic Pulmonary Aspergillosis after Surgical Treatment for Non-Small Cell Lung Cancer-An Analysis of Risk Factors and Clinical Outcomes. J Fungi (Basel) 2024; 10:335. [PMID: 38786690 PMCID: PMC11121761 DOI: 10.3390/jof10050335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/23/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Chronic pulmonary aspergillosis (CPA) is a rare but significant complication of lung cancer surgery. Its effect on survival remains unclear. Our aim was to describe the outcomes of the patients who developed CPA following the surgery for non-small cell lung cancer (NSCLC), identify the risk factors associated with its development following lung resection, and evaluate its impact on survival. All the patients with a diagnosis of CPA and operated NSCLC were identified in the National Aspergillosis Centre (NAC) database (2009-2020). Additional patients were identified in the Northwest Clinical Outcomes Research Registry (2012-2019) database. A regression analysis was performed to examine potential links between CPA and long-term outcomes and also to identify the factors associated with the development of CPA. The primary outcomes were the development of CPA, 1-year and 5-year mortality, and overall survival. Thirty-two patients diagnosed with CPA after lung resection were identified in the NAC database, of which 11 were also contained within the NCORR database, with a prevalence of 0.2% (n = 11/4425). Post-operative CPA was associated with significantly lower survival on log-rank analysis (p = 0.020). Mortality at one year was 25.0% (n = 8) and 59.4% (n = 19) at five years after the CPA diagnosis. On univariable analysis, a lower mean percentage-predicted forced expiratory volume in 1 s, ischaemic heart disease, and chronic obstructive pulmonary disease were all significantly associated with CPA development. CPA is a rare complication following lung cancer surgery which has a significant impact on long-term survival. Its development may be associated with pre-existing cardiopulmonary comorbidities. Further research in larger cohorts is required to substantiate these findings.
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Affiliation(s)
- George Whittaker
- Department of Thoracic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK; (M.T.); (F.G.)
| | - Marcus Taylor
- Department of Thoracic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK; (M.T.); (F.G.)
- Division of Cardiovascular Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Mathilde Chamula
- National Aspergillosis Centre, Department of Infectious Diseases, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK; (M.C.); (C.K.)
| | - Felice Granato
- Department of Thoracic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK; (M.T.); (F.G.)
| | - Haval Balata
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK;
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Manchester M13 9PL, UK
| | - Chris Kosmidis
- National Aspergillosis Centre, Department of Infectious Diseases, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK; (M.C.); (C.K.)
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK
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Carter C, Kahai R, Cunningham J, Kilduff J, Hough N, Baxter C, Connell D, Shah A. Chronic pulmonary aspergillosis - a guide for the general physician. Clin Med (Lond) 2024; 24:100019. [PMID: 38281665 PMCID: PMC11024841 DOI: 10.1016/j.clinme.2024.100019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
This collaborative article presents a review of chronic pulmonary aspergillosis (CPA) from the perspective of a multidisciplinary team comprising of respiratory physicians, radiologists, mycologists, dietitians, pharmacists, physiotherapists and palliative care specialists. The review synthesises current knowledge on CPA, emphasising the intricate interplay between clinical, radiological, and microbiological aspects. We highlight the importance of assessing each patient as multidisciplinary team to ensure personalised treatment strategies and a holistic approach to patient care.
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Affiliation(s)
- Charlotte Carter
- Registrar in respiratory medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Rasleen Kahai
- Respiratory dietitian, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Josie Cunningham
- Pharmacist independent prescriber, Frimley Park NHS Foundation Trust, Frimley, UK
| | - Jennifer Kilduff
- Physiotherapist in respiratory medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Natasha Hough
- Consultant physician in respiratory medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Caroline Baxter
- Consultant physician in respiratory medicine, National Aspergillosis Centre, Manchester NHS Foundation Trust, Manchester, UK
| | - David Connell
- Consultant physician in respiratory medicine, NHS Tayside, Dundee, UK
| | - Anand Shah
- Consultant physician in respiratory medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK, and MRC Centre of Global Infectious Disease Analysis, Imperial College London, London, UK
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Chuang T, Fu P. Chronic pulmonary Aspergillosis in a patient with poorly controlled diabetes: A case report and literatures review. Respirol Case Rep 2024; 12:e01283. [PMID: 38282720 PMCID: PMC10811610 DOI: 10.1002/rcr2.1283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024] Open
Abstract
Chronic pulmonary aspergillosis (CPA) often manifests in patients with a history of pulmonary tuberculosis and is typically characterized by recurrent hemoptysis, weight loss, and frequently coexists with poorly controlled diabetes. While weight gain is acknowledged as a valuable clinical marker for monitoring therapeutic responses in CPA, there is a scarcity of case reports exploring this aspect. Furthermore, the impact of stringent blood sugar management in diminishing CPA activity and preventing the recurrence of hemoptysis is also underreported. In this context, we present the case of a 64-year-old male who experienced massive hemoptysis. He had a background of uncontrolled diabetes and a history of fully treated pulmonary tuberculosis. Following therapeutic embolization, he was diagnosed with CPA that had transformed into invasive pulmonary aspergillosis (IPA) and underwent antifungal therapy for 9 months. Notably, we observed an inverse correlation between the patient's improved blood sugar control and weight gain with the serum IgG levels for Aspergillosis. This case highlights the potential benefits of non-invasive monitoring of CPA activity and the identification of treatment responders through effective blood sugar management and weight gain.
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Affiliation(s)
- Tzu‐I Chuang
- Division of Chest Medicine, Department of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
| | - Pin‐Kuei Fu
- Division of Chest Medicine, Department of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
- Division of Clinical Trial, Department of Medical ResearchTaichung Veterans General HospitalTaichungTaiwan
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Otálora-Otálora BA, López-Rivera JJ, Aristizábal-Guzmán C, Isaza-Ruget MA, Álvarez-Moreno CA. Host Transcriptional Regulatory Genes and Microbiome Networks Crosstalk through Immune Receptors Establishing Normal and Tumor Multiomics Metafirm of the Oral-Gut-Lung Axis. Int J Mol Sci 2023; 24:16638. [PMID: 38068961 PMCID: PMC10706695 DOI: 10.3390/ijms242316638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/13/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
The microbiome has shown a correlation with the diet and lifestyle of each population in health and disease, the ability to communicate at the cellular level with the host through innate and adaptative immune receptors, and therefore an important role in modulating inflammatory process related to the establishment and progression of cancer. The oral cavity is one of the most important interaction windows between the human body and the environment, allowing the entry of an important number of microorganisms and their passage across the gastrointestinal tract and lungs. In this review, the contribution of the microbiome network to the establishment of systemic diseases like cancer is analyzed through their synergistic interactions and bidirectional crosstalk in the oral-gut-lung axis as well as its communication with the host cells. Moreover, the impact of the characteristic microbiota of each population in the formation of the multiomics molecular metafirm of the oral-gut-lung axis is also analyzed through state-of-the-art sequencing techniques, which allow a global study of the molecular processes involved of the flow of the microbiota environmental signals through cancer-related cells and its relationship with the establishment of the transcription factor network responsible for the control of regulatory processes involved with tumorigenesis.
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Affiliation(s)
| | - Juan Javier López-Rivera
- Grupo de Investigación INPAC, Specialized Laboratory, Clinica Universitaria Colombia, Clínica Colsanitas S.A., Bogotá 111321, Colombia;
| | - Claudia Aristizábal-Guzmán
- Grupo de Investigación INPAC, Unidad de Investigación, Fundación Universitaria Sanitas, Bogotá 110131, Colombia;
| | - Mario Arturo Isaza-Ruget
- Keralty, Sanitas International Organization, Grupo de Investigación INPAC, Fundación Universitaria Sanitas, Bogotá 110131, Colombia;
| | - Carlos Arturo Álvarez-Moreno
- Infectious Diseases Department, Clinica Universitaria Colombia, Clínica Colsanitas S.A., Bogotá 111321, Colombia;
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Bilal H, Zhang D, Shafiq M, Khan MN, chen C, Khan S, Cai L, Khan RU, Hu H, Zeng Y. Epidemiology and antifungal susceptibilities of clinically isolated Aspergillus species in South China. Epidemiol Infect 2023; 151:e184. [PMID: 37846567 PMCID: PMC10644062 DOI: 10.1017/s095026882300167x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/12/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023] Open
Abstract
Aspergillosis is a rising concern worldwide; however, its prevalence is not well documented in China. This retrospective study determined Aspergillus's epidemiology and antifungal susceptibilities at Meizhou People's Hospital, South China. From 2017 to 2022, the demographic, clinical, and laboratory data about aspergillosis were collected from the hospital's records and analysed using descriptive statistics, chi-square test, and ANOVA. Of 474 aspergillosis cases, A. fumigatus (75.32%) was the most common, followed by A. niger (9.92%), A. flavus (8.86%), and A. terreus (5.91%). A 5.94-fold increase in aspergillosis occurred during the study duration, with the highest cases reported from the intensive care unit (52.74%) - chronic pulmonary aspergillosis (79.1%) and isolated from sputum (62.93%). Only 38 (8.02%) patients used immunosuppressant drugs, while gastroenteritis (5.7%), haematologic malignancy (4.22%), and cardiovascular disease (4.22%) were the most prevalent underlying illnesses. In A. fumigatus, the wild-type (WT) isolates against amphotericin B (99.1%) were higher than triazoles (97-98%), whereas, in non-fumigatus Aspergillus species, the triazole (95-100%) WT proportion was greater than amphotericin B (91-95%). Additionally, there were significantly fewer WT A. fumigatus isolates for itraconazole and posaconazole in outpatients than inpatients. These findings may aid in better understanding and management of aspergillosis in the region.
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Affiliation(s)
- Hazrat Bilal
- Department of Dermatology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Dongxing Zhang
- Department of Dermatology, Meizhou Dongshan Hospital, Meizhou, Guangdong Province, China
- Department of Dermatology, Meizhou People’s Hospital, Meizhou, Guangdong Province, China
| | - Muhammad Shafiq
- Research Institute of Clinical Pharmacy, Shantou University Medical College, Shantou, China
| | - Muhammad Nadeem Khan
- Faculty of Biological Sciences, Department of Microbiology, Quaid-I-Azam University, Islamabad, Pakistan
| | - Canhua chen
- Clinical Laboratory, Meizhou People’s Hospital, Meizhou, Guangdong Province, China
| | - Sabir Khan
- Department of Dermatology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lin Cai
- Department of Dermatology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Rahat Ullah Khan
- Institute of Microbiology Faculty of Veterinary and Animal Sciences, Gomal University, Dera Ismail Khan, Pakistan
| | - Haibin Hu
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang, China
| | - Yuebin Zeng
- Department of Dermatology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Dermatology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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