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Aksoy E, Yildirim E, Ozmen I, Yilmaz NO, Karaman AK, Takir H, Ozbaki F, Agca M, Berk A. Clinical Features, Treatment Outcome and Potential risk Factors for Recurrence Among Patients with Chronic Pulmonary Aspergillosis in a Resource-limited Setting: A Retrospective Observational Study. Mycopathologia 2024; 189:76. [PMID: 39172211 DOI: 10.1007/s11046-024-00884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 08/09/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE To evaluate the clinical characteristics and treatment outcomes of patients with chronic pulmonary aspergillosis (CPA) and to determine risk factors for disease recurrence. METHODS A total of 43 patients with CPA (mean ± SD age: 61.4 ± 10.5 years, 83.7% were males) were included in this retrospective study. Data on demographic, clinical and disease-related characteristics, galactomannan (GM) test positivity in bronchoalveolar lavage (BAL) samples, histopathological diagnosis, imaging (CT) findings and CPA forms, antifungal therapy, recurrence rate and time to recurrence were recorded. RESULTS Chronic obstructive pulmonary disease (COPD;76.7%) was the leading predisposing factor, and the aspergillus nodule (37.2%) was the most prevalent CPA form.GM test positivity was noted in 89.7% (35/39) of BAL samples. Median duration of voriconazole treatment was 180 days. CPA recurrence was noted in 14.0% of patients, while the comorbid tuberculosis sequela (66.7% vs. 16.2%, p = 0.02) and mild immunosuppressive disorder (100.0% vs. 51.4%, p = 0.032) were significantly more common in patients with recurrence vs. those without recurrence. Recurrence rate was 50.0% (3 of 6 patients) in patients with simple aspergilloma, and ranged from 0.0% to 25.0% in those with other CPA forms. Treatment duration and time to recurrence ranged 70-270 days and 1.1-37 months, respectively in simple aspergilloma, while they were ranged 150-180 days and 30-43.3 months, respectively in other CPA forms. CONCLUSIONS Our findings indicate the importance of considering CPA in differential diagnosis in patients with predisposing conditions, and emphasize the tuberculosis sequela, immunosuppressive disorder and the certain CPA forms managed with shorter duration of antifungal therapy (i.e., simple aspergilloma) as the potential risk factors of CPA recurrence.
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Affiliation(s)
- Emine Aksoy
- Clinics of Chest Diseases, University of Health Sciences, Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Elif Yildirim
- Clinics of Chest Diseases, University of Health Sciences, Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ipek Ozmen
- Clinics of Chest Diseases, University of Health Sciences, Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Nermin Ozer Yilmaz
- Clinics of Infectious Diseases, University of Health Sciences, Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Kursat Karaman
- Clinics of Radiology, University of Health Sciences, Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Huriye Takir
- Clinics of Chest Diseases, University of Health Sciences, Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Fatma Ozbaki
- Clinics of Chest Diseases, University of Health Sciences, Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Meltem Agca
- Clinics of Chest Diseases, University of Health Sciences, Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Aysegul Berk
- Clinics of Chest Diseases, University of Health Sciences, Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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López-Medrano F, Carver PL, Rutjanawech S, Aranha-Camargo LF, Fernandes R, Belga S, Daniels SA, Mueller NJ, Burkhard S, Theodoropoulos NM, Postma DF, van Duijn PJ, Arnaiz de Las Revillas F, Pérez Del Molino-Bernal C, Hand J, Lowe A, Bodro M, Vanino E, Fernández-Cruz A, Ramos-Martínez A, Makek MJ, Bou Mjahed R, Manuel O, Kamar N, Calvo-Cano A, Rueda-Carrasco L, Muñoz P, Álvarez-Uría A, Pérez-Recio S, Sabé N, Rodríguez-Álvarez R, Silva JT, Mularoni A, Vidal E, Alonso-Titos J, Del Rosal T, Classen AY, Goss CW, Agarwal M, Mejía-Chew C. Clinical Management and Outcomes of Nontuberculous Mycobacterial Infections in Solid Organ Transplant Recipients: A Multinational Case-control Study. Transplantation 2024:00007890-990000000-00830. [PMID: 39049076 DOI: 10.1097/tp.0000000000005156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND The management and outcomes of nontuberculous mycobacterial (NTM) infections in solid organ transplant (SOT) recipients are poorly characterized. We aimed to describe the management and 1-y mortality of these patients. METHODS Retrospective, multinational, 1:2 matched case-control study included SOT recipients aged 12 y old or older diagnosed with NTM infection between January 1, 2008, and December 31, 2018. Controls were matched on transplanted organs, NTM treatment center, and posttransplant survival at least equal to the time to NTM diagnosis. The primary aim was 1-y mortality after NTM diagnosis. Differences between cases and controls were compared using the log-rank test, and Cox regression models were used to identify factors associated with mortality at 12 mo among cases. RESULTS In 85 patients and 169 controls, the median age at the time of SOT was 54 y (interquartile range, 40-62 y), 59% were men, and the lungs were the most common site of infection after SOT (57.6%). One-year mortality was significantly higher in cases than in controls (20% versus 3%; P < 0.001), and higher mortality was associated with lung transplantation (hazard ratio 3.27; 95% confidence interval [1.1-9.77]; P = 0.034). Median time (interquartile range) from diagnosis to treatment initiation (20 [4-42] versus 11 [3-21] d) or the reduction of net immunosuppression (36% versus 45%, hazard ratio 1.35 [95% CI, 0.41-4.43], P = 0.618) did not differ between survivors and those who died. CONCLUSIONS NTM disease in SOT recipients is associated with a higher mortality risk, especially among lung transplant recipients. Time to NTM treatment and reduction in net immunosuppression were not associated with mortality.
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Affiliation(s)
- Francisco López-Medrano
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación del Hospital 12 de Octubre (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Peggy L Carver
- Department of Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Sasinuch Rutjanawech
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Luis F Aranha-Camargo
- Department of Infectious Diseases, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Ruan Fernandes
- Department of Infectious Diseases, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Sara Belga
- Department of Infectious Diseases, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Shay-Anne Daniels
- Department of Infectious Diseases, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Nicolas J Mueller
- Department of Infectious Diseases, University Hospital Zurich, Zurich, Switzerland
| | - Sara Burkhard
- Department of Infectious Diseases, University Hospital Zurich, Zurich, Switzerland
| | - Nicole M Theodoropoulos
- Department of Infectious Diseases, University of Massachusetts Chan Medical School, Worcester, MA
| | - Douwe F Postma
- Department of Internal Medicine and Infectious Diseases, Groningen, the Netherlands
| | - Pleun J van Duijn
- Certe Laboratory for Infectious Diseases, Department of Clinical Microbiology, Groningen, the Netherlands
| | - Francisco Arnaiz de Las Revillas
- Infectious Diseases and Microbiology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Cantabria, Spain
- CIBERINFEC (CB21/13/00068), ISCIII, Madrid, Spain
| | - Concepción Pérez Del Molino-Bernal
- Infectious Diseases and Microbiology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Cantabria, Spain
- CIBERINFEC (CB21/13/00068), ISCIII, Madrid, Spain
| | - Jonathan Hand
- Department of Infectious Diseases, Ochsner Medical Center, New Orleans, LA
| | - Adam Lowe
- Department of Infectious Diseases, Ochsner Medical Center, New Orleans, LA
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic Barcelona, Barcelona, Spain
| | - Elisa Vanino
- Infectious Diseases Unit, IRCCS Policlinico Sant'Orsola, University of Bologna, Bologna, Italy
- Infectious Diseases Unit, Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Ana Fernández-Cruz
- Department of Infectious Diseases, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Antonio Ramos-Martínez
- Department of Infectious Diseases, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Mateja Jankovic Makek
- Department of Infectious Diseases, School of Medicine, University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ribal Bou Mjahed
- Department of Infectious Diseases, School of Medicine, University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia
| | - Oriol Manuel
- Department of Infectious Diseases, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Nassim Kamar
- Department of Nephrology and Organs Transplantation, Toulouse Rangueil University, INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Disease (Infinity), Paul Sabatier University, Toulouse, France
| | - Antonia Calvo-Cano
- Infectious Disease Department, University Hospital Badajoz, Badajoz, Spain
| | | | - Patricia Muñoz
- Departamento de Medicina, Hospital Gregorio Marañón, Biomedical Research Institute Gregorio Marañon (IiSGM), CIBERES, Universidad Complutense, Madrid, Spain
| | - Ana Álvarez-Uría
- Departamento de Medicina, Hospital Gregorio Marañón, Biomedical Research Institute Gregorio Marañon (IiSGM), CIBERES, Universidad Complutense, Madrid, Spain
| | - Sandra Pérez-Recio
- Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge, Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Sabé
- Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge, Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - José Tiago Silva
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación del Hospital 12 de Octubre (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Alessandra Mularoni
- Department of Infectious Diseases, IRCC-ISMETT, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Elisa Vidal
- Department of Infectious Diseases, Reina Sofía University Hospital, Córdoba, Spain
| | - Juana Alonso-Titos
- Department of Nephrology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Teresa Del Rosal
- Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
| | - Annika Y Classen
- Department I for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Charles W Goss
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Mansi Agarwal
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Carlos Mejía-Chew
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
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Arendrup MC, Armstrong-James D, Borman AM, Denning DW, Fisher MC, Gorton R, Maertens J, Martin-Loeches I, Mehra V, Mercier T, Price J, Rautemaa-Richardson R, Wake R, Andrews N, White PL. The Impact of the Fungal Priority Pathogens List on Medical Mycology: A Northern European Perspective. Open Forum Infect Dis 2024; 11:ofae372. [PMID: 39045012 PMCID: PMC11263880 DOI: 10.1093/ofid/ofae372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
Fungal diseases represent a considerable global health concern, affecting >1 billion people annually. In response to this growing challenge, the World Health Organization introduced the pivotal fungal priority pathogens list (FPPL) in late 2022. The FPPL highlights the challenges in estimating the global burden of fungal diseases and antifungal resistance (AFR), as well as limited surveillance capabilities and lack of routine AFR testing. Furthermore, training programs should incorporate sufficient information on fungal diseases, necessitating global advocacy to educate health care professionals and scientists. Established international guidelines and the FPPL are vital in strengthening local guidance on tackling fungal diseases. Future iterations of the FPPL have the potential to refine the list further, addressing its limitations and advancing our collective ability to combat fungal diseases effectively. Napp Pharmaceuticals Limited (Mundipharma UK) organized a workshop with key experts from Northern Europe to discuss the impact of the FPPL on regional clinical practice.
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Affiliation(s)
- Maiken Cavling Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Andrew M Borman
- Mycology Reference Laboratory, UK Health Security Agency, Bristol, UK
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - David W Denning
- Manchester Fungal Infection Group, The University of Manchester, Manchester, UK
- Global Action For Fungal Infections, Geneva, Switzerland
| | - Matthew C Fisher
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Rebecca Gorton
- Department of Infection Sciences, Health Services Laboratories, London, UK
| | - Johan Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, St. James's Hospital, Dublin, Ireland
- Hospital Clinic, IDIBAPS, Universidad de Barcelona, Spain
- CIBERes, Barcelona, Spain
| | - Varun Mehra
- Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, London, UK
| | - Toine Mercier
- Department of Oncology-Hematology, AZ Sint-Maarten, Mechelen, Belgium
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Jessica Price
- Public Health Wales Mycology Reference Laboratory, UHW, Cardiff, UK
| | - Riina Rautemaa-Richardson
- Department of Infectious Diseases, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, NIHR Manchester Biomedical Research Centre (BRC) at the Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
- Mycology Reference Centre Manchester (MRCM), ECMM Excellence Centre of Medical Mycology, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Rachel Wake
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Natalie Andrews
- Napp Pharmaceuticals Limited, a member of the Mundipharma network of independent associated companies, Cambridge, UK
| | - P Lewis White
- Public Health Wales Mycology Reference Laboratory, UHW, Cardiff, UK
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Salmanton-García J, Koehler P, Grothe JH, Mellinghoff SC, Sal E, Simon M, Stemler J, Cornely OA, Sprute R. The Cologne ECMM Excellence Center: A Two-Year Analysis of External Consultation Service for Invasive Fungal Infections. Mycopathologia 2024; 189:25. [PMID: 38466469 PMCID: PMC10927858 DOI: 10.1007/s11046-023-00822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/11/2023] [Indexed: 03/13/2024]
Abstract
The European Confederation of Medical Mycology (ECMM), formed due to the surge in invasive fungal infections (IFI), initiated the Excellence Centers program in 2016 to guide stakeholders to leading medical mycology sites. This report focuses on the Cologne ECMM Excellence Center, recognized with Diamond status for active global involvement in 2017. The center offers free consultation via email and phone, responding within 24 h for life-threatening IFI, collecting data on origin, pathogens, infection details, and more. Over two years, 189 requests were received globally, predominantly from Germany (85%), mainly involving Aspergillus spp., Mucorales, and Candida spp. Fungal mixed infections occurred in 4% of cases. The center's service effectively addresses IFI challenges, advocating for a comprehensive study encompassing all ECMM Excellence Centers to enhance global mycological care. Proactive expansion of consultancy platforms is crucial, with future analyses needed to assess expert advice's impact on patient outcomes.
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Affiliation(s)
- Jon Salmanton-García
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Philipp Koehler
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Jan-Hendrik Grothe
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
| | - Sibylle C Mellinghoff
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Ertan Sal
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
| | - Michaela Simon
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
| | - Jannik Stemler
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany.
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany.
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
- Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.
| | - Rosanne Sprute
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
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Tashiro M, Takazono T, Izumikawa K. Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, treatment, and unresolved challenges. Ther Adv Infect Dis 2024; 11:20499361241253751. [PMID: 38899061 PMCID: PMC11186400 DOI: 10.1177/20499361241253751] [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: 12/17/2023] [Accepted: 04/23/2024] [Indexed: 06/21/2024] Open
Abstract
Chronic pulmonary aspergillosis (CPA) is a challenging respiratory infection caused by the environmental fungus Aspergillus. CPA has a poor prognosis, with reported 1-year mortality rates ranging from 7% to 32% and 5-year mortality rates ranging from 38% to 52%. A comprehensive understanding of the pathogen, pathophysiology, risk factors, diagnosis, surgery, hemoptysis treatment, pharmacological therapy, and prognosis is essential to manage CPA effectively. In particular, Aspergillus drug resistance and cryptic species pose significant challenges. CPA lacks tissue invasion and has specific features such as aspergilloma. The most critical risk factor for the development of CPA is pulmonary cavitation. Diagnostic approaches vary by CPA subtype, with computed tomography (CT) imaging and Aspergillus IgG antibodies being key. Treatment strategies include surgery, hemoptysis management, and antifungal therapy. Surgery is the curative option. However, reported postoperative mortality rates range from 0% to 5% and complications range from 11% to 63%. Simple aspergilloma generally has a low postoperative mortality rate, making surgery the first choice. Hemoptysis, observed in 50% of CPA patients, is a significant symptom and can be life-threatening. Bronchial artery embolization achieves hemostasis in 64% to 100% of cases, but 50% experience recurrent hemoptysis. The efficacy of antifungal therapy for CPA varies, with itraconazole reported to be 43-76%, voriconazole 32-80%, posaconazole 44-61%, isavuconazole 82.7%, echinocandins 42-77%, and liposomal amphotericin B 52-73%. Combinatorial treatments such as bronchoscopic triazole administration, inhalation, or direct injection of amphotericin B at the site of infection also show efficacy. A treatment duration of more than 6 months is recommended, with better efficacy reported for periods of more than 1 year. In anticipation of improvements in CPA management, ongoing advances in basic and clinical research are expected to contribute to the future of CPA management.
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Affiliation(s)
- Masato Tashiro
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Takahiro Takazono
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
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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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7
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Zhu RS, Zhou LH, Cheng JH, Luo Y, Qiu WJ, Huang JT, Jiang YK, Zhao HZ, Wang X, Chen ZQ, Zhu LP. Diagnostic Laboratory Features and Performance of an Aspergillus IgG Lateral Flow Assay in a Chronic Pulmonary Aspergillosis Cohort. Microbiol Spectr 2023; 11:e0026423. [PMID: 37125929 PMCID: PMC10269518 DOI: 10.1128/spectrum.00264-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/10/2023] [Indexed: 05/02/2023] Open
Abstract
Chronic pulmonary aspergillosis (CPA) is a chronic and progressive fungal disease with high morbidity and mortality. Avoiding diagnostic delay and misdiagnosis are concerns for CPA patients. However, diagnostic practice is poorly evaluated, especially in resource-constrained areas where Aspergillus antibody testing tools are lacking. This study aimed to investigate the diagnostic laboratory findings in a retrospective CPA cohort and to evaluate the performance of a novel Aspergillus IgG lateral flow assay (LFA; Era Biology, Tianjin, China). During January 2016 and December 2021, suspected CPA patients were screened at the Center for Infectious Diseases at Huashan Hospital. A total of 126 CPA patients were enrolled. Aspergillus IgG was positive in 72.1% with chronic cavitary pulmonary aspergillosis, 75.0% with chronic necrotizing pulmonary aspergillosis, 41.7% with simple aspergilloma, and 30.3% with Aspergillus nodule(s). The cavitary CPA subtypes had significantly higher levels of Aspergillus IgG. Aspergillus IgG was negative in 52 patients, who were finally diagnosed by histopathology, respiratory culture, and metagenomic next-generation sequencing (mNGS). Sputum culture was positive in 39.3% (42/107) of patients and Aspergillus fumigatus was the most common species (69.0%, 29/42). For CPA cohort versus controls, the sensitivity and specificity of the LFA were 55.6% and 92.7%, respectively. In a subgroup analysis, the LFA was highly sensitive for A. fumigatus-associated chronic cavitary pulmonary aspergillosis (CCPA; 96.2%, 26/27). Given the complexity of the disease, a combination of serological and non-serological tests should be considered to avoid misdiagnosis of CPA. The novel LFA has a satisfactory performance and allows earlier screening and diagnosis of CPA patients. IMPORTANCE There are concerns on avoiding diagnostic delay and misdiagnosis for chronic pulmonary aspergillosis due to its high morbidity and mortality. A proportion of CPA patients test negative for Aspergillus IgG. An optimal diagnostic strategy for CPA requires in-depth investigation based on real-world diagnostic practice, which has been rarely discussed. We summarized the clinical and diagnostic laboratory findings of 126 CPA patients with various CPA subtypes. Aspergillus IgG was the most sensitive test for diagnosing CPA. However, it was negative in 52 patients, who were finally diagnosed by non-serological tests, including biopsy, respiratory culture, and metagenomic next-generation sequencing. We also evaluated a novel Aspergillus IgG lateral flow assay, which showed a satisfactory performance in cavitary CPA patients and was highly specific to Aspergillus fumigatus. This study gives a full picture of the diagnostic practice for CPA patients in Chinese context and calls for early diagnosis of CPA with combined approaches.
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Affiliation(s)
- Rong-Sheng Zhu
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Ling-Hong Zhou
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Jia-Hui Cheng
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu Luo
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Wen-Jia Qiu
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun-Tian Huang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying-Kui Jiang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Hua-Zhen Zhao
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Xuan Wang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhong-Qing Chen
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China
| | - Li-Ping Zhu
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
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Ocansey BK, Otoo B, Gbadamosi H, Afriyie-Mensah JS, Opintan JA, Kosmidis C, Denning DW. Importance of Aspergillus-Specific Antibody Screening for Diagnosis of Chronic Pulmonary Aspergillosis after Tuberculosis Treatment: A Prospective Follow-Up Study in Ghana. J Fungi (Basel) 2022; 9:jof9010026. [PMID: 36675847 PMCID: PMC9863599 DOI: 10.3390/jof9010026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
Chronic pulmonary aspergillosis (CPA) often occurs in patients that have been previously treated for pulmonary tuberculosis (PTB). A limited number of studies have looked at the development of CPA at different times following the completion of a PTB treatment course. This prospective longitudinal study aimed to determine the incidence of CPA at two timepoints, at the end of the PTB treatment (T1) and six months post-treatment (T2). Patients with confirmed PTB from a previous study who were placed on anti-TB medication were followed up and screened for CPA at T1 and T2 by assessing their symptoms, evaluating their quality of life, and screening them for Aspergillus infection by performing antibody testing and cultures. CPA was defined by the Global Action for Fungal Infections (GAFFI) diagnostic algorithm. Forty-one patients were enrolled, of whom thirty-three patients (80%) and twenty-eight patients (68%) were resurveyed at T1 and T2, respectively. The rate of new CPA was 3.3% (1/33) and 7.4% (2/27) at T1 and T2, respectively, with an overall incidence of 10.7% (3/28) among the patients at both T1 and T2. A positive Aspergillus-specific antibody test was an indicator for CPA in all three patients. Aspergillus-specific antibody screening during and after the end of an anti-TB treatment regimen may be important for early detection of CPA in high-PTB-burden settings.
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Affiliation(s)
- Bright K. Ocansey
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9NT, UK
- Correspondence: or ; Tel.: +44-7539-311-942
| | - Benjamin Otoo
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Hafisatu Gbadamosi
- Radiology Department, Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana
| | - Jane S. Afriyie-Mensah
- Chest Diseases Unit, Department of Medicine, Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra GA-221-1570, Ghana
| | - Japheth A. Opintan
- Department of Medical Microbiology, University of Ghana Medical School, Accra GA-270-4330, Ghana
| | - Chris Kosmidis
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9NT, UK
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
| | - David W. Denning
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9NT, UK
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