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Affiliation(s)
- C-T Yang
- Department of Internal Medicine, Taipei Veterans General Hospital Yuli branch, No. 91, Xinxing St., Yuli, Hualien 98142, Taiwan
| | - S-W Pan
- Department of Internal Medicine, Taipei Veterans General Hospital Yuli branch, No. 91, Xinxing St., Yuli, Hualien 98142, Taiwan
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Beitou Dist., Taipei 12117, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei 112304, Taiwan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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2
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Harding MC, Gibson SJ, Beaudoin JR. Cavitary Lung Lesion in a Tuberculosis-Negative Patient. Fed Pract 2021; 38:465-467. [PMID: 34733067 DOI: 10.12788/fp.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A patient with worsening chronic cough, shortness of breath, and hemoptysis tested negative for tuberculosis; but a chest computed tomography scan showed an upper left lobe cavitary lesion.
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Affiliation(s)
- Michael C Harding
- is a PGY-2 Resident, and is a PGY-3 Resident, both in the combined Family Medicine and Preventive Medicine Residency at Franklin Square/Johns Hopkins in Baltimore, Maryland. is a PGY-2 Resident in the Internal Medicine Residency at the National Capital Consortium in Bethesda, Maryland
| | - Steven J Gibson
- is a PGY-2 Resident, and is a PGY-3 Resident, both in the combined Family Medicine and Preventive Medicine Residency at Franklin Square/Johns Hopkins in Baltimore, Maryland. is a PGY-2 Resident in the Internal Medicine Residency at the National Capital Consortium in Bethesda, Maryland
| | - Jarett R Beaudoin
- is a PGY-2 Resident, and is a PGY-3 Resident, both in the combined Family Medicine and Preventive Medicine Residency at Franklin Square/Johns Hopkins in Baltimore, Maryland. is a PGY-2 Resident in the Internal Medicine Residency at the National Capital Consortium in Bethesda, Maryland
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3
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Chen X, Zhou Y, Zhang L, Xu J, Liang S. The effects of antifungal therapy on the recurrence of aspergillus infection after pulmonary aspergilloma resection: a study protocol for a single-center, prospective, non-blind, randomized, 24-month, parallel group study. BMC Pulm Med 2021; 21:335. [PMID: 34715827 PMCID: PMC8555331 DOI: 10.1186/s12890-021-01702-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022] Open
Abstract
Background In recent years, the incidence of pulmonary aspergilloma has increased. The harm of aspergilloma is life-threatening massive hemoptysis, and the conventional treatment is surgical treatment. However, whether the antifungal treatment after surgery is required and the course of treatment before and after surgery are still unclear. Methods In this study, patients with pulmonary aspergilloma confirmed pathologically after surgery will be selected as subjects to conduct a single-center, randomized, parallel grouping, prospective, 2-year clinical study. Through regular visits, the recurrence of aspergillus infection, quality of life, lung function indicators, safety of antifungal therapy and other indicators were recorded to evaluate the recurrence risk of aspergillus infection and safety of antifungal agents. Cox proportional risk regression model was used to analyze the influencing factors of antifungal therapy on aspergillus infection recurrence after aspergillus bulbectomy. Cox multiple regression model was used for optimal model fitting, and regression coefficient (β), relative risk (RR) and 95% confidence interval of RR were calculated. Discussion The study will explore whether antifungal therapy could improve the quality of life, reduce the recurrence of aspergillus infection, and ultimately improve the prognosis of patients with aspergilloma. The study results will provide high-quality evidence-based medical evidence for the formulation, revision and optimization of international and domestic clinical guidelines and expert consensus on chronic aspergillus lung disease, effectively improve the clinical treatment effect of aspergilloma, and form the latest concept of diagnosis and treatment of aspergilloma. Trial registration: The trial was registered on the Chinese Clinical Trial Registry website (https://www.chictr.org.cn/showprojen.aspx?proj=33231). Registration number: ChiCTR1800019990.
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Affiliation(s)
- Xianqiu Chen
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 507 Zheng Min Road, Shanghai, 200433, China
| | - Yiming Zhou
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Lijuan Zhang
- Department of Epidemiology, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jinfu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 507 Zheng Min Road, Shanghai, 200433, China
| | - Shuo Liang
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 507 Zheng Min Road, Shanghai, 200433, China.
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4
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Ravindra CM, Rajaram M, Madhusmita M, ChToi P, Sneha L. Pulmonary Aspergillus and Mucor Co-Infection: A report of two cases. Sultan Qaboos Univ Med J 2021; 21:495-498. [PMID: 34522421 PMCID: PMC8407904 DOI: 10.18295/squmj.8.2021.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/13/2020] [Accepted: 08/09/2020] [Indexed: 11/18/2022] Open
Abstract
Co-infections or consecutive infections of mucormycosis and aspergillosis are very rare. Additionally, distinguishing between these two infections is also difficult as both these conditions have similar clinical features. We report two similar cases from Tamilnadu, who presented to a tertiary care centre in Puducherry, India in 2017 (first case) and 2019 (second case). The first case was a 70-year-old, non-diabetic male patient who presented with haemoptysis with a prior history of pulmonary tuberculosis. Computed tomography bronchial angiography revealed an air-crescent sign and the histopathological examination showed a fungal ball (aspergillus and mucor) in the right upper lobe and foci of fungal infection in the middle lobe. The second case was a 65-year-old diabetic male patient who presented with blackish expectoration and haemoptysis. A high-resolution computed tomography scan showed a reverse-halo sign in the right upper lobe. The results of the bronchoscopy-guided biopsy were consistent with a diagnosis of mixed mucormycosis and aspergillosis with angioinvasion. Both patients responded to amphotericin B with surgical excision of the affected lobe in the first case. A high degree of clinical suspicion, early surgical intervention and antifungal therapy are essential in the treatment of this rare co-infection.
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Affiliation(s)
- Chari M Ravindra
- Jawaharlal Institute of Postgraduate Medical Education & Research
| | - Manju Rajaram
- Jawaharlal Institute of Postgraduate Medical Education & Research
| | - M Madhusmita
- Jawaharlal Institute of Postgraduate Medical Education & Research
| | - Pampa ChToi
- Jawaharlal Institute of Postgraduate Medical Education & Research
| | - L Sneha
- Jawaharlal Institute of Postgraduate Medical Education & Research
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5
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Setianingrum F, Rautemaa-Richardson R, Shah R, Denning DW. Clinical outcomes of patients with chronic pulmonary aspergillosis managed surgically. Eur J Cardiothorac Surg 2020; 58:997-1003. [DOI: 10.1093/ejcts/ezaa137] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 12/25/2022] Open
Abstract
Abstract
OBJECTIVES
Surgical resection is one treatment modality for chronic pulmonary aspergillosis (CPA), and sometimes a preoperative presumption of lung cancer turns out to be CPA. We have audited our surgical experience with regard to risk factors for relapse, and the value of postoperative monitoring of Aspergillus-immunogolubulin G (IgG) titres.
METHODS
All patients with CPA surgically treated at National Aspergillosis Centre (NAC), Manchester, UK (2007–2018), were retrospectively evaluated. Surgical procedures, underlying disorders, Aspergillus-IgG titres (ImmunoCap) and antifungal therapy were evaluated for symptom control, operative complications, CPA relapse and mortality.
RESULTS
A total of 61 patients with CPA (28 males, 33 females) were operated on primarily for antifungal therapy failure (51%, n = 31) and presumed lung malignancies (38%, n = 23). Procedures included lobectomy (64%, n = 39), wedge resection (28%, n = 17), segmentectomy (n = 3), pneumonectomy (n = 3) and decortication (n = 2). Overall, 25 (41%) patients relapsed, 26 months (standard deviation: 24.8 months) after surgery. Antifungal therapy before surgery (P = 0.002) or both before and after surgery (P = 0.005) were protective for relapse. The relapse rate within 3 years after surgery (33%, n = 20) was higher than the 3–10 years after surgery (8%, n = 5). At the end of follow-up, the median Aspergillus-IgG titre was lower than at relapse in 12 patients (67 vs 126 mg/l) (P = 0.016).
CONCLUSIONS
Surgery in these selected patients with CPA resulted in favourable outcomes. Relapse is common after surgical treatment of CPA but can be minimized with antifungal therapy, emphasizing the importance of an accurate diagnosis prior to surgery.
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Affiliation(s)
- Findra Setianingrum
- Department of Parasitology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Riina Rautemaa-Richardson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- National Aspergillosis Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Rajesh Shah
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Cardiology and Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - David W Denning
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- National Aspergillosis Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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6
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Sharma A, Bisht D, Das S, Rai G, Dutt S, Arora VK. Molecular Detection of Aspergillus in Sputum of Patients with Lower Respiratory Tract Infections. Int J Appl Basic Med Res 2020; 10:86-90. [PMID: 32566523 PMCID: PMC7289198 DOI: 10.4103/ijabmr.ijabmr_364_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/30/2019] [Accepted: 02/13/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Raised incidences of respiratory tract infections due to fungal agents in immunocompetent individuals are a cause of concern due to the unavailability of rapid diagnostic methods. MATERIALS AND METHODS Sputum and serum samples were collected from patients having lower respiratory tract infections (LRTIs), serum samples were screened for the presence of anti Aspergillus antibodies and sputum samples were homogenized and processed for identification of Aspergillus by conventional methods and further subjected to polymerase chain reaction (PCR) using genus-specific ITS 4-5 primers. RESULTS PCR identified Aspergillus in 28% sputum samples, which was high as compared to conventional methods. CONCLUSION Simple conventional PCR technique proves to be useful screening in for early identification of Aspergillus colonization in patients with LRTI, which can prevent irreversible damage in their lungs by fungal invasion.
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Affiliation(s)
- Alosha Sharma
- Department of Microbiology, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
| | - Dakshina Bisht
- Department of Microbiology, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
| | - Shukla Das
- Department of Microbiology, UCMS, GTBH, New Delhi, India
| | - Gargi Rai
- Department of Microbiology, UCMS, GTBH, New Delhi, India
| | - Shyama Dutt
- Department of Microbiology, UCMS, GTBH, New Delhi, India
| | - V K Arora
- Department of TB and Chest, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
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7
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Harmouchi H, Sani R, Issoufou I, Lakranbi M, Ouadnouni Y, Smahi M. Pulmonary aspergilloma: from classification to management. Asian Cardiovasc Thorac Ann 2019; 28:33-38. [PMID: 31799858 DOI: 10.1177/0218492319895113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pulmonary aspergilloma is a form of aspergillosis characterized by the colonization of a preexisting pulmonary cavity, most often of tuberculosis origin. Clinical symptoms are predominately hemoptysis that can be life-threatening, and thoracic computed tomography can distinguish simple from complex pulmonary aspergilloma. The best therapeutic option remains surgery which allows surgical resection of the mycetoma and the underlying cavity. Nonsurgical treatment is performed in inoperable patients because of severe respiratory failure or a poor general condition.
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Affiliation(s)
| | - Rabiou Sani
- Faculty of Medicine, Abdou Moumouni University, Niamey, Niger
| | | | - Marouane Lakranbi
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Yassine Ouadnouni
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Mohamed Smahi
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
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Sehgal IS, Dhooria S, Choudhary H, Aggarwal AN, Garg M, Chakrabarti A, Agarwal R. Efficiency of A fumigatus-specific IgG and galactomannan testing in the diagnosis of simple aspergilloma. Mycoses 2019; 62:1108-1115. [PMID: 31408547 DOI: 10.1111/myc.12987] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND An early diagnosis of chronic pulmonary aspergillosis (CPA) at the stage of simple aspergilloma (SA) remains a challenge in low- and middle-income countries, where imaging may not be routinely available. OBJECTIVE We investigate the role of Aspergillus fumigatus-specific IgG in serum, and galactomannan (GM) in bronchoalveolar lavage fluid (BALF) and serum for the diagnosis of SA. METHODS We included 46 consecutive treatment-naïve subjects with SA. The 81 controls were subjects of treated pulmonary tuberculosis with residual radiological abnormality and minimal symptoms; and subjects with pulmonary disorders other than CPA who underwent bronchoscopy. The diagnosis of SA was based on consistent clinical features along with radiological manifestations (cavity with fungal ball). RESULTS Using receiver operating characteristic (ROC) curve analysis, the best cut-off value for A fumigatus-specific IgG was 27.3 mgA/L (AUROC, 0.839; sensitivity, 63.5%; specificity, 98.3%). The best cut-off value for serum and BALF-GM was 0.7 (AUROC, 0.636; sensitivity, 32%; specificity, 96.2%) and 2.5 (AUROC, 0.833; sensitivity, 63.7%; specificity, 97.1%), respectively. A combination of A fumigatus-specific IgG (>27 mgA/L) or serum GM (≥0.7) or BALF-GM (≥2.5) had a sensitivity and specificity of 82.6% and 96%, respectively. CONCLUSIONS A combination of serological tests has the best sensitivity in diagnosing SA. More studies are needed to confirm our findings.
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Affiliation(s)
- Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Hansraj Choudhary
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Garg
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Kim TH, Koo HJ, Lim CM, Hong SB, Huh JW, Jo KW, Shim TS, Kim WS, Koh Y. Risk factors of severe hemoptysis in patients with fungus ball. J Thorac Dis 2019; 11:4249-4257. [PMID: 31737310 DOI: 10.21037/jtd.2019.09.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Hemoptysis is one of the most important complications associated with fungus ball. However, the association of the primary size of the fungus ball and its change with the incidence of hemoptysis was not fully established. This study aims to determine the clinical risk factors of severe hemoptysis and natural course of fungus ball. Methods A retrospective study on patients with fungus ball was performed. Patients with severe hemoptysis-related events were compared to those without events, and the predictors for severe hemoptysis were investigated by Cox regression analysis. Three subgroups (decreased, stable, and increased) were classified according to the long-term size change, and the severe hemoptysis-free survival duration was analyzed by the Kaplan-Meier survival curve. Results Among 173 patients, 50 (28.9%) experienced severe hemoptysis-related events. Risk-adjusted analysis revealed that age [hazard ratio (HR), 0.964; 95% confidence interval (CI), 0.939-0.989], blood-tinged sputum [HR, 2.717; 95% CI, 1.513-4.879], and thick wall cavitary fungus balls [HR, 2.332; 95% CI, 1.290-4.215] were significant predictors of severe hemoptysis-related events in patients with fungus ball. However, the baseline size of the fungus ball and its change rate were not independent risk factors for severe hemoptysis-related events. Besides, the decreased group did not have a favorable outcome in severe hemoptysis related to fungus ball. Conclusions In a tertiary hospital, the incidence of severe hemoptysis-related events in patients with fungus ball was not low and reached 28.9%. Young patients, those with thick wall cavitary fungus ball, and those with complaints of blood-tinged sputum should be considered for early surgical treatment to prevent severe hemoptysis.
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Affiliation(s)
- Tae Hoon Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hyun Jung Koo
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung Wook Jo
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Sun Shim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Sung Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Harmouchi H, Lakranbi M, Issoufou I, Ouadnouni Y, Smahi M. Pulmonary aspergilloma: surgical outcome of 79 patients in a Moroccan center. Asian Cardiovasc Thorac Ann 2019; 27:476-480. [DOI: 10.1177/0218492319855492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Pulmonary aspergilloma presents in two clinical and radiological forms: simple and complex aspergilloma. Surgery is the best therapeutic option, most often by anatomic lung resection. Our aim was to report the surgical outcomes according to our experience. Methods A retrospective study was conducted on data of 79 patients operated on for pulmonary aspergilloma over a period of 10 years. There were 57 (72.15%) men and 22 women (27.84%), with a mean age of 40.45 years. Results Tuberculosis, all-form combined, was the predominant pathological antecedent in 57 (72.15%) patients, and hemoptysis was the most frequent functional sign in 43 (54.43%). The right side was involved in 39 (49.36%) patients. All patients were operated on via a posterolateral thoracotomy, and an extrapleural plane was necessary in 40 (50.63%). The surgical procedure was a lobectomy in 38 (48.10%) patients and a pneumonectomy in 14 (17.72%). Transfusion of red blood cells was carried out in 10 (12.65%) patients, with one (1.26%) requiring a rethoracotomy for postoperative clotted hemothorax. Two (2.53%) patients presented with empyema after pneumonectomy. The mortality rate was 2.53% (2 patients), and the mean follow-up was 2.5 years. Conclusion Surgery for pulmonary aspergilloma is associated with a high rate of morbidity and mortality. This surgery has been performed in our department with a very acceptable rate of mortality, especially considering that all patients were operated on by open surgery.
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Affiliation(s)
- Hicham Harmouchi
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Hassan II, Fez, Morocco
| | - Marouane Lakranbi
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Hassan II, Fez, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Ibrahim Issoufou
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Hassan II, Fez, Morocco
| | - Yassine Ouadnouni
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Hassan II, Fez, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Mohammed Smahi
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Hassan II, Fez, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
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11
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Bekasiak A, Shnawa A, Tedrow J. Pulmonary aspergilloma with subcutaneous fistula resulting in massive hemoptysis & subcutaneous emphysema. Respir Med Case Rep 2019; 27:100853. [PMID: 31193387 PMCID: PMC6527897 DOI: 10.1016/j.rmcr.2019.100853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 05/04/2019] [Accepted: 05/05/2019] [Indexed: 11/26/2022] Open
Abstract
Aspergillomas growing in pre-existing lung cavities can lead to presentations of hemoptysis. We present a case of a 73-year-old male with non-small cell lung carcinoma (NSCLC) and known 4 cm left cavitary lesion in the left upper lobe presenting with cough and hemoptysis, leading to the diagnosis of a pulmonary aspergilloma complicated by chest wall subcutaneous emphysema due to cavitary-subcutaneous fistula in the setting of excessive cough. This case sheds light on subcutaneous emphysema as a potential rare complication of aspergillomas in patients without prior trauma.
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Affiliation(s)
- Anthony Bekasiak
- St. Elizabeth's Medical Center, Tufts University School of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, USA
| | - Aya Shnawa
- St. Elizabeth's Medical Center, Tufts University School of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, USA
| | - John Tedrow
- St. Elizabeth's Medical Center, Tufts University School of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, USA
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12
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Zheng S, Li X, Hu B, Li H. Is adjuvant antifungal therapy after video-assisted thoracic surgery for pulmonary aspergilloma necessary? J Thorac Dis 2018; 10:6060-6065. [PMID: 30622777 DOI: 10.21037/jtd.2018.09.151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background The aim of this current retrospective study was to assess the necessity of postoperative antifungal therapy for pulmonary aspergilloma (PA) patients who underwent video-assisted thoracic surgery (VATS) lung resection. Methods We enrolled 22 PA patients who underwent VATS lung resection between 2014 and 2018. Of these, 12 patients were prescribed antifungal agents during the perioperative period (group A), and the other 10 were treated with surgery alone without any antifungal therapy postoperatively (group B). All patients were immunocompetent. Results Seven patients (58.3%) developed postoperative complications in group A, including 2 cases of empyema (16.7%), 1 case of bronchopleural fistula (8.3%), 1 case of pneumonia (8.3%), 1 case of wound infection (8.3%), 1 case of bleeding (8.3%) and 1 case of atelectasis (8.3%). In group B, 3 patients (30%) developed postoperative complications, including 2 cases of pneumonia (20%) and 1 case of empyema (10%). There was no significant difference between the groups with respect to postoperative complications rates (P=0.23). The follow-up period ranged from 1 to 38 months (a median of 19 months), during which no hospital deaths, recurrence of disease or lesion relapses were noted in either group. Conclusions Our results suggested that postoperative adjuvant antifungal therapy has limited advantages for the surgical treatment of PA in immunocompetent patients.
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Affiliation(s)
- Shuo Zheng
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Xin Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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13
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Bongomin F, Harris C, Hayes G, Kosmidis C, Denning DW. Twelve-month clinical outcomes of 206 patients with chronic pulmonary aspergillosis. PLoS One 2018; 13:e0193732. [PMID: 29634721 PMCID: PMC5892866 DOI: 10.1371/journal.pone.0193732] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 02/16/2018] [Indexed: 11/18/2022] Open
Abstract
There is a paucity of evidence surrounding the optimal antifungal therapy for use in chronic pulmonary aspergillosis (CPA) and the duration of therapy remains unclear. We retrospectively evaluated treatment outcomes, including change in quality of life scores (St George’s Respiratory Questionnaire (QoL)), weight and Aspergillus IgG at 6 and 12 months following initiation of therapy in a cohort of 206 CPA patients referred to the UK National Aspergillosis Centre (NAC), Manchester between April 2013 and March 2015. One hundred and forty-two patients (69%) were azole naïve at presentation and 105 (74%) (Group A) were commenced on itraconazole, 27 (19%) on voriconazole, and 10 (7%) were not treated medically. The remainder (64 patients, 31%) had previously trialled, or remained on, azole therapy at inclusion (Group B) of whom 46 (72%) received itraconazole, 16 (25%) voriconazole, and 2 (3%) posaconazole. Initial therapy was continued for 12 months in 78 patients (48%) of those treated; the azole was changed in 62 (32%) patients and discontinued in 56 (29%) patients for adverse reactions (32, 57%), azole resistance (11, 20%), clinical failure (8, 14%) or clinical stability (5, 9%). Azole discontinuation rates were higher in Group B than in Group A (42% vs. 22%, p = 0.003). For all patients who survived, weight increased (median of 62.2Kg at baseline, to 64.8 at 12 months), mean Aspergillus IgG declined from 260 (baseline) to 154 (12 months) and QoL improved from 62.2/100 (baseline) to 57.2/100 (12 months). At 12 months, there was no difference in median survival between Groups A and B (95% vs. 91%, p = 0.173). The rate of emergence of resistance during therapy was 13% for itraconazole compared to 5% for voriconazole. Bronchial artery embolization was done in 9 (4.4%) patients and lobectomy in 7 (3.2%). The optimal duration of azole therapy in CPA is undetermined due to the absence of evidenced based endpoints allowing clinical trials to be undertaken. However we have demonstrated itraconazole and voriconazole are modestly effective for CPA, especially if given for 12 months, but fewer than 50% of patients manage this duration. This suggests extended therapy may be required for demonstrable clinical improvement.
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Affiliation(s)
- Felix Bongomin
- The National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Chris Harris
- The National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Gemma Hayes
- The National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Chris Kosmidis
- The National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- The Manchester Academic Health Service Centre, Manchester, United Kingdom
| | - David W. Denning
- The National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- The Manchester Academic Health Service Centre, Manchester, United Kingdom
- * E-mail:
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14
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Kawamoto H, Suzuki M, Shiozawa A, Miyawaki E, Yamamoto S, Kobayashi K, Takasaki J, Takeda Y, Hojo M, Sugiyama H. Massive Hemoptysis with a Fungus Ball-like Shadow in an Old Tuberculosis Cavity That Was Shown to Be a Clot by Bronchoscopy. Intern Med 2018; 57:377-381. [PMID: 29093390 PMCID: PMC5827319 DOI: 10.2169/internalmedicine.8967-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Development of aspergilloma is common in cases with a fungus ball-like shadow in cavities due to old tuberculosis. Some reports have shown that blood clots tend to appear as a fungus ball-like shadow. A 71-year-old man with a history of pulmonary tuberculosis presented with a fungus ball-like shadow in an old cavity and hemoptysis. There was no evidence of aspergillus infection on various examinations. We confirmed a blood clot and aneurysm of an artery under direct vision by bronchoscopy. A lateral thoracic artery aneurysm was detected by angiography. Transcatheter arterial embolization was performed. After treatment, the artery aneurysm disappeared.
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Affiliation(s)
- Hironori Kawamoto
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
- Department of Respiratory Medicine, Jikei University Hospital, Japan
| | - Manabu Suzuki
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Ayako Shiozawa
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Eriko Miyawaki
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Shota Yamamoto
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Konomi Kobayashi
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Jin Takasaki
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Yuichiro Takeda
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Masayuki Hojo
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Haruhito Sugiyama
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
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15
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Ngo Nonga B, Bang GA, Jemea B, Savom E, Yone P, Mbatchou N, Ze JJ. Complex Pulmonary Aspergilloma: Surgical Challenges in a Third World Setting. Surg Res Pract 2018; 2018:6570741. [PMID: 29594190 PMCID: PMC5821956 DOI: 10.1155/2018/6570741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/14/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Surgery for pulmonary aspergilloma (PA), especially complex forms, is greatly challenging in a resource-poor setting such as Cameroon. We report our experience of surgical management of PA in this environment. METHOD We prospectively assessed patients who underwent surgery for PA from January 2012 to May 2015, at the University Hospital Center of Yaoundé. Records were reviewed for demographics, history and physical examinations, radiological findings, surgical procedures, and outcomes. The study has received approval from the institutional ethics committees. RESULTS In total, 20 patients (17 males and 3 females (sex ratio, 5.66); mean age, 30 years; range, 23-65 years) with a past history of tuberculosis were assessed. The median follow-up was 21.5 months. The primary symptom was hemoptysis, followed by cough and chest pain. All patients underwent surgical treatment and lung resection. Postoperative complications (bleeding, air leak, empyema, and severe anemia) occurred in 4 patients and 1 patient died. Although 3 patients were lost to follow-up, the survival rate was 80% with improvement of the preoperative symptoms. CONCLUSION Although surgery for complex aspergilloma is very challenging in environments such as ours, we believe that it is the best treatment modality for symptomatic diseases in our setting.
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Affiliation(s)
- Bernadette Ngo Nonga
- Department of Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Guy Aristide Bang
- Department of Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Bonaventure Jemea
- Department of Surgery and Specialties, Service of Anesthesia, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Eric Savom
- Department of Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Perfura Yone
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ngahane Mbatchou
- Department of Internal Medicine, Faculty of Medicine and Pharmacy, University of Douala, Douala, Cameroon
| | - Jean Jacques Ze
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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16
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Xia Y, Zhou H, Zhu F, Zhang W, Wu C, Lu L. Diagnosis and treatment of pulmonary cavity after liver transplantation. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:301. [PMID: 28856141 DOI: 10.21037/atm.2017.05.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although the outcomes have improved in the current era, pulmonary infection remains a significant post-transplant complication in liver transplant (LT) recipients. Pulmonary infection with cavity formation often leads to higher mortality rates after LT. We wished to investigate the diagnosis and treatment of pulmonary cavity (PC) formation after LT. METHODS We evaluated (retrospectively) five cases of PC formation, shown on CT scans of the chest after LT, by analyzing imaging features, diagnosis, treatment, liver function, and the concentration changes and efficacy of immunosuppressants. RESULTS According to the results from the CT scan, serum Aspergillus galactomannan (GM) assay, the purified protein derivative (PPD) skin test, and the sputum smears and blood culture, three cases were diagnosed with Aspergillus infection, and the other two cases were diagnosed with Mycobacterium tuberculosis infection. Liver function and FK506 concentration were monitored during treatment. Antibiotics used for treatment of Aspergillus and Mycobacterium tuberculosis infections affected liver function and FK506 concentration. However, after adjustment of drug doses, antibiotic treatment was tolerated in all patients. Four cases were cured, but 1 patient died of Aspergillus infection. CONCLUSIONS Distinguishing between Aspergillus infection and Mycobacterium tuberculosis infection for PCs after liver transplantation (LT) using a CT scan is difficult. The diagnosis can be confirmed using clinical characteristics, sputum culture, GM assay, PPD, and sputum smears. Early diagnosis and treatment could lead to a better prognosis.
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Affiliation(s)
- Yongxiang Xia
- Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.,Key Laboratory of Living Donor Liver Transplantation, National Health and Family Planning Commission, Nanjing 210029, China
| | - Haoming Zhou
- Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.,Key Laboratory of Living Donor Liver Transplantation, National Health and Family Planning Commission, Nanjing 210029, China
| | - Feipeng Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wei Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Chen Wu
- Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.,Key Laboratory of Living Donor Liver Transplantation, National Health and Family Planning Commission, Nanjing 210029, China
| | - Ling Lu
- Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.,Key Laboratory of Living Donor Liver Transplantation, National Health and Family Planning Commission, Nanjing 210029, China
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17
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Roy PM, Khanna S, Mehta Y, Khan AZ. Aspergilloma of the Lung: Strategy to Prevent Endobronchial Spillage. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:373-375. [PMID: 27828805 DOI: 10.1097/imi.0000000000000304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aspergilloma of the lung eroding into the airway may lead to perioperative endobronchial spillage and contamination of the normal lung. Our aim in this group of patients who are undergoing robotic- or video-assisted thoracoscopic lobectomy is to protect the contralateral lung and, if possible, uninvolved lobes of ipsilateral lung. Double-lumen endobronchial tubes do provide lung protection to the contralateral lung intraoperatively, but there is no protection to the ipsilateral lung lobes not involved by the disease process. Moreover, there is no lung protection against endobronchial spillage during the period of induction of general anesthesia, when the cough reflex and gag reflex are absent. We have devised a technique to advance from side selection to lobe selection, that is, selective lobar isolation to prevent perioperative contamination of uninvolved lung lobes. This technique has two components viz positioning of the patient and securing the airway. The technique can also be used in other conditions such as hydatid cyst of the lung, lung abscess communicating with the airway and bleeding into the airway.
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Affiliation(s)
- Preety Mittal Roy
- From the Departments of *Anaesthesia and Critical Care and †Thoracic Surgery, Medanta, The Medicity, Gurgaon, India
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18
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Barac A, Vukicevic TA, Ilic AD, Rubino S, Zugic V, Stevanovic G. Complications of chronic necrotizing pulmonary aspergillosis: review of published case reports. Rev Inst Med Trop Sao Paulo 2017; 59:e19. [PMID: 28423094 PMCID: PMC5440998 DOI: 10.1590/s1678-9946201759019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/09/2017] [Indexed: 11/24/2022] Open
Abstract
Chronic necrotizing pulmonary aspergillosis (CNPA), a form of chronic pulmonary
aspergillosis (CPA), affects immunocompetent or mildly immunocompromised persons with
underlying pulmonary disease. These conditions are associated with high morbidity and
mortality and often require long-term antifungal treatment. The long-term prognosis
for patients with CNPA and the potential complications of CNPA have not been well
documented. The aim of this study was to review published papers that report cases of
CNPA complications and to highlight risk factors for development of CNPA. The
complications in conjunction associated with CNPA are as follows: pseudomembranous
necrotizing tracheobronchial aspergillosis, ankylosing spondylarthritis, pulmonary
silicosis, acute respiratory distress syndrome, pulmonary Mycobacterium avium complex
(MAC) disease, superinfection with Mycobacterium tuberculosis, and and pneumothorax.
The diagnosis of CNPA is still a challenge. Culture and histologic examinations of
bronchoscopically identified tracheobronchial mucus plugs and necrotic material
should be performed in all immunocompromised individuals, even when the radiographic
findings are unchanged. Early detection of intraluminal growth of
Aspergillus and prompt antifungal therapy may facilitate the
management of these patients and prevent development of complications.
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Affiliation(s)
- Aleksandra Barac
- Clinical Centre of Serbia, Clinic for Infectious and Tropic Diseases, Belgrade, Serbia
| | - Tatjana Adzic Vukicevic
- University of Belgrade, School of Medicine, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Pulmonology, Belgrade, Serbia
| | - Aleksandra Dudvarski Ilic
- University of Belgrade, School of Medicine, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Pulmonology, Belgrade, Serbia
| | - Salvatore Rubino
- University of Sassari, Department of Biomedical Sciences, Sassari, Italy
| | - Vladimir Zugic
- University of Belgrade, School of Medicine, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Pulmonology, Belgrade, Serbia
| | - Goran Stevanovic
- Clinical Centre of Serbia, Clinic for Infectious and Tropic Diseases, Belgrade, Serbia.,University of Belgrade, School of Medicine, Belgrade, Serbia
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19
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Roy PM, Khanna S, Mehta Y, Khan AZ. Aspergilloma of the Lung: Strategy to Prevent Endobronchial Spillage. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Preety Mittal Roy
- Department of Anaesthesia and Critical Care, Medanta, The Medicity, Gurgaon, India
| | - Sangeeta Khanna
- Department of Anaesthesia and Critical Care, Medanta, The Medicity, Gurgaon, India
| | - Yatin Mehta
- Department of Anaesthesia and Critical Care, Medanta, The Medicity, Gurgaon, India
| | - Ali Zamir Khan
- Department of Thoracic Surgery, Medanta, The Medicity, Gurgaon, India
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20
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Ofori A, Steinmetz AR, Akaasi J, Asafu Adjaye Frimpong GA, Norman BR, Obeng-Baah J, Bedu-Addo G, Phillips RO. Pulmonary aspergilloma: An evasive disease. Int J Mycobacteriol 2016; 5:235-9. [PMID: 27242239 DOI: 10.1016/j.ijmyco.2016.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/05/2016] [Indexed: 11/24/2022] Open
Abstract
Aspergillomas are often misdiagnosed as tuberculosis (TB) in developing countries where the prevalence of TB is high, hemoptysis is often equated with TB, and most patients are diagnosed clinically. This report describes the case of a patient being treated for smear-negative TB who presented with hemoptysis and was found to have an aspergilloma.
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Affiliation(s)
- Afua Ofori
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Alexis R Steinmetz
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
| | - John Akaasi
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Betty R Norman
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joseph Obeng-Baah
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - George Bedu-Addo
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard O Phillips
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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21
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Clinical characteristics of patients with Aspergillus species isolation from respiratory samples: Comparison of chronic pulmonary aspergillosis and colonization. Respir Investig 2015; 54:92-7. [PMID: 26879478 DOI: 10.1016/j.resinv.2015.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 08/13/2015] [Accepted: 08/25/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND With advancements in anti-fungal drugs, it has become more important to correctly diagnose chronic pulmonary aspergillosis (CPA); however, it is not easy to distinguish CPA from colonization when Aspergillus species are isolated from respiratory samples. The aim of the study was to clarify the particular clinical characteristics of patients with CPA vs. those with colonization. METHODS We retrospectively reviewed the medical records of 110 patients with Aspergillus species isolation from respiratory samples, to analyze and compare the differences between CPA and colonization of the Aspergillus species. RESULTS The median age of all analyzed was 71 years (range: 31-92 years); 64 were female (58%). The most frequently cultured Aspergillus species was Aspergillus fumigatus (48.3%), followed by A. niger (29.2%). Thirty patients (27.4%) were diagnosed with CPA, vs. 75 (68.2%) with colonization and 5 (4.5%) with allergic bronchopulmonary aspergillosis. Compared with the colonization group, the CPA group included more males (CPA vs. colonization: 49.3% vs. 13.3%) and subjects with a low body mass index (18.45 kg/m2 vs. 21.09 kg/m2). As for the underlying pulmonary diseases, the patients with CPA showed a significantly higher prevalence of sequelae of pulmonary tuberculosis (40% vs. 8%) and a history of thoracic surgery (43% vs. 13%) than those with colonization. Asthma was less frequent in the CPA group than in the colonization group (0% vs. 20%). We found no significantly important underlying extrapulmonary diseases. CONCLUSIONS Patients with CPA display clinical characteristics distinct from those seen in subjects with colonization.
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22
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Koyama K, Ohshima N, Suzuki J, Kawashima M, Okuda K, Sato R, Suzukawa M, Nagai H, Matsui H, Ohta K. Evaluation of clinical characteristics and prognosis of chronic pulmonary aspergillosis depending on the underlying lung diseases: Emphysema vs prior tuberculosis. J Infect Chemother 2015; 21:795-801. [PMID: 26410549 DOI: 10.1016/j.jiac.2015.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/21/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE There have been scarce data evaluating the differences of clinical characteristics and prognosis of chronic pulmonary aspergillosis (CPA) depending on underlying pulmonary diseases. We tried to clarify them in CPA patients who had pulmonary emphysema or previous pulmonary tuberculosis. METHODS We reviewed and evaluated CPA patients diagnosed between 2007 and 2013 with pulmonary emphysema (PE group; n = 29), with previous pulmonary tuberculosis (PT group; n = 47) and with combination of these 2 underlying conditions (CTE group; n = 24). RESULTS In CT findings, fungus balls were rare in PE group (7% in PE group and 36% in PT group; p = 0.006). Compared with PT group, PE group patients exhibited more frequent preceding antibiotics administration (45% vs 11%; p = 0.002) and fever (52% vs 17%; p = 0.002), less frequent hemosputum (24% vs 57%; p = 0.008), and more frequent consolidations in imaging (79% vs 38%; p = 0.001) and respiratory failure (34% vs 13%; p = 0.020), possibly suggesting more acute clinical manifestations of CPA in emphysematous patients. Trend of the differences between PT and PE group was not changed when patients with fungal balls were excluded. Multivariate Cox regression analysis of risks for all-cause mortality revealed age (HR, 1.079; p = 0.002) and emphysema (HR, 2.45; p = 0.040) as risk factors. CONCLUSIONS Assessment of underlying lung diseases is needed when we estimate prognosis and consider treatment of CPA patients. Particularly, emphysematous patients can be presented as refractory pneumonia and show poor prognosis.
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Affiliation(s)
- Kazuya Koyama
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
| | - Nobuharu Ohshima
- Asthma and Allergy Center, National Hospital Organization Tokyo National Hospital, Japan
| | - Junko Suzuki
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Masahiro Kawashima
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Kenichi Okuda
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Ryota Sato
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Maho Suzukawa
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Hideaki Nagai
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Hirotoshi Matsui
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
| | - Ken Ohta
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan; Asthma and Allergy Center, National Hospital Organization Tokyo National Hospital, Japan
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23
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Evaluation of the Double Agar Gel Immunodiffusion Test and of the Enzyme-Linked Immunosorbent Assay in the Diagnosis and Follow-Up of Patients with Chronic Pulmonary Aspergillosis. PLoS One 2015; 10:e0134841. [PMID: 26271000 PMCID: PMC4536220 DOI: 10.1371/journal.pone.0134841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/15/2015] [Indexed: 11/26/2022] Open
Abstract
The diagnosis of chronic pulmonary aspergillosis (CPA) depends on the radiologic image and the identification of specific antibodies. The present study aimed to evaluate accuracy parameters of enzyme-linked immunosorbent assay (ELISA) and of the determination of serum galactomannan level in the diagnosis of patients with CPA, comparing these results with the double agar gel immunodiffusion (DID) test. In addition, the prevalence of cross-reactivity and the serological progression after treatment were evaluated by comparing DID and ELISA. Six study groups were formed: G1: 22 patients with CPA, 17 of whom had Aspergillus fungus ball, one chronic cavitary pulmonary aspergillosis (CCPA) and four chronic fibrosing pulmonary aspergillosis (CFPA); G2: 28 patients with pulmonary tuberculosis (TB); G3: 23 patients with histoplasmosis (HST); G4: 50 patients with paracoccidioidomycosis (PCM); G5: 20 patients with cryptococcosis (CRC); and G6: 200 healthy controls. Serum antibodies were measured by DID and ELISA, with two antigen preparations—Aspergillus fumigatus (DID1, ELISA1) and a pool of A. fumigatus, A. flavus and A. niger antigens (DID2, ELISA2). The Platélia Aspergillus Enzyme Immunoassay (EIA) kit was used to measure galactomannan. The cut-off points of ELISA were determined for each antigen preparation and for the 95% and 99% confidence intervals. Despite the low sensitivity, DID was the technique of choice due to its specificity, positive and negative predictive values and positive likelihood ratio–especially with the antigen pool and due to the low frequency of cross-reactivity. ELISA1 and a 0.090 cut-off showed high sensitivity, specificity and negative predictive value, but a high frequency of cross-reactivity with CRC. The best degree of agreement was observed between ELISA1 and ELISA2. The detection of serum galactomannan showed high sensitivity, comparable to ELISA2. The immunodiffusion test showed an excellent relationship with the progression after treatment, which made it the reaction of choice for patient follow-up.
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24
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Pagès PB, Grima R, Mordant P, Grand B, Badia A, Le Pimpec-Barthes F, Bernard A, Riquet M. [Does antifungal therapy influence postoperative morbidity or long-term survival after surgical resection for pulmonary aspergilloma?]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:322-328. [PMID: 25457220 DOI: 10.1016/j.pneumo.2014.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/24/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Surgical resection of pulmonary aspergilloma is associated with symptoms control, complications prevention, and improved survival, given that the disease is localized and the patient fit enough to undergo surgery. In these operable forms, the impact of perioperative antifungal therapy remains controversial. The purpose of this study was to analyze the impact of antifungal therapy on postoperative morbidity and overall survival in patients with operable pulmonary aspergilloma. METHODS The clinical records of 113 patients who underwent thoracic surgery for aspergilloma in our institution from January 1989 to December 2010 were retrospectively reviewed. Of these, 64 patients received antifungal therapy in the perioperative period and were included in group 1, and 49 patients did not receive antifungal therapy and were included in group 2. RESULTS Postoperative complication rates were 31.2% in group 1 and 20.4% in group 2 (P = 0.30). Univariable analysis showed that immunocompromised status (P < 0.001), past history of cancer (P = 0.50), preoperative purulent sputum (P = 0.024), and pneumonectomy (P < 0.001) were significantly associated with postoperative complications, but that antifungal therapy was not. Five- and 10-year overall survival rates were respectively 78.3% and 57.8% in group 1 vs. 85.9% and 65.7% in group 2 (P = 0.23). Multivariate analysis revealed that age higher than 50, immunocompromised status and pneumonectomy were significantly associated with adverse long-term survival (χ(2) = 6.59, df = 5, P < 0.001), but that antifungal therapy was not. CONCLUSION Antifungal therapy has no significant impact on postoperative morbidity or long-term survival following surgical resection of pulmonary aspergilloma. Such procedure is associated with acceptable postoperative morbidity and long-term survival.
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Affiliation(s)
- P-B Pagès
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France; Service de chirurgie thoracique et cardiovasculaire, CHU Bocage, université de Bourgogne, 21000 Dijon, France
| | - R Grima
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - P Mordant
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - B Grand
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - A Badia
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec-Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - A Bernard
- Service de chirurgie thoracique et cardiovasculaire, CHU Bocage, université de Bourgogne, 21000 Dijon, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France.
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Warris A. The biology of pulmonary aspergillus infections. J Infect 2014; 69 Suppl 1:S36-41. [PMID: 25135079 DOI: 10.1016/j.jinf.2014.07.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 01/08/2023]
Abstract
Pulmonary aspergillus infections are mainly caused by Aspergillus fumigatus and can be classified based on clinical syndromes into saphrophytic infections, allergic disease and invasive disease. Invasive pulmonary aspergillosis, occurring in immunocompromised patients, reflects the most serious disease with a high case-fatality rate. Patients with cystic fibrosis and severe asthma might develop allergic bronchopulmonary aspergillosis, while saphrophytic infections are observed in patients with lung cavities mainly due to tuberculosis. Histopathologically, a differentiation can be made into angio-invasive and airway-invasive disease. If the host response is too weak or too strong, Aspergillus species are able to cause disease characterized either by damage from the fungus itself or through an exaggerated inflammatory response of the host, in both situations leading to overt disease associated with specific clinical signs and symptoms. The unraveling of the specific host - Aspergillus interaction has not been performed to a great extent and needs attention to improve the management of those clinical syndromes.
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Affiliation(s)
- Adilia Warris
- University of Aberdeen, School of Medicine and Dentistry, Division of Applied Medicine, Institute of Medical Sciences, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK.
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Moodley L, Pillay J, Dheda K. Aspergilloma and the surgeon. J Thorac Dis 2014; 6:202-9. [PMID: 24624284 DOI: 10.3978/j.issn.2072-1439.2013.12.40] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 12/24/2013] [Indexed: 11/14/2022]
Abstract
Aspergillus fungus is a ubiquitous saprophyte that is the causative organism for the development of an aspergilloma. The most common species causing an aspergilloma is the Apergillus fumigatus. An aspergilloma is a conglomeration of mucus, inflammatory cells and altered blood elements. Aspergillomas typically form in pre-existing lung pathology, most notably and commonly in old healed tuberculosis cavities. They are classified into simple and complex types that have clinical relevance. Symptoms are very variable and it is not uncommon to incidentally find a lung aspergilloma. In most case series, the most common presenting symptom is haemoptysis which varies from mild to catastrophic bleeds. Given the limited information about the natural history of the disease, there is unfortunately no recognised factor or variable which can predict how an aspergilloma will manifest itself, hence the manner of treatment is a still a topic of debate among treating physicians. The mainstay of treatment is surgical intervention and medical options although disappointing at the current stage, require further investigation in light of the newer available anti-fungal agents. The need for surgical intervention is however not as clear-cut as one would like, since many patients have multiple co-morbidities and other diffuse or focal lung pathology, making the decision process indeterminate in certain instances. In this review, we focus on the different surgical options available for the management of aspergilloma across variable clinical settings, and we propose an approach to its management.
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Affiliation(s)
- Loven Moodley
- 1 Chris Barnard Division of Cardiothoracic Surgery, 2 Division of Pulmonology, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Jehron Pillay
- 1 Chris Barnard Division of Cardiothoracic Surgery, 2 Division of Pulmonology, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Keertan Dheda
- 1 Chris Barnard Division of Cardiothoracic Surgery, 2 Division of Pulmonology, Groote Schuur Hospital, University of Cape Town, South Africa
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Watanabe H, Uruma T, Tsunoda T, Tazaki G, Suga A, Nakamura Y, Yamada S, Tajiri T. Lung metastasis of transitional cell cancer of the urothelium, with fungus ball-like shadows closely resembling aspergilloma: A case report and review of the literature. Oncol Lett 2014; 8:95-98. [PMID: 24959226 PMCID: PMC4063589 DOI: 10.3892/ol.2014.2076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/20/2014] [Indexed: 11/06/2022] Open
Abstract
The present study reports the case of a 67-year-old female patient who was initially diagnosed with pulmonary aspergilloma. This diagnosis was based on a chest computed tomography (CT) scan showing a cavitary lesion of 3.5 cm in diameter, with fungus ball-like shadows inside, and an air crescent sign in the right upper lung. At 63 years old, the patient was treated for transitional cell cancer of the urothelium (non-invasive, pT1N0M0) by total cystectomy, ileal conduit diversion and urostomy. For 4 years post-operatively, the patient was healthy and had no clinical symptoms, and the air crescent sign was not identified by chest CT until the patient had reached 67 years of age. However, a final diagnosis of lung metastasis of transitional cell cancer of the urothelium was histopathologically identified subsequent to video-assisted thoracic surgery. Although it is rare that transitional cell cancer moves to the lung and makes a cavitary lesion, a differential diagnosis of cancer is necessary, even when examining infected patients with air crescent signs that are characteristic of aspergilloma. The physician must be mindful of metastatic pulmonary tumors that closely resemble aspergillomas, not only in infectious diseases, but also in oncological practice. Primary surgical removal should be considered.
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Affiliation(s)
- Hidehiro Watanabe
- Department of Respiratory Medicine and Infection Control, Tokyo Medical University, Ibaraki Medical Center, Ami, Ibaraki 300-0395, Japan ; Department of Respiratory Medicine, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo 192-0032, Japan
| | - Tomonori Uruma
- Department of Respiratory Medicine and Infection Control, Tokyo Medical University, Ibaraki Medical Center, Ami, Ibaraki 300-0395, Japan ; Department of Respiratory Medicine, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo 192-0032, Japan
| | - Tokuro Tsunoda
- Department of Respiratory Medicine, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo 192-0032, Japan
| | - Gen Tazaki
- Department of Respiratory Medicine, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo 192-0032, Japan
| | - Atsushi Suga
- Department of General Thoracic Surgery, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo 192-0032, Japan
| | - Yusuke Nakamura
- Department of General Thoracic Surgery, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo 192-0032, Japan
| | - Shunsuke Yamada
- Department of General Thoracic Surgery, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo 192-0032, Japan
| | - Takuma Tajiri
- Department of Pathology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo 192-0032, Japan
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Benhamed L, Woelffle D. Adjuvant antifungal therapy after pulmonary surgery for aspergilloma: is it useful?: Table 1:. Interact Cardiovasc Thorac Surg 2014; 18:835-7. [DOI: 10.1093/icvts/ivu069] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kurosaki F, Bando M, Nakayama M, Mato N, Nakaya T, Yamasawa H, Yoshimoto T, Fukushima N, Sugiyama Y. Clinical features of pulmonary aspergillosis associated with interstitial pneumonia. Intern Med 2014; 53:1299-306. [PMID: 24930648 DOI: 10.2169/internalmedicine.53.1578] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We retrospectively investigated the clinical features of pulmonary aspergillosis associated with interstitial pneumonia. METHODS We reviewed the medical records of all patients treated for interstitial pneumonia with or without pulmonary aspergillosis at our institution between April 2006 and August 2012 and evaluated the clinical features as well as risk and prognostic factors for pulmonary aspergillosis associated with interstitial pneumonia. RESULTS Among 539 patients with interstitial pneumonia, 15 who suffered from pulmonary aspergillosis were identified. The median age was 69.2±7.0 years, and fourteen patients were men. The subtypes of pulmonary aspergillosis were chronic pulmonary aspergillosis (n=14) and invasive pulmonary aspergillosis (n=1). The forms of interstitial pneumonia included idiopathic pulmonary fibrosis (n=9), rheumatoid arthritis-related interstitial pneumonia (n=4) and pleuroparenchymal fibroelastosis (n=2). The underlying conditions were emphysema (n=9) and a history of oral corticosteroid and/or immunosuppressive use (n=4). Home oxygen therapy (HOT) was administered in 11 patients. Following the diagnosis of pulmonary aspergillosis, all patients were treated with antifungal drugs. Ten patients (66.6%) died. A comparison of the interstitial pneumonia patients with and without pulmonary aspergillosis showed that the presence of emphysema, use of HOT and death were significantly associated with pulmonary aspergillosis. CONCLUSION Pulmonary aspergillosis is one of the major complications of interstitial pneumonia and its prognosis is poor. Therefore, providing careful monitoring and proper treatment is extremely important.
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Affiliation(s)
- Fumio Kurosaki
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
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Pohl C, Jugheli L, Haraka F, Mfinanga E, Said K, Reither K. Pulmonary aspergilloma: a treatment challenge in sub-Saharan Africa. PLoS Negl Trop Dis 2013; 7:e2352. [PMID: 24205413 PMCID: PMC3812098 DOI: 10.1371/journal.pntd.0002352] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Christian Pohl
- Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, United Republic of Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Levan Jugheli
- Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, United Republic of Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fredrick Haraka
- Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, United Republic of Tanzania
| | - Elirehema Mfinanga
- Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, United Republic of Tanzania
| | - Khadija Said
- Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, United Republic of Tanzania
| | - Klaus Reither
- Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, United Republic of Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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The immune interplay between the host and the pathogen in Aspergillus fumigatus lung infection. BIOMED RESEARCH INTERNATIONAL 2013; 2013:693023. [PMID: 23984400 PMCID: PMC3745895 DOI: 10.1155/2013/693023] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 06/14/2013] [Indexed: 12/22/2022]
Abstract
The interplay between Aspergillus fumigatus and the host immune response in lung infection has been subject of studies over the last years due to its importance in immunocompromised patients. The multifactorial virulence factors of A. fumigatus are related to the fungus biological characteristics, for example, structure, ability to grow and adapt to high temperatures and stress conditions, besides capability of evading the immune system and causing damage to the host. In this context, the fungus recognition by the host innate immunity occurs when the pathogen disrupts the natural and chemical barriers followed by the activation of acquired immunity. It seems clear that a Th1 response has a protective role, whereas Th2 reactions are often associated with higher fungal burden, and Th17 response is still controversial. Furthermore, a fine regulation of the effector immunity is required to avoid excessive tissue damage associated with fungal clearance, and this role could be attributed to regulatory T cells. Finally, in this work we reviewed the aspects involved in the complex interplay between the host immune response and the pathogen virulence factors, highlighting the immunological issues and the importance of its better understanding to the development of novel therapeutic approaches for invasive lung aspergillosis.
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Yonker LM, Mark EJ, Canapari CA. Aspergilloma in a patient with an occult congenital pulmonary airway malformation. Pediatr Pulmonol 2012; 47:308-10. [PMID: 21905264 DOI: 10.1002/ppul.21538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 06/10/2011] [Indexed: 11/06/2022]
Abstract
We describe the case of a 14-year-old male who presented with a right upper lobe aspergilloma forming in a previously occult congenital pulmonary airway malformation. This is the first case describing an aspergilloma forming within a CPAM.
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Affiliation(s)
- Lael M Yonker
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts, USA.
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Fatal Hemoptysis due to Chronic Cavitary Pulmonary Aspergillosis Complicated by Nontuberculous Mycobacterial Tuberculosis. Case Rep Infect Dis 2011; 2011:837146. [PMID: 22567480 PMCID: PMC3336246 DOI: 10.1155/2011/837146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 06/10/2011] [Indexed: 11/18/2022] Open
Abstract
A 51-year-old man, with a history of severe COPD and bilateral pneumothorax, who was under treatment for pulmonary tuberculosis due to mycobacterium avium, was admitted due to high-grade fever, weight loss, cough, and production of purulent sputum, for almost one month without any special improvement despite adequate antibiotics treatment in outpatient setting. A CT scan revealed multiple consolidations, fibrosis, scaring, and cavitary lesions in both upper lobes with newly shadows which were fungus balls inside them. Aspergillus flavius was isolated in three sputum samples, a diagnosis of chronic cavitary pulmonary aspergillosis was made, and treatment with intravenous amphotericin B was started. An initially clinical improvement was noted, and a first episode of minor hemoptysis was treated with conservative measures. Unfortunately a second major episode of hemoptysis occurred and he died almost immediately. Aspergilloma is defined as the presence of a fungus ball inside a preexisting pulmonary cavity or dilated airway and is one of the clinical conditions associated with the clinical spectrum of pulmonary colonization. Tuberculosis is the most common underling disease. Hemoptysis is the most common symptom. Antifungal antibiotics, surgical interventions, bronchial arteries embolization, and intracavity infusion of antibiotics have been proposed without always adequate sufficiency.
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Maheshwari V, Varshney M, Alam K, Khan R, Jain A, Gaur K, Bhargava R. Aspergilloma lung mimicking tuberculosis. BMJ Case Rep 2011; 2011:bcr.04.2011.4051. [PMID: 22696736 DOI: 10.1136/bcr.04.2011.4051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 50-year-old male presented with haemoptysis. Patient had previous history of pulmonary tuberculosis. A tentative diagnosis of fungal ball was made on radiological examination. Surgical removal of lobe of lung was done and on histopathological examination a final diagnosis of aspergilloma was rendered.
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Affiliation(s)
- Veena Maheshwari
- Pathology Department, J N Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Limper AH, Knox KS, Sarosi GA, Ampel NM, Bennett JE, Catanzaro A, Davies SF, Dismukes WE, Hage CA, Marr KA, Mody CH, Perfect JR, Stevens DA. An official American Thoracic Society statement: Treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med 2011; 183:96-128. [PMID: 21193785 DOI: 10.1164/rccm.2008-740st] [Citation(s) in RCA: 367] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
With increasing numbers of immune-compromised patients with malignancy, hematologic disease, and HIV, as well as those receiving immunosupressive drug regimens for the management of organ transplantation or autoimmune inflammatory conditions, the incidence of fungal infections has dramatically increased over recent years. Definitive diagnosis of pulmonary fungal infections has also been substantially assisted by the development of newer diagnostic methods and techniques, including the use of antigen detection, polymerase chain reaction, serologies, computed tomography and positron emission tomography scans, bronchoscopy, mediastinoscopy, and video-assisted thorascopic biopsy. At the same time, the introduction of new treatment modalities has significantly broadened options available to physicians who treat these conditions. While traditionally antifungal therapy was limited to the use of amphotericin B, flucytosine, and a handful of clinically available azole agents, current pharmacologic treatment options include potent new azole compounds with extended antifungal activity, lipid forms of amphotericin B, and newer antifungal drugs, including the echinocandins. In view of the changing treatment of pulmonary fungal infections, the American Thoracic Society convened a working group of experts in fungal infections to develop a concise clinical statement of current therapeutic options for those fungal infections of particular relevance to pulmonary and critical care practice. This document focuses on three primary areas of concern: the endemic mycoses, including histoplasmosis, sporotrichosis, blastomycosis, and coccidioidomycosis; fungal infections of special concern for immune-compromised and critically ill patients, including cryptococcosis, aspergillosis, candidiasis, and Pneumocystis pneumonia; and rare and emerging fungal infections.
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Gupta PR, Vyas A, Meena RC, Sharma S, Khayam N, Subramanian IM, Kanoongo D, Solanki V, Bansal A. Clinical profile of pulmonary aspergilloma complicating residual tubercular cavitations in Northen Indian patients. Lung India 2010; 27:209-11. [PMID: 21139716 PMCID: PMC2988170 DOI: 10.4103/0970-2113.71947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Little is known regarding the clinical profile of Aspergilloma in Indian patients. Such a study was undertaken at Hospital for Chest and TB, Jaipur. MATERIALS AND METHODS Old, treated patients of pulmonary tuberculosis showing ball like lesion/s inside cavity/ies or a recent thickening of cavity wall were enrolled. Morning sputa samples were collected in the patients who were able to raise sputum and were examined by KOH mount and fungal culture. Serum anti-aspergillus antibodies were estimated in all the patients. Twenty normal healthy subjects were included to serve as control. All patients showing a positive or borderline positive serology were diagnosed as pulmonary aspergilloma (PA group). The remaining patients formed the non-aspergilloma group (Non PA group). RESULTS A total of 98 study patients could be classified as PA group (54 patients by serology alone, 44 patients by serology as well as sputum culture). The remaining 152 patients were classified as non PA group. Hemoptysis alone or along with other chest symptoms was significantly more common in PA group as compared to non PA group patients (P<0.001), more so in those with ball like lesions. But chest symptoms other than hemoptysis were more common in non PA group. Within the PA group, 21 (13 with ball like lesions and 8 with thickening of cavity wall) had clinical symptoms suggestive of CNPA and two patients (one each with ball like lesions and thickening of cavity wall) had clinical symptoms suggestive of ABPA. CONCLUSION The clinical profile of pulmonary Aspergilloma in Indian patients is very protean ranging from saprophytic disease to CNPA and less commonly to ABPA.
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Affiliation(s)
- P. R. Gupta
- Department of Pulmonary Medicine, SMS Medical College, Jaipur, India
| | - Aruna Vyas
- Department of Microbiology, SMS Medical College, Jaipur, India
| | - R. C. Meena
- Department of Chest and TB, SMS Medical College, Jaipur, India
| | - Shivraj Sharma
- Department of Chest and TB, SMS Medical College, Jaipur, India
| | - N. Khayam
- Department of Microbiology, SMS Medical College, Jaipur, India
| | | | - D. Kanoongo
- Department of Chest and TB, SMS Medical College, Jaipur, India
| | - V. Solanki
- Department of Pulmonary Medicine, SMS Medical College, Jaipur, India
| | - A. Bansal
- Department of Pulmonary Medicine, SMS Medical College, Jaipur, India
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Sagan D, Goździuk K, Korobowicz E. Predictive and Prognostic Value of Preoperative Symptoms in the Surgical Treatment of Pulmonary Aspergilloma. J Surg Res 2010; 163:e35-43. [DOI: 10.1016/j.jss.2010.06.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 06/11/2010] [Accepted: 06/15/2010] [Indexed: 10/19/2022]
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Sagan D, Goździuk K. Surgery for Pulmonary Aspergilloma in Immunocompetent Patients: No Benefit From Adjuvant Antifungal Pharmacotherapy. Ann Thorac Surg 2010; 89:1603-10. [DOI: 10.1016/j.athoracsur.2010.02.037] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 02/10/2010] [Accepted: 02/12/2010] [Indexed: 11/29/2022]
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Pulmonary aspergilloma: Analysis of prognosis in relation to symptoms and treatment. J Thorac Cardiovasc Surg 2009; 138:820-5. [DOI: 10.1016/j.jtcvs.2009.01.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 12/10/2008] [Accepted: 01/24/2009] [Indexed: 11/20/2022]
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Abstract
Aspergillus can cause several forms of pulmonary disease ranging from colonization to invasive aspergillosis and largely depends on the underlying lung and immune function of the host. This article reviews the clinical presentation, diagnosis, pathogenesis, and treatment of noninvasive forms of Aspergillus infection, including allergic bronchopulmonary aspergillosis (ABPA), aspergilloma, and chronic pulmonary aspergillosis (CPA). ABPA is caused by a hypersensitivity reaction to Aspergillus species and is most commonly seen in patients who have asthma or cystic fibrosis. Aspergillomas, or fungus balls, can develop in previous areas of cavitary lung disease, most commonly from tuberculosis. CPA has also been termed semi-invasive aspergillosis and usually occurs in patients who have underlying lung disease or mild immunosuppression.
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Affiliation(s)
- Brent P Riscili
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Medical Center, Davis Heart and Lung Research Institute, Columbus, OH 43210, USA
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Affiliation(s)
- Buzdar M S Nabi
- Department of Pulmonary, Critical Care Medicine and Thoracic Surgery, Services Institute of Medical Sciences, Lahore, Pakistan.
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Hsu YH. Aspergilloma in the Pulmonary Cavity. Tzu Chi Med J 2008. [DOI: 10.1016/s1016-3190(08)60062-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Aspergillus is involved in various lung illnesses related to type of exposition and immunity host response, local (tracheobronchial) and global. Allergic bronchopulmonary aspergillosis is due to a hypersensitivity response, diagnosis must be considered in presence of severe asthma with radiologic opacities, blood eosinophilia and elevated total serum IgE levels. Bronchial colonization is often accidentally discovered, but needs a monitoring. Pulmonary aspergilloma, often asymptomatic, grows in a preexisting cavity. Aspergillus bronchitis is a prolonged superficious endobronchial infection. Pseudomembranous necrotizing tracheobronchitis is a microinvasive bronchial infection, which prognosis is very bad. Acute invasive pulmonary aspergillosis affects quite always immunocompromised patients, but cases are not exceptional in patients with prior lung disease. Chronic necrotizing pulmonary aspergillosis may be divided in chronic cavitary and chronic fibrosing pulmonary aspergillosis, and subacute invasive aspergillosis according to the course of the disease, radiological outcome first. Management of diseases caused by Aspergillus is evolving with new diagnostic tools (PCR, Aspergillus antigenemia) and with new generation antifungal drugs.
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Affiliation(s)
- S Blandin
- Service de pneumologie, centre hospitalier Plateau-d'Ouilly, BP 436, 69655 Villefranche-sur-Saône cedex, France.
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A Hybrid Lesion of Lung Cancer and Aspergillosis. Clin Med Oncol 2008. [DOI: 10.1177/117955490800200303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 74-year-old man presented with gradual wall thickening of a cystic lung lesion. Serologic tests indicated Aspergillus infection, but neither fungal organisms nor evidence of malignant disease were recovered from repeated sputum collections, a bronchoscopic lung biopsy specimen, or bronchial washings. Treatment with antifungal agents did not result in clinical improvement. Surgical resection of the lesion demonstrated both squamous cell carcinoma and aspergillosis. These distinct disorders share common radiologic manifestations that can present a diagnostic challenge, as in the present case.
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Camuset J, Lavolé A, Wislez M, Khalil A, Bellocq A, Bazelly B, Mayaud C, Cadranel J. [Bronchopulmonary aspergillosis infections in the non-immunocompromised patient]. REVUE DE PNEUMOLOGIE CLINIQUE 2007; 63:155-66. [PMID: 17675939 DOI: 10.1016/s0761-8417(07)90120-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The definition of broncho-pulmonary aspergillosis infections in non-immunocompromised patients remains vague and a wide range of clinical, radiological and pathological entities have been described with a variety of names, i.e. simple aspergilloma, complex aspergilloma, semi-invasive aspergillosis, chronic necrotizing pulmonary aspergillosis, chronic cavitary and fibrosing pulmonary and pleural aspergillosis, pseudomembranous tracheobronchitis caused by Aspergillus, and invasive aspergillosis. However, these disease entities share common characteristics suggesting that they belong to the same group of pulmonary aspergillosis infectious disorders: 1- a specific diathesis responsible for the deterioration in local or systemic defenses against infection (alcohol, tobacco abuse, or diabetes); 2- an underlying bronchopulmonary disease responsible or not for the presence of a residual pleural or bronchopulmonary cavity (active tuberculosis or tuberculosis sequelae, bronchial dilatation, sarcoidosis, COPD); 3- generally, the prolonged use of low-dose oral or inhaled corticosteroids and 4- little or no vascular invasion, a granulomatous reaction and a low tendency for metastasis. There are no established treatment guidelines for broncho-pulmonary aspergillosis infection in non-immunocompromised patients, except for invasive aspergillosis. Bronchial artery embolization may stop hemoptysis in certain cases. Surgery is generally impossible because of impaired respiratory function or the severity of the comorbidity and when it is possible morbidity and mortality are very high. Numerous clinical cases and short retrospective series have reported the effect over time of the various antifungal agents available. Oral triazoles, i.e. itraconazole, and in particular voriconazole, appear to provide suitable treatment for broncho-pulmonary aspergillosis infections in non-immunocompromised patients.
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Affiliation(s)
- J Camuset
- Service de Pneumologie, Hôpital Victor-Dupouy, Argenteuil
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48
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Kreymborg KG, Seyfarth HJ, Gessner C, Schütz A, Hammerschmidt S, Eichfeld U, Borte G, Wirtz H. Diagnosis of aspergilloma in a pleural cavity (persistent pneumothorax) using classic imaging methods. Mycoses 2006; 49:210-5. [PMID: 16681812 DOI: 10.1111/j.1439-0507.2006.01236.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The diagnosis of pulmonary aspergillosis is based on serum-analysis, as well as histological and microbiological analysis of bronchial lavage and transbronchial biopsies. When Aspergillus develops within a preformed cavity, however, these tests are likely to be negative. In this situation, classic imaging techniques such as chest X-ray and high resolution-computed tomography (HR-CT) can be of great diagnostic use. We here describe the case of a 62-year-old woman with a history of breast cancer and subsequent ablation of the left breast and radiotherapy. The case demonstrates an example of a pleuropulmonary aspergilloma, in which sero- and micro-biological detection failed. Thorax HR-CT exhibited the cavity, a small persistent pneumothorax, partially filled by an oval density. This density clearly dislocated according to gravity following a positional change of the patient from supine to prone. The density thus revealed mobility which was typical of aspergilloma. Following excision, this diagnosis was confirmed. A density within a cavity may be differentiated by its mobility from differential diagnoses such as lung cancer which would not be expected to exhibit mobility.
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49
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Gifford AH, Lahey T, Fordham Von Reyn C. Fatal hemoptysis from invasiveAspergillus nigerin a patient with cavitary lung disease andMycobacterium avium complexinfection. Med Mycol 2006; 44:557-60. [PMID: 16966174 DOI: 10.1080/13693780600575635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Invasive aspergillosis typically afflicts immunocompromised patients, whereas pulmonary aspergilloma is a recognized complication of pre-existing cavitary lung disease in immunocompetent hosts. In both cases, the most prevalent pathogens are Aspergillus fumigatus and Aspergillus flavus. We describe a case of fatal hemoptysis from invasive Aspergillus niger infection in the setting of bullous lung disease, steroid-treated sarcoidosis, and Mycobacterium avium complex infection. This report highlights the potential for A. niger to cause invasive disease in conjunction with other pathologic processes in the lung.
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Affiliation(s)
- Alex H Gifford
- Section of General Internal Medicine, Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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Kobashi Y, Yoshida K, Miyashita N, Niki Y, Matsushima T. Chronic necrotizing pulmonary aspergillosis complicated by a cavitary lesion caused by Pulmonary Mycobacterium-avium complex disease. Intern Med 2005; 44:246-50. [PMID: 15805716 DOI: 10.2169/internalmedicine.44.246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 66-year-old woman who had undergone one year's treatment for pulmonary nontuberculous mycobacterial disease due to Mycobacterium avium (rifampicin, ethambutol, clarithromycin, streptomycin-->levofloxacin) five years earlier was admitted to our hospital because of continuous fever and a newly detected abnormal chest shadow, which was like a fungus ball in the right upper lobe on chest computed tomography in the giant cavitary lesion caused by pulmonary Mycobacterium-avium complex (MAC) disease. A diagnosis of chronic necrotizing pulmonary aspergillosis (CNPA) complicated by pulmonary MAC disease was made because Aspergillus niger was isolated from several sputum specimens, anti-aspergillus antibody was positive, and clinical symptoms such as fever, were disclosed with the radiological finding of a fungus ball-like shadow and an infiltration shadow around the cavity. The patient had received various forms of antifungal chemotherapy, but the clinical effect had been poor. Since then, she had been slowly worsening. Although mycetomas, with the typical appearance of a fungus ball on a chest radiograph, have been reported to easily form in cavitary lesions caused by previous pulmonary tuberculosis, we believe, as illustrated by the present case, that they could also form in such lesions caused by pulmonary MAC disease, since the frequency of pulmonary nontuberculous mycobacterial disease has recently been increasing in comparison with that of pulmonary tuberculosis.
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Affiliation(s)
- Yoshihiro Kobashi
- Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192
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