A Surgically Treated Case of Chronic Necrotizing Aspergillosis with Pleural Invasion

Lee, Kyung-Hak; Ryu, Se Min; Park, Sung Min; Park, Hyun-Seok; Lee, Kang Hoon; Cho, Seong-Joon

doi:10.5090/kjtcs.2012.45.1.56

Cited by 3 publications

(7 citation statements)

References 5 publications

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“…Successful first‐line therapy intravenously as well as – experimental – instillation into a cavity has been reported . AMB has also been used in a multimodal treatment approach to irrigate pleural space after upper lobe resection for complicated CNPA in a patient with comorbidities . Successful inhalational treatment in combination with other antifungals has been reported occasionally…”

Section: Treatment Options and Prognosismentioning

confidence: 99%

Chronic pulmonary aspergillosis

Schweer,

Bangard,

Hekmat

et al. 2013

Mycoses

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Summary Chronic pulmonary aspergillosis (CPA) is a group of consuming diseases usually presenting with prolonged and relapsing cough, dyspnoea and weight loss. Acute symptoms such as haemoptysis and bronchial or pulmonary haemorrhage may occasionally occur. CPA affects patients with underlying pulmonary conditions, for example, chronic obstructive pulmonary disease or mycobacteriosis or common immunosuppressive conditions such as diabetes. Precise epidemiology is unknown, and while prevalence is considered low the chronic and relapsing nature of the disease challenges the treating physician. Diagnostics largely rely on serologic Aspergillus precipitins and findings on thoracic computed tomography. The latter are manifold comprising cavity formation, pleural involvement and sometimes aspergilloma. Other markers for aspergillosis are less helpful, in part due to the non‐ or semi‐invasive nature of these forms of Aspergillus infection. Various antifungals were shown to be effective in CPA treatment. Azoles are the most frequently applied antifungals in the outpatient setting, but are now compromised by findings of Aspergillus resistance. Long‐term prognosis is not fully elucidated and may be driven by the underlying morbidities. Prospective registry‐type studies may be suitable to systematically broaden our CPA knowledge base. This article gives an overview of the available literature and proposes a clinical working algorithm for CPA management.

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Section: Treatment Options and Prognosismentioning

confidence: 99%

Chronic pulmonary aspergillosis

Schweer,

Bangard,

Hekmat

et al. 2013

Mycoses

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“…Usually, Aspergillus pleuritis and Aspergillus empyema occur via bronchopulmonary fistulas, which arise after surgical treatment for lung cancer, tuberculosis and recurrent pneumonia (2). As other causes of Aspergillus pleuritis, the direct pleural invasion of Aspergillus from contiguous pulmonary lesions, such as aspergilloma and chronic necrotizing pulmonary aspergillosis, has been reported (3)(4)(5)(6). It has also been reported that cases of bronchopleurocutaneous fistulas and percutaneous puncture of pulmonary aspergilloma can result in dissemination to the thoracic cavity (7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

Pleuritis Clinically Diagnosed as Aspergillosis during the Course of Microscopic Polyangiitis

et al. 2014

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Pleural aspergillosis is a rare fungal infection. We herein report a case of pleuritis clinically diagnosed as aspergillosis without apparent Aspergillus lung lesions. A 75-year-old man receiving immunosuppressive therapy due to microscopic polyangiitis was admitted for treatment of massive pleural effusion. Histology of the parietal pleura revealed septate hyphae. In addition, a hematological marker of Aspergillus indicated Aspergillus pleuritis. The pleural effusion resolved after administration of the voriconazole. The trigger for invasion of Aspergillus into the pleura was thought to be spontaneous pneumothorax, which had occurred five months earlier.

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“…However, a late response was observed after itraconazole administration, suggesting that antifungal therapy may indeed have increased efficacy in the long term [36]. Antifungal treatment may be combined with surgery in certain cases of prolonged illness or frequent haemoptysis [38], but this has not been found to offer any overall improvement in patient morbidity or mortality in the last decade [39]. It is also considered hazardous and should only be performed in high-risk patients [40].…”

Section: Cpa: Current Treatment Optionsmentioning

confidence: 99%

“…According to recent IDSA guidelines, in patients at a low surgical risk, surgical resection can offer a permanent cure as well as avoid haemoptysis and locoregional extension, and therefore improves survival [35,38,42]. Possible procedures include lobectomy, pulmonectomy, atypical resection, cavernostomy and thoracoplasty [43].…”

Section: Cpa: Current Treatment Optionsmentioning

confidence: 99%

“…In those with compromising underlying diseases, impaired respiratory function, poor general health and in the elderly, there is a high frequency of postoperative morbidity and mortality as well as a lack of published randomised clinical trial data [7,42,43,45]. Surgical treatment should be considered when the clinical benefit outweighs the risk to the patient [38] and the cost of treatment; this was illustrated in a retrospective study conducted by Chen et al [46 ](tables 4, 5). Farid et al [47],in a recent study on 30 patients who underwent surgery for CPA (12 with simple aspergillomas and 18 with CCPA), reported that surgery offered good outcomes with acceptable morbidity.…”

Section: Cpa: Current Treatment Optionsmentioning

confidence: 99%

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Chronic Pulmonary Aspergillosis: An Update on Diagnosis and Treatment

Godet¹,

Philippe

Laurent

et al. 2014

Respiration

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Chronic pulmonary aspergillosis (CPA) affects individuals with non-systemic or mildly systemic immunodepression or altered pulmonary integrity due to underlying disease. It has been reported with a variety of clinical and radiological patterns. The condition should be distinguished from simple aspergilloma and allergic bronchopulmonary aspergillosis as well as invasive aspergillosis in severely immunocompromised patients. CPA generally requires long-term antifungal treatment and surgery may be considered. Life-threatening haemoptysis may be prevented by bronchial arteriography with embolisation. However, currently there are no documented treatment recommendations for CPA. This review provides an up-to-date practical overview of this condition, including a comprehensive update on diagnosis and management.

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A Surgically Treated Case of Chronic Necrotizing Aspergillosis with Pleural Invasion

Cited by 3 publications

References 5 publications

Chronic pulmonary aspergillosis

Chronic pulmonary aspergillosis

Pleuritis Clinically Diagnosed as Aspergillosis during the Course of Microscopic Polyangiitis

Chronic Pulmonary Aspergillosis: An Update on Diagnosis and Treatment

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