Chronic pulmonary aspergillosis in a tertiary tuberculosis institute: A common entity missed commonly

Singhal, Ritu; Gupta, Amitesh; Singla, Neeta; Singla, Rupak; Jha, Ritika; Nair, Shweta; Choudhary, Madhumita Paul; Bhattacherjee, Nilotpal

doi:10.1016/j.ijtb.2023.03.014

Cited by 2 publications

(3 citation statements)

References 48 publications

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Section: Introductionmentioning

confidence: 99%

“…Chronic pulmonary aspergillosis (CPA) is a progressive respiratory syndrome predominantly affecting individuals who are immunocompetent or subtly immunocompromised, particularly those with underlying structural lung diseases, most notably post‐treatment tuberculosis (TB) 1 . In recent years, it has become an increasingly important global public health concern 1,2 . As per the recommendations by the European Confederation of Medical Mycology (ECMM), indicators for monitoring CPA include imaging assessment, culture from respiratory samples, and serology on Aspergillus ‐specific IgG 3 .…”

Section: Introductionmentioning

confidence: 99%

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Chronic pulmonary Aspergillosis in a patient with poorly controlled diabetes: A case report and literatures review

Chuang,

2024

Respirology Case Reports

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Chronic pulmonary aspergillosis (CPA) often manifests in patients with a history of pulmonary tuberculosis and is typically characterized by recurrent hemoptysis, weight loss, and frequently coexists with poorly controlled diabetes. While weight gain is acknowledged as a valuable clinical marker for monitoring therapeutic responses in CPA, there is a scarcity of case reports exploring this aspect. Furthermore, the impact of stringent blood sugar management in diminishing CPA activity and preventing the recurrence of hemoptysis is also underreported. In this context, we present the case of a 64‐year‐old male who experienced massive hemoptysis. He had a background of uncontrolled diabetes and a history of fully treated pulmonary tuberculosis. Following therapeutic embolization, he was diagnosed with CPA that had transformed into invasive pulmonary aspergillosis (IPA) and underwent antifungal therapy for 9 months. Notably, we observed an inverse correlation between the patient's improved blood sugar control and weight gain with the serum IgG levels for Aspergillosis. This case highlights the potential benefits of non‐invasive monitoring of CPA activity and the identification of treatment responders through effective blood sugar management and weight gain.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chronic pulmonary Aspergillosis in a patient with poorly controlled diabetes: A case report and literatures review

Chuang,

2024

Respirology Case Reports

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“… 8 However, much remains to be learned about this patient population, the disease itself, and the optimal use of available therapeutic modalities. 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, treatment, and unresolved challenges

Tashiro,

Takazono,

Izumikawa

2024

Therapeutic Advances in Infection

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Chronic pulmonary aspergillosis (CPA) is a challenging respiratory infection caused by the environmental fungus Aspergillus. CPA has a poor prognosis, with reported 1-year mortality rates ranging from 7% to 32% and 5-year mortality rates ranging from 38% to 52%. A comprehensive understanding of the pathogen, pathophysiology, risk factors, diagnosis, surgery, hemoptysis treatment, pharmacological therapy, and prognosis is essential to manage CPA effectively. In particular, Aspergillus drug resistance and cryptic species pose significant challenges. CPA lacks tissue invasion and has specific features such as aspergilloma. The most critical risk factor for the development of CPA is pulmonary cavitation. Diagnostic approaches vary by CPA subtype, with computed tomography (CT) imaging and Aspergillus IgG antibodies being key. Treatment strategies include surgery, hemoptysis management, and antifungal therapy. Surgery is the curative option. However, reported postoperative mortality rates range from 0% to 5% and complications range from 11% to 63%. Simple aspergilloma generally has a low postoperative mortality rate, making surgery the first choice. Hemoptysis, observed in 50% of CPA patients, is a significant symptom and can be life-threatening. Bronchial artery embolization achieves hemostasis in 64% to 100% of cases, but 50% experience recurrent hemoptysis. The efficacy of antifungal therapy for CPA varies, with itraconazole reported to be 43–76%, voriconazole 32–80%, posaconazole 44–61%, isavuconazole 82.7%, echinocandins 42–77%, and liposomal amphotericin B 52–73%. Combinatorial treatments such as bronchoscopic triazole administration, inhalation, or direct injection of amphotericin B at the site of infection also show efficacy. A treatment duration of more than 6 months is recommended, with better efficacy reported for periods of more than 1 year. In anticipation of improvements in CPA management, ongoing advances in basic and clinical research are expected to contribute to the future of CPA management.

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Chronic pulmonary aspergillosis in a tertiary tuberculosis institute: A common entity missed commonly

Cited by 2 publications

References 48 publications

Chronic pulmonary Aspergillosis in a patient with poorly controlled diabetes: A case report and literatures review

Chronic pulmonary Aspergillosis in a patient with poorly controlled diabetes: A case report and literatures review

Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, treatment, and unresolved challenges

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