Clinical characteristics and prognosis of chronic pulmonary aspergillosis

Ohba, Hisano; Miwa, Seiichi; Shirai, Masahiro; Kanai, Miho; Eifuku, Tatsuru; Suda, Takafumi; Hayakawa, Hiroshi; Chida, Kingo

doi:10.1016/j.rmed.2012.01.014

Cited by 130 publications

(110 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Due to the aggressiveness of invasive aspergillosis, early diagnosis become extremely important (Kriengkauykiat et al, 2011;Baddley et al, 2012;Ohba et al, 2012). In clinic setting, CT combined with fiberoptic bronchoscopy, bronchoalveolar lavage and biopsy are commonly recommened diagnostic methods (Godet et al, 2012;Reinwald et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Phase II Study on Voriconazole for Treatment of Chinese Patients with Malignant Hematological Disorders and Invasive Aspergillosis

Zhang

Huang²,

Xu³

et al. 2012

Asian Pacific Journal of Cancer Prevention

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Phase II Study on Voriconazole for Treatment of Chinese Patients with Malignant Hematological Disorders and Invasive Aspergillosis

Zhang

Huang²,

Xu³

et al. 2012

Asian Pacific Journal of Cancer Prevention

View full text Add to dashboard Cite

“…The presence of anti-Aspergillus antibodies differentiates between infected and colonised patients with a positive predictive value of 100% for detecting infection [29]. Numerous commercial assays are available, in addition to some in-house serology methods, usually Aspergillus precipitins detection by immunodiffusion or counter-immunoelectrophoresis [5,29,42,43,[45][46][47][52][53][54]. The three articles comparing different serological assays for Aspergillus IgG serology do not allow a definitive conclusion about comparative diagnostic performance for CPA [42][43][44].…”

Section: Contribution Of Galactomannan Antigen To the Diagnosis Of Cpamentioning

confidence: 99%

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Denning¹,

Cadranel²,

et al. 2015

View full text Add to dashboard Cite

Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ∼240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferably via video-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with single Aspergillus nodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up. @ERSpublications ERS and ESCMID guideline for the management of chronic pulmonary aspergillosis released

show abstract

“…In patients with CPA, the body mass index (BMI) is an independent predictor of the prognosis (14). However, the prognostic factors of CNPA have not been clarified using a large number of patients.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors in 194 Patients with Chronic Necrotizing Pulmonary Aspergillosis

Nakamoto¹,

Takayanagi²,

Kanauchi

et al. 2013

Intern. Med.

View full text Add to dashboard Cite

Objective The prognostic factors of chronic necrotizing pulmonary aspergillosis remain unclear. We assessed the prognostic factors of all-cause mortality in patients with chronic necrotizing pulmonary aspergillosis, focusing especially on underlying pulmonary disease, first-line treatment and host predisposition. Methods We retrospectively analyzed the medical records of 194 patients negative for HIV who had chronic necrotizing pulmonary aspergillosis treated at our institution in Saitama, Japan. Results The patients (median age, 68.5 years) were followed over a median follow-up time of 2.6 years. The underlying pulmonary diseases consisted of previous pulmonary tuberculosis in 59 (30.4%) patients, emphysema in 39 (20.1%) patients, interstitial lung disease in 32 (16.5%) patients, nontuberculous mycobacteriosis in 29 (14.9%) patients and other diseases in 35 (18%) patients. The first-line treatments included observation in 65 (33.5%) patients, itraconazole in 56 (28.9%) patients, micafungin in 46 (23.7%) patients, voriconazole in 22 (11.3%) patients and amphotericin B (including liposomal amphotericin B) in five (2.6%) patients. The overall cumulative mortality rate was 50.2% at five years and 67.4% at 10 years. Multivariate Cox proportional hazard modeling found an older age, the presence of systemic comorbidities, baseline corticosteroid use, a body mass index of <18.5 kg/m 2 and a C-reactive protein level of ! 5.0 mg/dL to be negative prognostic factors for all-cause mortality. ConclusionThe 5-year mortality rate of chronic necrotizing pulmonary aspergillosis was 50.2%. When clinical trials are designed and implemented to test effective drug therapies in patients with chronic necrotizing pulmonary aspergillosis, the trial patients should be stratified according to these prognostic factors prior to randomization.

show abstract

Clinical characteristics and prognosis of chronic pulmonary aspergillosis

Abstract: CPA is a disease with a poor prognosis, which shows distinct clinical characteristics from colonization.

Cited by 130 publications

References 18 publications

Phase II Study on Voriconazole for Treatment of Chinese Patients with Malignant Hematological Disorders and Invasive Aspergillosis

Phase II Study on Voriconazole for Treatment of Chinese Patients with Malignant Hematological Disorders and Invasive Aspergillosis

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Prognostic Factors in 194 Patients with Chronic Necrotizing Pulmonary Aspergillosis

Contact Info

Product

Resources

About