Clinical features and diagnosis of chronic pulmonary aspergillosis in Chinese patients

Abstract

Chronic pulmonary aspergillosis (CPA) has recently been recognized as a significant global health burden. In China, the diagnosis of CPA is still unfamiliar to most doctors. The aim of this study was to demonstrate the clinical manifestations and diagnoses of CPA in China.A multidisciplinary team of doctors retrospectively screened 690 records of patients diagnosed with pulmonary aspergillosis from January 2000 to December 2016 at Peking Union Medical College Hospital, Beijing, China. Of these, 69 patients were diagnosed with CPA. The patients’ clinical characteristics were then retrieved and analyzed. Demographic, laboratory, and radiological data for these patients were compared by CPA type.Of the 69 patients diagnosed with CPA, 10 patients were diagnosed with chronic cavitary pulmonary aspergillosis (CCPA), 15 patients with semi-invasive aspergillosis (SAIA), 41 patients with simple aspergilloma, and 3 patients with Aspergillus nodule. Further, 53.3% of the SAIA patients were obviously immunocompromised, and 60% of the CCPA patients, 26.7% of the SAIA patients, 7.3% of the simple aspergilloma cases were mildly immunocompromised. Previous underlying lung abnormalities were observed in 20% of CCPA patients, 53.3% of SAIA patients, and 80.5% of simple aspergilloma patients. The most common symptoms in the CPA patients were cough (92.8%), hemoptysis (63.8%), chronic sputum (23.2%), and fever (17.4%). The most common computerized tomography abnormalities were cavities (94.2%), nodule (84.1%), consolidation (4.3%), pleural thickening (2.9%), and infiltration (2.9%). CCPA, SAIA and simple aspergilloma patients were significantly different with respect to their course before diagnosis, constitutional symptoms, fever, hemoptysis, breathlessness, white blood cell count, erythrocyte sedimentation rate, high-sensitivity C-reactive protein count, presence of nodule, and presence of a solitary lesion (all P < .05). Furthermore, SAIA patients had a significantly shorter course before diagnosis and a significantly higher white blood cell count compared with CCPA patients (both P < .01).In China, underlying systemic immunocompromising conditions and lung diseases with mechanical impediments contribute to CPA. Simple aspergillosis was the most common diagnosis in CPA patients. The imaging characteristics of simple aspergillosis and Aspergillus nodules were quite discriminable, while CCPA, and SAIA were similar in their clinical and radiological features. Distinguishing between CCPA and SAIA depends mainly on the physician's clinical judgment.

Prospective study of the serum Aspergillus-specific IgG, IgA and IgM assays for chronic pulmonary aspergillosis diagnosis

“…The main systemic symptoms were cough, sputum production and fever, but the rate of chest pain was not high. The rate of haemoptysis (26.2%) was lower than other reports (49 and 63.8%) [6, 15]. One of the possible reasons is that the numbers of bronchiectasis and PTB, which contribute to haemoptysis, were small in our study.…”

“…Nineteen of 42 CPA patients (including 17 inpatients and 2 outpatients) had pyrexia during the study period. The rate of fever (45.2%) was higher than other published papers reported (17.4 and 21%) [6, 15]. Among this group of CPA patients, 13 patients had other infections, 3 patients have connective tissue disease and 4 patients had pyrexia probably attributable to CPA.…”

“…After excluding PTB and nontuberculous mycobacterial (NTM), according to our data, the most common underlying disease of CPA patients was bronchiectasis, followed by COPD. However, some studies reported that COPD was considered as the primary underlying diseases [6, 14, 15]. Possible factors contributing to the difference are as follows.…”

Chronic Nodular Pulmonary Aspergillosis in a Patient with Rheumatoid Arthritis

“…Only two reports of Aspergillus nodules have been published in the literature. Hou et al reported that 3 of 69 patients with chronic pulmonary aspergillosis were diagnosed with Aspergillus nodules (5). Similarly, Muldoon et al reported 33 cases of Aspergillus nodules, 13 of which showed no evidence of tissue invasion upon pathological examination (6).…”

Diagnostic value of serum Aspergillus IgG antibody for invasive pulmonary aspergillosis and chronic pulmonary aspergillosis in non-agranulocytic patients

“…There were 36 males and 22 females, aged from 46 to 75 years (60.7 ± 14.6), and 37 IPA (63.8%) and 21 CPA cases (36.2%) were included. The CPA cases included 3 simple aspergilloma (SA), 10 chronic cavitary pulmonary aspergillosis (CCPA) and 8 subacute invasive aspergillosis (SAIA) cases [14]. Among these pulmonary aspergillosis patients, 7 patients (12.1%) has no other underlying diseases, 26 patients (44.8%) had chronic respiratory disease, and 15 patients (25.9%) had diabetes (Table 1).…”