Fungus colonisation of pulmonary rheumatoid nodule

Cavazza, Alberto; Paci, Massimiliano; Turrini, Eleonora; Dallari, Rossano; Rossi, Giulio

doi:10.1136/jcp.56.8.636

Cited by 16 publications

(10 citation statements)

References 4 publications

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“…Aspergillus nodules (figures 6 and 13) are very similar in appearance to malignancy, coccidioidal nodules [75], NTM [76] and actinomycosis [77], as well as rheumatoid nodules [78,79]. Most such lesions are rounded in appearance and may have low attenuation or cavitation within.…”

Section: Imaging Findingsmentioning

confidence: 99%

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

Denning¹,

Cadranel²,

et al. 2015

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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

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Section: Imaging Findingsmentioning

confidence: 99%

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

Denning¹,

Cadranel²,

et al. 2015

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“…Although fungal colonization of rheumatoid nodules has been reported twice in the past, 1,2 this case appears morphologically distinct and, as a result, raises several further issues with regard to this rare entity. In one report, an eosinophilic infiltration around the edge of the colonized rheumatoid nodule, and in the airways, was described 1 but, to the best of our knowledge, an eosinophilic pneumonia adjacent to, and distinct from a rheumatoid nodule colonized with aspergillus has not been reported.…”

mentioning

confidence: 85%

“…Sir: Fungal colonization of pulmonary rheumatoid nodules has been reported only twice in the past 1,2 . We report a case of aspergillus colonization of rheumatoid nodules occurring in the presence of a marked eosinophilic infiltrate within the nodules and an eosinophilic pneumonia both adjacent to, and distinct from, the rheumatoid nodules.…”

mentioning

confidence: 92%

Eosinophilic pneumonia and aspergillus colonization of rheumatoid nodules

2005

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“…рис. 6, 13) по внешне му виду очень похожи на злокачественные опухоли, кокцидиомикозные узлы [75], НТМ [76] и акти номикоз [77], а также ревматоидные узлы [78,79]. В большинстве случаев эти образования имеют округлую форму с просветлением или полостью внутри.…”

Section: клинические рекомендацииunclassified

Diagnosis and treatment of chronic pulmonary aspergillosis: clinical guidelines of European Society for Clinical Microbiology and Infectious Diseases and European Respiratory Society

Denning¹,

Cadranel²,

Ader³

et al. 2017

Pulʹmonologiâ (Mosk.)

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Chronic pulmonary aspergillosis (CPA) is infrequent respiratory disease which is difficult for diagnosis and can complicate other respiratory diseases and conditions. Currently, there are about 240,000 CPA patients in Europe. The most prevalent variant of CPA is chronic cavitary pulmonary aspergillosis (CCPA) which could progress to chronic fibrosing pulmonary aspergillosis (CFPA) when is untreated. Aspergillus nodules and single aspergilloma are less frequent clinical variants of this disease. All clinical variants of aspergillosis could be found in nonimmunocompromised patients with different underlying pulmonary disorders. Subacute invasive pulmonary aspergillosis, which was referred to as chronic necrotising pulmonary aspergillosis, is the most rapidly progressive clinical variant of the infection (< 3 months); it is typically diagnosed in moderately immunocompromised patients and should be treated as invasive aspergillosis. Diagnosis and management of CPA patients were previously described in sporadic guidelines. Due to this, expert group have been convened to develop clinical, radiological and microbiological guidelines. Diagnosis of CPA requires a combination of the following criteria existing for 3 months or more: one or more cavities in the lungs with or without fungal mass inside or nodules found on radiological examination; direct evidence of Aspergillus infection (using microscopic examination or biopsy culturing) or immunological response to Aspergillus spp. and exclusion of alternative diseases. Antibodies against Aspergillus spp. (precipitins) are increased in > 90% of patients. Aspergilloma should be resected if technically possible; videoassisted thoracic surgery is preferable. Chronic cavitary pulmonary aspergillosis requires longterm oral antifungal therapy to improve the patients' health and respiratory symptoms, to arrest haemoptysis and prevent the disease progression. Azole serum concentration and drug interaction should be thoroughly monitored to avoid toxic effects. Haemoptysis could be arrested using therapy with tranexamic acid or bronchial artery embolization; surgical resection of the lung is rarely required. Haemoptysis could indicate therapeutic failure and / or resistance to antifungals. Patients with a single Aspergillus nodule need antifungal therapy only if surgical resection is impossible. Antifungal therapy could be beneficial in patients with multiple Aspergillusis nodules; these patients need careful followup.

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Fungus colonisation of pulmonary rheumatoid nodule

Cited by 16 publications

References 4 publications

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

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

Eosinophilic pneumonia and aspergillus colonization of rheumatoid nodules

Diagnosis and treatment of chronic pulmonary aspergillosis: clinical guidelines of European Society for Clinical Microbiology and Infectious Diseases and European Respiratory Society

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