Infection of the pleura by Aspergillus fumigatus

Abstract

Pleural aspergillosis occurs mostly in established cases of pleural empyema with a broncho-pleural fistula. Ten such patients are reported here: in all, Aspergillus fumigatus infection was related to tuberculosis. In three cases with an active, sputum-positive tuberculous process the pleural empyema was a complication of spontaneous pneumothorax in two, and of lung resection in one. In two cases the empyema occurred as a complication of tuberculous pleuritis, but A. fumigatus infection was noted only after the sputum had become negative for tubercle bacilli. In five patients with inactive tuberculosis, the empyema was a late com;plication of pneumothorax therapy. found in the sputum. A catheter was inserted into the pleural cavity, and Gram-negative bacilli sensitive to chloramphenicol were recovered from the pleural fluid. The patient was given a course of streptomycin, isoniazid, penicillin, and chloramphenicol therapy. In spite of this he deteriorated and after two months died of circulatory and respiratory failure. At necropsy both the adhesions and the pleura were covered by greenish fibrous masses which showed Aspergillus fumigatus on microscopical examination. In the apical posterior part of the visceral pleura an opening communication with the parenchymal lung cavity was found. Multiple tuberculous cavities were seen in both lungs.In this case the empyema resulted from perforation of the tuberculous cavity into the pleura. Secondary aspergillous infection of the empyema was not recognized during lifetime.

Aspergillosis

“…It may also result from invasion into the pleura of infection in previously damaged lung. In most cases it is a late complication of tuberculosis, following pleufitis, therapeutic or spontaneous pneumofllorax, or pulmonary resection (46). It has also occurred in sarcoidosis, asbestosis, following pneumonectomy, or after insertion of a thoracotomy tube.…”

Case 8-2002

“…1 Aspergillosis often causes nodular pleural thickening and is associated with tuberculosis or postoperative lung infection. 18 In the current case, the absence of pleural changes, the negative cultures for fungus, the indolent course, the low glucose level in the pleural fluid, and the absence of a history of travel to areas where histoplasmosis is endemic make fungal disease an unlikely diagnosis.…”

Combined systemic and intrapleural treatment of Aspergillus pulmonary empyema after invasive aspergillosis

“…[1][2][3][4] Less frequently pleural aspergillosis appears to arise from rupture of an aspergilloma cavity into the pleural space or from direct infection of the pleura in the course of invasive pulmonary aspergillosis. [1][2][3][4] Less frequently pleural aspergillosis appears to arise from rupture of an aspergilloma cavity into the pleural space or from direct infection of the pleura in the course of invasive pulmonary aspergillosis.…”

“…Surgical decortication or pleuropneumonectomy are appropriate if disease is extensive but are associated with high postoperative complication rates. [2][3][4] We believe that this is the first report describing intrapleural antifungal treatment in a child with Aspergillus empyema. Local administration of antifungal agents may be an alternative to surgery in Aspergillus pleural empyema and in localized aspergillomas.…”