Local treatment of aspergilloma of the lung with a paste containing nystatin or amphotericin B

Krakówka, P; Traczyk, K; Walczak, Jerzy; Halweg, H; Z, Elsner; Pawlicka, L

doi:10.1016/0041-3879(70)90071-1

Cited by 48 publications

(29 citation statements)

References 3 publications

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“…In the past, cavitary lung lesions (aspergillomas) have been treated with local installations of AmB (1,11,14,18). In these uncontrolled studies, many patients responded favorably, and single doses of up to 50 mg in 10 to 20 ml of 5% glucose in water and total doses of 500 mg were well tolerated.…”

Section: Resultsmentioning

confidence: 99%

Aerosol amphotericin B is effective for prophylaxis and therapy in a rat model of pulmonary aspergillosis

Schmitt

Bernard

Hauser

et al. 1988

Antimicrob Agents Chemother

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Invasive pulmonary aspergillosis is a major life-threatening complication among transplant recipients and patients receiving cancer chemotherapy. In a rat model of progressive pulmonary aspergfliosis that is characterized by hyphal bronchopneumonia, aerosol amphotericin B (aero-AmB; 1.6 mg/kg given 2 days before infection) significantly delayed mortality in rats compared with animals in a control group. The first death in the aero-AmB-treated group occurred on day 11, by which time seven of the eight control animals had died. The same dose of aero-AmB given as treatment (1.6 mg/kg given 24 h after infection and then daily for 6 days) was also effective. In this trial, eight of the ten animals treated with aero-AmB survived for 7 days, whereas only one of ten control animals survived. The most commonly encountered form of disease in these patients is pulmonary aspergillosis (7). Acute fatal sinusitis (27, 28), head and neck involvement (24), cutaneous disease (5), and catheter-related infections (3) have also been described.Invasive pulmonary aspergillosis is difficult to diagnose, even with the use of invasive techniques. Thus the standard treatment, intravenous amphotericin B (AmB), often must be given empirically, despite its severe toxicity and despite the fact that patients do not tolerate it well. Moreover, AmB is not always effective, and correction of the underlying disorder (e.g., the resolution of granulocytopenia) is usually required to achieve a favorable outcome.In a study of the distribution and activity of amphotericin B in humans, we found the highest concentrations of drug in the liver, spleen, and kidneys (6). Concentrations above 7 ,ug/g of lung tissue were seen only in patients who had received at least 1.7 g of AmB. Our data also suggested that once amphotericin B accumulated in any organ it was eliminated slowly.A reduction of the number of aspergillus spores inhaled probably reduces the risk of developing invasive aspergillus pneumonia among susceptible hosts (19,21,22,25). Since AmB is highly fungicidal against aspergillus spores (23) and has a long half-life once it reaches the lung parenchyma, it may be an ideal candidate for prophylactic use when given as an aerosol. This route of administration should limit systemic toxicity and maximize effectiveness.In evaluated whether aerosol AmB (aero-AmB) given as prophylaxis (given once, 48 h before infection) or as therapy (given 24 h after infection and then daily for 6 days) influenced survival. Other studies were done to determine the pulmonary deposition and fungicidal activity of the drug after aerosol administration. MATERIALS AND METHODSAnimal model of pulmonary aspergiflosis. Male SpragueDawley rats (Charles River Breeding Laboratories, Wilmington, Mass.), weighing 125 to 150 g, were given cortisone acetate (100 mg/kg, given subcutaneously) three times per week throughout the experiment. They also received a low-protein diet (8% protein; ICN Biochemicals, Cleveland, Ohio) and tetracycline (250 mg dissolved in 750 ml of drinking water). ...

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Section: Resultsmentioning

confidence: 99%

Aerosol amphotericin B is effective for prophylaxis and therapy in a rat model of pulmonary aspergillosis

Schmitt

Bernard

Hauser

et al. 1988

Antimicrob Agents Chemother

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“…Several clinical reports have described the resolution of aspergilloma through the instillation of antifungal agents into pulmonary cavities, when systemic use of antifungals is ineffective or prevented by adverse events [104][105][106][107][108][109][110][111][112][113]. Instillation of antifungal agents may be delivered through an endobronchial catheter under bronchoscopic guidance, via a percutaneous transthoracic needle or catheter placed into the aspergilloma cavity.…”

Section: Duration Of Antifungal Therapy For Cpamentioning

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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“…В нескольких клинических сооб щениях описано разрешение аспергиллемы после внутриполостных инстилляций противогрибкового препарата, тогда как системная противогрибковая терапия была неэффективной либо вызывала побоч ные эффекты [104][105][106][107][108][109][110][111][112][113]. Введение противогрибко вого препарата в полость может осуществляться че рез эндобронхиальный катетер при бронхоскопии либо через чрескожную трансторакальную иглу или…”

Section: местная внутриполостная терапия при хлаunclassified

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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Local treatment of aspergilloma of the lung with a paste containing nystatin or amphotericin B

Cited by 48 publications

References 3 publications

Aerosol amphotericin B is effective for prophylaxis and therapy in a rat model of pulmonary aspergillosis

Aerosol amphotericin B is effective for prophylaxis and therapy in a rat model of pulmonary aspergillosis

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

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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