Management of pulmonary aspergilloma in the presence of active tuberculosis.

Abstract

The natural history of intracavitary aspergilloma, which is caused by the ubiquitous fungus Aspergillus fumigatus, remains unknown. Many reports, however, indicate that this opportunistic fungus colonises cavities in the upper lobes that result from pulmonary tuberculosis, lung cyst, lung abscess, bronchiectasis, neoplasms,' 3 sarcoidosis, and ankylosing spondylitis.4 5 The saprophyte forms a conglomeration of fragmented hyphae, fibrin, and inflammatory cells (called an aspergilloma, fungus ball, or mycetoma) with the radiological appearance of a crescent of air separating the mycetoma from the wall of the cavity.' 6-8 Patients who have old tuberculous cavities with superimposed aspergillomas tend to have recurrent and life threatening haemoptysis,5 '9-4 and this is clearly an important factor to be considered in assessing their need for surgery. Consequently, this study was undertaken to review our experience of the incidence, natural history, diagnosis, and management of pulmonary aspergilloma seen in residual tuberculous cavities in a chest clinic serving a rural and urban population where pulmonary tuberculosis is endemic. This represents the largest published series from a single institution in our geographical zone. Table 2 summarises the important clinical features in the 11 patients with aspergilloma associated with pulmonary tuberculosis. The duration of illness until presentation at the hospital ranged from one week to one and half years and the most frequent complaint was of recurrent haemoptysis, usually of one to two days' duration. Fever, productive cough, weight loss, and repeated haemoptysis with varying degrees of anaemia occurred in all patients. Five of the patients with severe or advanced pulmonary tuberculosis presented with dyspnoea and fatigue. There were four cases of finger clubbing. Clinical manifestations DiagnosisAcid fast bacilli were present in the sputum smear of nine of the 11 patients and the remaining two had 862

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

“…Over time, if untreated, these cavities enlarge and coalesce, and the fungal balls may appear or disappear [11]. The differential diagnosis includes active TB [26], NTM, histoplasmosis, actinomycosis, coccidioidomycosis and lung carcinoma, the last sometimes associated concurrently with chronic (or invasive) Aspergillus infection [73,74].…”

Management of post-tuberculous complex aspergilloma of the lung: role of surgical resection.

“…Opinion is divided on whether symptomless patients should have routine surgical resection' 11 1 or be treated medically. '4 There is no evidence that surgical resection improves prognosis except in patients with massive haemoptysis 18 and resection is complicated by a high rate of serious postoperative complications, 7 27 The difference in outcome may be related to the selection of cases for surgery.…”

“…Among nine cases of aspergilloma complicating active tuberculosis surgery resulted in two deaths from bleeding and three patients developed an empyema. 27 The difference in outcome may be related to the selection of cases for surgery.…”

Coexistência de colonização fúngica intracavitária (bola fúngica) e tuberculose ativa

“…The present study clinically corroborates this antagonism, demonstrating that, in cases in which the two diseases occurred concomitantly, there was no spatial coincidence. Although Adeyemo et al (5) drew attention to the simultaneity of fungus ball and active tuberculosis, they found no evidence of lesion simultaneity or of fungal etiology of the colonization. Other studies describing concomitance between fungus ball and tuberculosis were also unclear regarding the simultaneity of both agents in the same lesion (1) .…”