Percutaneous Intracavitary Antifungals for a Patient with Pulmonary Aspergilloma; with a Special Reference to in vivo Efficacies and in vitro Susceptibility Results.

Itoh, Taeko; Yamada, Hiroshi; Yamaguchi, Akihiko; Kawamata, Nakaaki; Kakei, Masafumi; Nozoe, Shin-ichi; Tanaka, Hiromitsu

doi:10.2169/internalmedicine.34.85

Cited by 10 publications

(8 citation statements)

References 9 publications

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“…Amphotericin B is currently the drug of choice for the treatment of invasive aspergillosis (125,126). It should be given at a dose of 1 mg/kg/day to 1.5 mg/kg/day (39). The overall response rate to amphotericin B is 37%, with a range of 14% to 83% (127).…”

Section: Invasive Aspergillosismentioning

confidence: 99%

“…In fact, Hammerman et al (38) showed that intravenous administration of amphotericin B is no more effective than a pulmonary toilet regimen in the management of patients with aspergillomas. Intracavitary or endobronchial instillation of antifungal agents has also been attempted with variable outcomes (20,23,26,(39)(40)(41)(42)(43)(44)(45); these measures may stop life-threatening hemoptysis and improve clinical symptoms. Corticosteroid therapy may improve symptoms (20) but carries the risk of dissemination or enlargement of the fungus ball.…”

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confidence: 99%

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Aspergillus‐Related Lung Disease

Al-Alawi

Ryan

Flint

et al. 2005

Canadian Respiratory Journal

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Aspergillus is a ubiquitous dimorphic fungus that causes a variety of human diseases ranging in severity from trivial to life-threatening, depending on the host response. An intact host defence is important to prevent disease, but individuals with pre-existing structural lung disease, atopy, occupational exposure or impaired immunity are susceptible. Three distinctive patterns of aspergillus-related lung disease are recognized: saprophytic infestation of airways, cavities and necrotic tissue; allergic disease including extrinsic allergic alveolitis, asthma, allergic bronchopulmonary aspergillosis, bronchocentric granulomatosis and chronic eosinophilic pneumonia; and airway and tissue invasive disease -- pseudomembranous tracheobronchitis, acute bronchopneumonia, angioinvasive aspergillosis, chronic necrotizing aspergillosis and invasive pleural disease. A broad knowledge of these clinical presentations and a high index of suspicion are required to ensure timely diagnosis and treatment of the potentially lethal manifestations of aspergillus-related pulmonary disease. In the present report, the clinical, radiographic and pathological aspects of the various aspergillus-related lung diseases are briefly reviewed.

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Section: Invasive Aspergillosismentioning

confidence: 99%

mentioning

confidence: 99%

Aspergillus‐Related Lung Disease

Al-Alawi

Ryan

Flint

et al. 2005

Canadian Respiratory Journal

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“…This is of advantage for these severely ill patients, considering the already heavy hepato-renal cytotoxic potential caused by chemotherapy. Bronchoscopic application of drug solutions has been used for the treatment of pulmonary tuberculous cavities, Echinococcus cysts and chronic saprophytic pulmonary aspergilloma with good results [18,19,20,21,22,35,36,37]. To our knowledge, the only published study for local treatment of acute IPA were 10 haemato-oncological patients treated by CT-guided percutaneous application of antifungal drugs.…”

Section: Discussionmentioning

confidence: 99%

“…The local instillation of antifungal agents by bronchoscopy is therefore an interesting and rational therapeutic approach with the further advantage of minimizing the risk of systemic toxic levels as a consequence of systemic application. Endobronchial as well as percutanous intracavitary instillation therapy has already proved successful in classical chronic saprophytic pulmonary aspergillomas [18,19,20,21,22]. In immunocompromised patients with acute IPA experience, however, is limited [23,24,25].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Invasive Pulmonary Aspergillosis in Neutropenic Patients by Additional Bronchoscopic Amphotericin B Instillation

Winkler¹,

Müller²,

Nenoff³

et al. 2007

Respiration

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Background: Invasive pulmonary aspergillosis (IPA) remains a life-threatening condition despite systemic antifungal therapy. Objectives: This retrospective analysis investigated whether additional bronchoscopic instillation of amphotericin B (amB) would improve efficacy of antifungal treatment in patients with haematological malignancies suffering from IPA. Methods: Twenty patients (40.6 ± 14.2 years, 14 male) with preceding chemotherapy, bone marrow or stem cell transplantation complicated by severe IPA who did not respond sufficiently to systemic antifungal therapy were additionally treated by repeated bronchoscopic instillations of amB solution (91 instillations, on average 4.6 ± 2.2 instillations per patient over a period of 24.1 ± 21.0 days). Therapeutic response to this combined treatment regimen was monitored by chest X-ray and CT scan. Results: The mean infiltration sizes during systemic antifungal therapy alone (mean duration 11.9 ± 9.9 days) did not change significantly. However, after additional bronchoscopic instillation of amB solution infiltration sizes were reduced significantly (p < 0.05). A total resolution of infiltrates was seen in 3 and a partial reduction in 13 of 20 patients. Mean duration of total antifungal treatment was 50.1 ± 24.0 days. The mean follow-up period was 34.1 ± 31.2 months. The IPA-related mortality rate was 18.8% (3 of 16 patients). Conclusions: Additional bronchoscopic instillation of amB may improve the efficacy of systemic antifungal therapy in patients with haematological malignancies complicated by severe IPA. Bronchoscopic instillation of amB should be considered as an additional treatment option in cases with IPA unresponsive to systemic therapy.

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“…Хирургические вмешательства не всегда возможны из за сопутствующей патологии и низкой легочной функции. Предпринимались попытки чрескожного введения противогрибковых препаратов в полости аспергиллом при противопоказаниях к хирургичес кому лечению, но они были успешными только в от дельных случаях [242][243][244]. Применение противо грибковых препаратов ограничено, они должны назначаться только больным с подозрением на нали чие полуинвазивного компонента.…”

Section: аспергилломыunclassified