Pulmonary Aspergilloma and Allergic Bronchopulmonary Aspergillosis Following the 2018 Heavy Rain Event in Western Japan

Ando, Eri; Nakasuka, Takamasa; Kubo, Toshio; Taniguchi, Akihiko; Ninomiya, Kiichiro; Kato, Yuka; Ichihara, Eiki; Ohashi, Kadoaki; Rai, Kammei; Hotta, Katsuyuki; Yamane, Masaomi; Miyahara, Nobuaki; Tabata, Masahiro; Maeda, Yoshinobu; Kiura, Katsuyuki

doi:10.2169/internalmedicine.7124-21

Cited by 2 publications

(1 citation statement)

References 16 publications

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“… 54 Aspergillus -related lung diseases also include allergic diseases such as asthma, allergic bronchopulmonary aspergillosis (ABPA), and hypersensitivity pneumonitis. 55 – 57 Reports indicate that 5% of patients with CPA have concomitant ABPA, highlighting the need for vigilance in diagnosing both conditions when managing patients with CPA. 58 , 59 Thus, pulmonary aspergillosis is broadly classified into three types: acute (invasive), chronic (non-invasive), and allergic ( Figure 2 ).…”

Section: Types Of Pulmonary Aspergillosismentioning

confidence: 99%

Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, treatment, and unresolved challenges

Tashiro,

Takazono,

Izumikawa

2024

Therapeutic Advances in Infection

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Chronic pulmonary aspergillosis (CPA) is a challenging respiratory infection caused by the environmental fungus Aspergillus. CPA has a poor prognosis, with reported 1-year mortality rates ranging from 7% to 32% and 5-year mortality rates ranging from 38% to 52%. A comprehensive understanding of the pathogen, pathophysiology, risk factors, diagnosis, surgery, hemoptysis treatment, pharmacological therapy, and prognosis is essential to manage CPA effectively. In particular, Aspergillus drug resistance and cryptic species pose significant challenges. CPA lacks tissue invasion and has specific features such as aspergilloma. The most critical risk factor for the development of CPA is pulmonary cavitation. Diagnostic approaches vary by CPA subtype, with computed tomography (CT) imaging and Aspergillus IgG antibodies being key. Treatment strategies include surgery, hemoptysis management, and antifungal therapy. Surgery is the curative option. However, reported postoperative mortality rates range from 0% to 5% and complications range from 11% to 63%. Simple aspergilloma generally has a low postoperative mortality rate, making surgery the first choice. Hemoptysis, observed in 50% of CPA patients, is a significant symptom and can be life-threatening. Bronchial artery embolization achieves hemostasis in 64% to 100% of cases, but 50% experience recurrent hemoptysis. The efficacy of antifungal therapy for CPA varies, with itraconazole reported to be 43–76%, voriconazole 32–80%, posaconazole 44–61%, isavuconazole 82.7%, echinocandins 42–77%, and liposomal amphotericin B 52–73%. Combinatorial treatments such as bronchoscopic triazole administration, inhalation, or direct injection of amphotericin B at the site of infection also show efficacy. A treatment duration of more than 6 months is recommended, with better efficacy reported for periods of more than 1 year. In anticipation of improvements in CPA management, ongoing advances in basic and clinical research are expected to contribute to the future of CPA management.

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