Pulmonary aspergillosis presenting with recurrent haemoptysis

Betancourt, Blas Y; Garofoli, Adrian C.; Sandhu, Jagbir; Boma, Noella; Sy, Alexander

doi:10.1136/bcr-2015-211249

Cited by 6 publications

(6 citation statements)

References 6 publications

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“…CPA characteristically presents with a history of cough (usually productive), haemoptysis and weight loss slowly developing over months (>3 months) to years in an apparently immunocompetent or subtly immunocompromised patient with prior or current lung disease [46]. The haemoptysis can be minor or significant and life-threatening (i.e., greater than 150 mL/day) [47]. Patients may also present with non-specific symptoms such as fatigue, chest discomfort, shortness of breath and, though unusual, fever and night sweats; these systemic symptoms provide a distinction between chronic cavitary pulmonary aspergillosis (CCPA) and a simple aspergilloma in which they do not occur [15,48,49].…”

Section: Clinical Diagnosismentioning

confidence: 99%

Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist

Bongomin

Asio

Baluku

et al. 2020

JoF

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Chronic pulmonary aspergillosis (CPA) is a spectrum of several progressive disease manifestations caused by Aspergillus species in patients with underlying structural lung diseases. Duration of symptoms longer than three months distinguishes CPA from acute and subacute invasive pulmonary aspergillosis. CPA affects over 3 million individuals worldwide. Its diagnostic approach requires a thorough Clinical, Radiological, Immunological and Mycological (CRIM) assessment. The diagnosis of CPA requires (1) demonstration of one or more cavities with or without a fungal ball present or nodules on chest imaging, (2) direct evidence of Aspergillus infection or an immunological response to Aspergillus species and (3) exclusion of alternative diagnoses, although CPA and mycobacterial disease can be synchronous. Aspergillus antibody is elevated in over 90% of patients and is the cornerstone for CPA diagnosis. Long-term oral antifungal therapy improves quality of life, arrests haemoptysis and prevents disease progression. Itraconazole and voriconazole are alternative first-line agents; voriconazole is preferred for patients with contra-indications to itraconazole and in those with severe disease (including large aspergilloma). In patients co-infected with tuberculosis (TB), it is not possible to treat TB with rifampicin and concurrently administer azoles, because of profound drug interactions. In those with pan-azole resistance or intolerance or progressive disease while on oral triazoles, short-term courses of intravenous liposomal amphotericin B or micafungin is used. Surgery benefits patients with well-circumscribed simple aspergillomas and should be offered earlier in low-resource settings.

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Section: Clinical Diagnosismentioning

confidence: 99%

Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist

Bongomin

Asio

Baluku

et al. 2020

JoF

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“…38 Hemoptysis and pneumothorax might also develop in some cases. 39,40 Invasive aspergillosis is rarely seen in patients affected by CF. However, it could develop in end-stage CF patient in intensive care units and in immunosuppressed CF patients after lung transplant, frequently in the form of Aspergillus tracheobronchitis, occurring mainly in the first 3 months after transplants and associated with high mortality (39%).…”

Section: Aspergillus Sppmentioning

confidence: 99%

Respiratory Fungal Diseases in Adult Patients With Cystic Fibrosis

Delfino

Puente

Briano

et al. 2019

Clin Med Insights Circ Respir Pulm Med

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Clinical manifestations of respiratory fungal diseases in adult cystic fibrosis (CF) patients are very heterogeneous, ranging from asymptomatic colonization to chronic infections, allergic disorders, or invasive diseases in immunosuppressed CF patients after lung transplantation. In this narrative review, mainly addressed to clinicians without expertise in CF who may nonetheless encounter adult CF patients presenting with acute and chronic respiratory syndromes, we briefly summarize the most representative clinical aspects of respiratory fungal diseases in adult CF patients.

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“…108 It also has a very high chance of recurrence. 109 A CT angiogram is almost always needed to delineate the source of the bleeding. 110…”

Section: Long-term Azole Therapymentioning

confidence: 99%

Chronic Pulmonary Aspergillosis: Clinical Presentation and Management

Evans,

Lawal,

Kosmidis

et al. 2023

Semin Respir Crit Care Med

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Chronic pulmonary aspergillosis (CPA) refers to a number of clinical syndromes resulting from the presence and local proliferation of Aspergillus organisms in the lungs of patients with chronic lung disease. CPA is more common than was realized two decades ago. Recognition remains poor, despite recent studies from many countries highlighting the high prevalence in at-risk populations. In low- and middle-income countries, CPA may be misdiagnosed and treated as tuberculosis (TB). In addition, CPA may develop following successful TB treatment. The coronavirus disease pandemic has resulted in significant disruption to provision of TB care, likely leading to more extensive lung damage, which could increase the risk for CPA.Although CPA refers to various syndromes, the classic presentation is that of chronic cavitary pulmonary aspergillosis, which manifests as one or more progressive cavities with or without a fungal ball, accompanied by systemic and respiratory symptoms for at least 3 months. Diagnosis relies on Aspergillus immunoglobulin G in serum, as sputum culture lacks sensitivity. Differential diagnosis includes mycobacterial infection, bacterial lung abscess or necrotizing pneumonia, lung cancer, and endemic fungi.The aim of antifungal treatment in CPA is to improve symptoms and quality of life, and to halt progression, and possibly reverse radiological changes. Current recommendations suggest treatment for 6 months, although in practice many patients remain on long-term treatment. Improvement may manifest as weight gain and improvement of symptoms such as productive cough, hemoptysis, and fatigue. Surgical management should be considered in cases of diagnostic uncertainty, in significant hemoptysis, and when there is concern for lack of response to therapy. Itraconazole and voriconazole are the first-line azoles, with more experience now accumulating with posaconazole and isavuconazole. Side effects are frequent and careful monitoring including therapeutic drug monitoring is essential. Intravenous antifungals such as echinocandins and amphotericin B are used in cases of azole intolerance or resistance, which often develop on treatment. Relapse is seen after completion of antifungal therapy in around 20% of cases, mostly in bilateral, high-burden disease.Several research priorities have been identified, including characterization of immune defects and genetic variants linked to CPA, pathogenetic mechanisms of Aspergillus adaptation in the lung environment, the contribution of non-fumigatus Aspergillus species, and the role of new antifungal agents, immunotherapy, and combination therapy.

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Pulmonary aspergillosis presenting with recurrent haemoptysis

Cited by 6 publications

References 6 publications

Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist

Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist

Respiratory Fungal Diseases in Adult Patients With Cystic Fibrosis

Chronic Pulmonary Aspergillosis: Clinical Presentation and Management

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