Pulmonary Aspergillosis: Therapeutic Management and Prognostic Factors from 16 Years of Monocenter Experience

Pabst, Stefan; Krüger, Michael; Skowasch, Dirk; Zhou, Hongsheng; Bürmann, Jens; Kaminski, Marcel

doi:10.1007/978-94-007-4546-9_29

Cited by 6 publications

(8 citation statements)

References 34 publications

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“…During the first year of follow‐up, there is reasonable treatment success in about half of the CPA patients . In the case series reporting long‐term outcome mortality ranged from 37% to 67% after 10–18 years . Older age, systemic comorbidities, corticosteroids, a body mass index of <18.5 kg m −2 and a C‐reactive protein level of ≥5.0 mg dl −1 at baseline were risk factors for all‐cause mortality .…”

Section: Treatment Options and Prognosismentioning

confidence: 99%

“…In stable subclinical disease watchful waiting may be indicated as much for simple aspergilloma as for CCPA and maybe CNPA …”

Section: Treatment Options and Prognosismentioning

confidence: 99%

“…Classically in patients eligible for surgery a simple aspergilloma is cured by resection of the cavity and the fungus ball (Fig. ).…”

Section: Treatment Options and Prognosismentioning

confidence: 99%

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Chronic pulmonary aspergillosis

Schweer,

Bangard,

Hekmat

et al. 2013

Mycoses

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Summary Chronic pulmonary aspergillosis (CPA) is a group of consuming diseases usually presenting with prolonged and relapsing cough, dyspnoea and weight loss. Acute symptoms such as haemoptysis and bronchial or pulmonary haemorrhage may occasionally occur. CPA affects patients with underlying pulmonary conditions, for example, chronic obstructive pulmonary disease or mycobacteriosis or common immunosuppressive conditions such as diabetes. Precise epidemiology is unknown, and while prevalence is considered low the chronic and relapsing nature of the disease challenges the treating physician. Diagnostics largely rely on serologic Aspergillus precipitins and findings on thoracic computed tomography. The latter are manifold comprising cavity formation, pleural involvement and sometimes aspergilloma. Other markers for aspergillosis are less helpful, in part due to the non‐ or semi‐invasive nature of these forms of Aspergillus infection. Various antifungals were shown to be effective in CPA treatment. Azoles are the most frequently applied antifungals in the outpatient setting, but are now compromised by findings of Aspergillus resistance. Long‐term prognosis is not fully elucidated and may be driven by the underlying morbidities. Prospective registry‐type studies may be suitable to systematically broaden our CPA knowledge base. This article gives an overview of the available literature and proposes a clinical working algorithm for CPA management.

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Section: Treatment Options and Prognosismentioning

confidence: 99%

“…In stable subclinical disease watchful waiting may be indicated as much for simple aspergilloma as for CCPA and maybe CNPA …”

Section: Treatment Options and Prognosismentioning

confidence: 99%

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Chronic pulmonary aspergillosis

Schweer,

Bangard,

Hekmat

et al. 2013

Mycoses

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“…Bisherige Daten zur Langzeit-Prognose sind weniger erfolgversprechend. Das Gesamtüberleben beträgt 37-67 % nach 10-18 Jahren [9,19,21]. Die Prognose heutiger Erstdiagnosen ist durch die geringere Toxizität neuerer Antimykotika und optimierte Behandlung der Grunderkrankungen möglicherweise verbessert.…”

Section: Diagnose ▼unclassified

Chronische pulmonale Aspergillose

Schweer

Wittersheim

Bangard

et al. 2014

Dtsch med Wochenschr

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Chronic pulmonary aspergillosis (CPA) is a rare complication in patients with either mild immunosuppression or various pulmonary diseases. Diagnosis and therapy are challenging because of unspecific symptoms like productive cough, weight loss, fever and haemoptysis. Differential diagnoses are manifold, and CPA is characterized by findings in chest CT and serologic proof of precipitins. Surgery is only recommended for simple aspergillomas. Recurrent prolonged courses of antifungal treatment yield satisfactory short-term outcome, but long-term prognosis is uncertain. We provide an overview of the literature and present four cases to illustrate disease diversity.

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“…However, a late response was observed after itraconazole administration, suggesting that antifungal therapy may indeed have increased efficacy in the long term [36]. Antifungal treatment may be combined with surgery in certain cases of prolonged illness or frequent haemoptysis [38], but this has not been found to offer any overall improvement in patient morbidity or mortality in the last decade [39]. It is also considered hazardous and should only be performed in high-risk patients [40].…”

Section: Cpa: Current Treatment Optionsmentioning

confidence: 99%

Chronic Pulmonary Aspergillosis: An Update on Diagnosis and Treatment

Godet¹,

Philippe

Laurent

et al. 2014

Respiration

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Chronic pulmonary aspergillosis (CPA) affects individuals with non-systemic or mildly systemic immunodepression or altered pulmonary integrity due to underlying disease. It has been reported with a variety of clinical and radiological patterns. The condition should be distinguished from simple aspergilloma and allergic bronchopulmonary aspergillosis as well as invasive aspergillosis in severely immunocompromised patients. CPA generally requires long-term antifungal treatment and surgery may be considered. Life-threatening haemoptysis may be prevented by bronchial arteriography with embolisation. However, currently there are no documented treatment recommendations for CPA. This review provides an up-to-date practical overview of this condition, including a comprehensive update on diagnosis and management.

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Pulmonary Aspergillosis: Therapeutic Management and Prognostic Factors from 16 Years of Monocenter Experience

Cited by 6 publications

References 34 publications

Chronic pulmonary aspergillosis

Chronic pulmonary aspergillosis

Chronische pulmonale Aspergillose

Chronic Pulmonary Aspergillosis: An Update on Diagnosis and Treatment

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