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This article discusses a study on fungal sinus aspergilloma (FSA), a rare condition characterized by the presence of fungal growth in the sinuses. The study included six patients with FSA and found that the frontal sinus was involved in one patient, while bilateral infection was reported in another case. The most common symptom was headache. The study also compared the incidence of bone erosion in FSA with other types of fungal sinusitis and found that FSA had a higher incidence of bone erosion. The authors suggest that recognizing the radiological features of FSA and obtaining tissue samples for analysis are important for accurate diagnosis and treatment planning. [Extracted from the article]

Background: Post‐tuberculosis lung abnormality (PTLA) is the most common risk factor for developing chronic pulmonary aspergillosis (CPA). However, the prevalence and incidence of CPA in PTLA patients in India remain unknown. Objectives: We aimed to ascertain the incidence and prevalence of CPA in subjects with PTLA. Methods: We identified a cohort of pulmonary tuberculosis who completed anti‐tuberculosis therapy (ATT) before November 2019 from the records of the 12 tuberculosis treatment centers attached to the national program. We recorded the clinical and demographic details. We performed computed tomography (CT) of the chest and estimated serum A. fumigatus‐specific IgG. We categorised subjects as PTLA with or without CPA using a composite of clinical, radiological, and microbiological features. We resurveyed the subjects at 6 months (or earlier) for the presence of new symptoms. We calculated the prevalence and the incidence rate (per 100‐person years) of CPA. Results: We included 117 subjects with PTLA, with a median of 3 years after ATT completion. Eleven subjects had CPA in the initial survey, and one additional case developed CPA during the second survey. The prevalence of CPA in PTLA subjects was 10.3% (12/117). The total observation period was 286.7 person‐years. The median (interquartile range) time to develop CPA after ATT completion was 12.5 (5–36.7) months. We found the CPA incidence rate (95% confidence interval) of 4.2 (1.8–6.5) per 100‐person years. Conclusion: Chronic pulmonary aspergillosis complicates 10% of PTLA subjects after successful outcomes with ATT. Four new CPA cases may develop per 100‐persons years of observation after ATT completion. We suggest screening patients with PTLA who develop new symptoms for CPA. [ABSTRACT FROM AUTHOR]

We report a case of a 57‐year‐old woman with pulmonary metastasis of breast cancer presenting with a characteristic cavitary shadow resembling aspergilloma. The primary tumor and metastases showed multiple histopathologic components, including squamous cell carcinoma. Although a fungal ball‐like shadow may indicate the presence of a pulmonary aspergilloma, a comprehensive examination, including bronchoscopy, should be considered. [ABSTRACT FROM AUTHOR]

Aspergillomas are found in pre‐existing cavities in pulmonary parenchyma. To the best of our knowledge, aspergilloma has not previously been reported in COVID‐19‐associated pulmonary architecture distortion combined with barotrauma from invasive mechanical ventilation therapy. We present a case of a 67‐year‐old woman, who suffered from severe COVID‐19 in the summer of 2020 with no suspicion of infection with Aspergillus in the acute phase. Ten months after discharge from her COVID‐related admission, she developed bilateral aspergillomas diagnosed by image diagnostics, bronchoscopy, and blood samples, and she now receives antifungal therapy. We would like to raise awareness on aspergilloma in post‐COVID‐19 patients, since it is an expected long‐term complication to COVID‐19 patients with pulmonary architectural distortion. [ABSTRACT FROM AUTHOR]

Fine‐needle aspiration cytology, a simple and inexpensive technique can aid in early diagnosis of aspergilloma. Here, we present a case of 55‐years‐old female with a past history of pulmonary tuberculosis and a right‐lung cavitary lesion, diagnosed as aspergilloma. [ABSTRACT FROM AUTHOR]

Background: Aspergillosis is a fungal infection with many clinical forms. Invasive aspergillosis is the most widely known severe manifestation, but other forms can need intensive care. Aim: Our purpose is to report a case of tracheal aspergilloma and provide a review of the literature concerning endobronchial aspergillus. Method: We report a case of tracheal aspergilloma causing tracheal obstruction in a patient admitted in the ICU for respiratory distress. The aspergilloma occurred in a tracheal stent implanted during tracheal allograft for tracheal cancer. A combination of local and systemic antifungal was used with successful result. [ABSTRACT FROM AUTHOR]

Background: Several previous studies have shown cavitary lung lesions in old pulmonary tuberculosis (PTB) increase the risk of fungus ball. Detection of galactomannan (GM) in bronchoalveolar lavage (BAL) is also proposed as a diagnostic approach for the fungus ball. Objectives: We evaluated the diagnosis of fungus balls and GM levels in BAL samples in PTB patients. Methods: A total of 110 PTB patients were evaluated for fungus ball during 2017‐2019. The patients were evaluated for radiological, histopathological results and mycological findings of BAL including GM detection and culture. The sensitivity, specificity and positive and negative predictive value for GM test were calculated. The optimal cut‐off for BAL GM testing was determined by receiver operating characteristic (ROC). Results: Of 110 PTB patients, nine (8.18%) showed fungus ball, all with old PTB. The molecularly confirmed Aspergillus species were A. flavus, A. fumigatus and A. ochraceus. The sensitivity and specificity of BAL GM ≥ 0.5 in old PTB patients with fungus ball were 100%, 41.5%, respectively. The statistical analysis of the mean ± SEM of BAL GM levels was demonstrated a higher levels of GM in patients with fungus ball/aspergilloma compared to old PTB patients without fungus ball/aspergilloma. The optimal cut‐off value for BAL GM was determined as 0.50 by ROC curve analysis. Conclusion: According to our results, we can recommend the detection of GM in BAL samples as a diagnostic approach for fungus ball in PTB patients. [ABSTRACT FROM AUTHOR]

Summary: Background: An early diagnosis of chronic pulmonary aspergillosis (CPA) at the stage of simple aspergilloma (SA) remains a challenge in low‐ and middle‐income countries, where imaging may not be routinely available. Objective: We investigate the role of Aspergillus fumigatus‐specific IgG in serum, and galactomannan (GM) in bronchoalveolar lavage fluid (BALF) and serum for the diagnosis of SA. Methods: We included 46 consecutive treatment‐naïve subjects with SA. The 81 controls were subjects of treated pulmonary tuberculosis with residual radiological abnormality and minimal symptoms; and subjects with pulmonary disorders other than CPA who underwent bronchoscopy. The diagnosis of SA was based on consistent clinical features along with radiological manifestations (cavity with fungal ball). Results: Using receiver operating characteristic (ROC) curve analysis, the best cut‐off value for A fumigatus‐specific IgG was 27.3 mgA/L (AUROC, 0.839; sensitivity, 63.5%; specificity, 98.3%). The best cut‐off value for serum and BALF‐GM was 0.7 (AUROC, 0.636; sensitivity, 32%; specificity, 96.2%) and 2.5 (AUROC, 0.833; sensitivity, 63.7%; specificity, 97.1%), respectively. A combination of A fumigatus‐specific IgG (>27 mgA/L) or serum GM (≥0.7) or BALF‐GM (≥2.5) had a sensitivity and specificity of 82.6% and 96%, respectively. Conclusions: A combination of serological tests has the best sensitivity in diagnosing SA. More studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Some Aspergillus species produce oxalic acid, which reacts with tissue calcium or blood to precipitate calcium oxalate. Oxalate crystals can induce lung and kidney damage. The presence of oxalate crystals can suggest the diagnosis of aspergillosis, even when Aspergillus hyphae are absent on microscopic slides. [ABSTRACT FROM AUTHOR]

Aspergillus infection localized to the renal allograft is a rare and potentially life-threatening infection and typically requires a combination of operative and medical management. We report the case of a renal allograft aspergilloma in a renal transplant patient presenting 2 years post transplant, successfully managed non-surgically. To our knowledge, this is the first report of a patient presenting with an allograft aspergilloma so long after transplantation and being successfully managed with antifungal therapy alone. [ABSTRACT FROM AUTHOR]

Increasing numbers of immunocompromised patients have led to a corresponding rise in the incidence of invasive Aspergillus infections. Despite advances in antifungal therapy coupled with reduction in immunosuppression, invasive aspergillosis is associated with significant morbidity and mortality. Although surgical debulking has proven effective in difficult-to-treat cases, patient comorbidities may prevent such intervention. Non-invasive alternatives to surgery are needed. Microwave ablation has many advantages over other ablative techniques, including convection profile, faster heating time, and higher intra-lesion temperatures, which may be associated with greater therapeutic efficacy. We report a case of microwave ablation as an adjunct to medical therapy in angioinvasive renal aspergilloma. [ABSTRACT FROM AUTHOR]

Patients with aspergilloma can be safely managed with supportive therapy in absence of massive haemoptysis. We hypothesised that chronic cavitary pulmonary aspergillosis ( CCPA) could also be managed on similar grounds. The aim of this prospective, randomised controlled trial was to evaluate the efficacy and safety of itraconazole in CCPA. Consecutive patients of CCPA with presence of chronic pulmonary/systemic symptoms; and pulmonary cavities; and presence of Aspergillus (immunological or microbiological) were randomised to receive either supportive treatment alone or itraconazole 400 mg daily for 6 months plus supportive therapy. Response was assessed clinically, radiologically and overall after 6 months therapy. A total of 31 patients (mean age, 37 years) were randomised to itraconazole ( n = 17) or the control ( n = 14) group. The number of patients showing overall response was significantly higher in the itraconazole group (76.5%) vs. the control (35.7%) group ( P = 0.02). The numbers of patients demonstrating clinical or radiological response were also significantly higher in the itraconazole group ( P = 0.016 and 0.01 respectively). Adverse events were noted in eight patients in the itraconazole group, however, none was serious or led to discontinuation of the study drug. Itraconazole was found to be superior to standard supportive treatment alone in stabilising cases of CCPA. (clinicaltrials.gov; NCT01259336). [ABSTRACT FROM AUTHOR]

Cardiac device-related infection caused by Aspergillus species is a rare finding associated with high mortality. Prompt recognition and treatment is imperative, but difficult as blood cultures are often negative and diagnosis requires a high index of suspicion. Live/real time three-dimensional transthoracic echocardiography (3D TTE) provides incremental knowledge in the characterization of valvular vegetations. Here, we provide a detailed description of an invasive cardiac device-related infection caused by Aspergillus fumigatus using 3D TTE. Findings described here highlight the role for 3D TTE in the prompt diagnosis of invasive cardiac Aspergillus infections as well as surgical planning in such cases. [ABSTRACT FROM AUTHOR]

Aspergillomas develop from progressive layers of mycelial growth on the walls of pulmonary cavities over months. Aspergillomas are characteristic of chronic pulmonary aspergillosis and are a risk factor for azole resistance. We investigated genotypic and phenotypic alterations in Aspergillus fumigatus recovered from aspergillomas. Aspergillomas were removed from three patients (two at surgery, one at autopsy) and dissected. Overall 92 colonies of A. fumigatus were isolated. Microsatellite typing was conducted to determine genetic type. Itraconazole, voriconazole and posaconazole susceptibilities were performed. The cyp51A gene was sequenced in 22 isolates. Isolates from Patient 1 ( n = 25) were azole susceptible and resistant, although all cyp51A sequences were wild type, the isolates split into two distinct clades. In Patient 2, isolates were less variable ( n = 10), all were azole susceptible. In Patient 3 only azole-resistant strains ( n = 57) were isolated, with M220K or M220T Cyp51A alterations, and microevolution was indicated. Marked diversity was observed in isolates from these patients; revealing differences in azole susceptibility, mechanism of resistance and genetic type. Importantly, routine sampling from respiratory specimens proved suboptimal in all cases; azole resistance was missed (Patient 1), cultures were negative (Patient 2) and high-level posaconazole resistance was not detected (Patient 3). [ABSTRACT FROM AUTHOR]

We present the case of a 39-year-old woman with a subfascial abscess. The patient had undergone radical hysterectomy for stage Ib1 cervical cancer. Six months after the surgery, she was found to have an elevated concentration of the serum squamous cell carcinoma antigen. Thereafter, she underwent magnetic resonance imaging and positron emission tomography–computed tomography. Magnetic resonance imaging revealed an irregular mass (diameter: 2 cm) in the abdominal wall. Increased 18F-fluorodeoxyglucose uptake into the mass was observed on positron emission tomography. Therefore, we could not rule out the possibility of the peritoneal dissemination of cervical cancer, and we resected the mass. The mass was pathologically and microbiologically diagnosed as a subfascial aspergilloma. The lesion was located in the subfascial area where a drain was inserted at the time of the primary laparotomy. [ABSTRACT FROM AUTHOR]

The diagnosis of pulmonary aspergillosis is based on serum-analysis, as well as histological and microbiological analysis of bronchial lavage and transbronchial biopsies. When Aspergillus develops within a preformed cavity, however, these tests are likely to be negative. In this situation, classic imaging techniques such as chest X-ray and high resolution-computed tomography (HR-CT) can be of great diagnostic use. We here describe the case of a 62-year-old woman with a history of breast cancer and subsequent ablation of the left breast and radiotherapy. The case demonstrates an example of a pleuropulmonary aspergilloma, in which sero- and micro-biological detection failed. Thorax HR-CT exhibited the cavity, a small persistent pneumothorax, partially filled by an oval density. This density clearly dislocated according to gravity following a positional change of the patient from supine to prone. The density thus revealed mobility which was typical of aspergilloma. Following excision, this diagnosis was confirmed. A density within a cavity may be differentiated by its mobility from differential diagnoses such as lung cancer which would not be expected to exhibit mobility. [ABSTRACT FROM AUTHOR]

Invasive pulmonary aspergillosis is a life-threatening disease, developing from infection mostly byAspergillus fumigatus. It is an opportunistic infection and occurs mostly in immunosuppressed patients, after tuberculosis, in patients with AIDS or malignomas. The most common symptom and complication is hemoptysis up to massive bleeding. Surgical treatment is obligatory on patients with a pulmonary aspergilloma. Time and form of intervention should be discussed between surgeon and pulmonologist. Resection should follow anatomical borders like lobectomy or pneumectomy. Any remaining intrathoracic cavities should be filled either with remaining lung tissue or with muscle flaps of latissimus or pectoralis muscle or omentum majus. Following these rules, intervention can be performed with reasonable mortality and morbidity rate. [ABSTRACT FROM AUTHOR]

Mycetomas of paranasal sinuses are more frequently diagnosed with the widespread use of nasal endoscopy and computed tomography (CT). We present a series of 109 cases treated by functional endoscopic sinus surgery (FESS) with a mean follow-up of 29 months. All localizations were seen, and contrary to what was initially thought, seven cases presented in multiple sites. Several clinical presentations were found, from a pansinusal involvement to a simple mycetoma hanging in a superior meatus. A heterogeneous sinus opacity with microcalcifications on CT scan is very suggestive of the diagnosis, but a homogeneous opacity may be encountered even with bone lysis. FESS was performed in all cases to obtain a wide opening of the affected sinuses, permitting a careful extraction of all fungal material. In the postoperative period, no medical treatment is prescribed. With a mean follow-up of 29 months, only four recurrences were seen. This study reinforces the interest in FESS for cases of mycetoma of the paranasal sinuses. [ABSTRACT FROM AUTHOR]

Abstract: A 69-year-old man developed an episode of severe community-acquired pneumonia 9 months after resection of aspergilloma. Although Aspergillus fumigatus was also isolated in the pleural cavity, it did not invade the remaining lung parenchyma. The patient developed progressive bilateral pneumonia leading to death from respiratory failure. Burkholderia cepacia was considered as prime pathogen, as it was repeatedly cultured from sputum and tracheal secretions, as well as the autopsy lung. B. cepacia is resistant to most antibiotics, and seldom causes pneumonia in patients without cystic fibrosis or chronic granulomatous disease. The precise reason that this apparently immunocompetent patient developed B. cepacia pneumonia remains unknown. [ABSTRACT FROM AUTHOR]