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Background and objective: There is a need for simple functional test to assess treatment response in chronic pulmonary aspergillosis (CPA) in resource-constrained settings. The one-minute-sit-to-stand test (1-min-STS) is one such test. However, the minimal important difference (MID) for 1-min-STS in subjects with CPA remains unknown. Herein, we estimate the MID for 1-min-STS for CPA subjects. Materials and Methods: We retrospectively reviewed the clinical details of CPA subjects treated with oral azoles for 6 months. We included only subjects who completed the 1-min-STS test at baseline and 6 months. We used the change in VAS (visual analogue scale, for overall improvement) as an external anchor. We used the anchor and the distribution (standard deviation-based) methods to determine the MID estimates. We used the anchor-based method only if there was correlation of 0.3 with the 1-min-STS test. Results: One hundred-eight subjects completed the 1-min-STS test at baseline and 6 months. We did not find significant correlation between the change in VAS for overall improvement (r² = 0.024, P value = 0.809) and the 1-min-STS test. The MID for the 1-min-STS test was 2 repetitions (range, 1.5--2.8 repetitions). Conclusion: The MID for the 1-min-STS test in subjects with CPA was 2 repetitions. Future studies using a global rating of change scale as an anchor must confirm our findings. [ABSTRACT FROM AUTHOR]

We report a coexistence of Mounir-Kuhn syndrome and aspergilloma in a 69-year-old male presented with hemoptysis, cough, shortness of breath and fever. This patient has a history of recurrent hospital admissions for infective exacerbations of chronic obstructive pulmonary disease. Diagnostic imaging revealed the presence of aspergilloma and marked dilatation of the trachea and main bronchi, leading to a diagnosis of Mounier-Kuhn syndrome. Given the frequent association of Mounier-Kuhn syndrome with recurrent respiratory infections, we recommend that clinicians consider this syndrome when evaluating patients with recurrent pneumonia.

Objective: In developing countries like India where tuberculosis is highly prevalent, the incidence of pulmonary aspergilloma is also high. Mortality and morbidity associated with surgical treatment of aspergilloma in previous studies has discouraged surgeons from taking up surgery as the preferred treatment. This study focuses on the clinical outcome of patients with pulmonary aspergilloma and its surgical management. Methods: Fifty-one patients who underwent thoracotomy for pulmonary aspergilloma from 2015 to 2017 were studied retrospectively by reviewing their medical records. Results: The most common clinical presentation of pulmonary aspergilloma was hemoptysis, which occurred in 76.0% of patients. Tuberculosis was the most common pre-existing disease (72%). High resolution computed tomography of chest, showed the typical "air-crescent" sign in all patients. Systemic antifungal therapy neither palliated the clinical symptoms nor eradicated the aspergilloma, and transarterial embolisation was also unsuccessful. Surgery offered the only chance of cure for both unilateral and bilateral disease. Procedures varied from segmentectomy to pneumonectomy with most (75%) undergoing lobectomy. There was no death following surgery and postoperative complications occurred in 5 patients. Postoperatively, most of the patients were symptom-free. Conclusion: Symptomatic pulmonary aspergilloma patients are best treated by early surgical intervention with good results in experienced centers. [ABSTRACT FROM AUTHOR]

Several cases reported in the literature have confirmed the link between pulmonary aspergillosis and various malignant diseases. Furthermore, it has been observed that the correlation between carcinoid tumor and lung adenocarcinoma is quite uncommon. The etiopathogenic mechanisms underlying these correlations remain poorly defined. We present the case of a patient with three of these diseases: a lung adenocarcinoma with a lepidic pattern, a typical carcinoid, and pulmonary aspergillosis. An additional noteworthy aspect of this case pertains to the timely detection of both lung malignancies. Thus, the necessity for further investigation to ascertain the pathogenic connection among the three diseases is underscored. The ultimate objective is to enhance the prognosis of individuals diagnosed with lung cancer, which is a prevailing malignant disease on a global scale. [ABSTRACT FROM AUTHOR]

Intracavitary pulmonary aspergilloma is a persistent and life-threatening infection that carries a mortality rate of up to 15%. It occurs when Aspergillus species gain entry to an existing lung cavity. In the absence of definitive treatment, patients may succumb to severe complications such as massive hemoptysis, cachexia, or secondary infections. Aspergillomas often show limited response to antifungal medications, mainly due to insufficient drug concentrations within the cavities. Surgery is frequently the preferred treatment option, but it poses significant risks, and many individuals are ineligible due to underlying health issues. We present the most extensive non-surgical fungal ball cohort to date, managed using an innovative multimodal strategy that combines antifungal therapy before and after bronchoscopic debulking. This was a cross-sectional observational study. For those who cannot undergo surgery, our medical center has pioneered a multimodal approach to aspergilloma resection. This approach combines bronchoscopic endoscopy with antifungal therapy and has been applied successfully to more than 18 patients that are presented in this series. The median age of the cohort was 58 years (range: 32–73), with an equal sex distribution. The mean percent predicted FEV1 was 65.3%. The mean follow-up duration was 3.6 years (range: 0.5–10 years). The cohort receiving antifungals systematically prior to debridement showed a reduction of the pre-existing cavity (40.38 mm versus 34.02 mm, p = 0.021). Across the 18 patients during the follow-up period, 94% remained recurrence-free (defined by symptoms and radiology). Our study fills a critical knowledge gap regarding the significance of initiating antifungal treatment before bronchoscopic debulking and presents a viable approach in these cases for which there is a current unmet therapeutic need. Plain Language Summary: The use of both medical and interventional methods to treat difficult fungal masses: A collection of cases showing efficacy for patients who can't undergo surgery Intracavitary pulmonary aspergilloma is a serious and potentially deadly infection with a death rate of up to 15%. It happens when certain types of fungi invade existing lung cavities. Without proper treatment, patients may experience severe complications like heavy bleeding from the lungs, weight loss, or other infections. Traditional antifungal medications often don't work well because they can't reach high enough concentrations in the cavities. Surgery is usually the best option, but it's risky and not possible for many due to other health problems. Our study introduces a new way to treat aspergilloma without surgery. We've treated a significant number of patients using a combination of antifungal drugs and a procedure called bronchoscopic debulking. This involves removing the fungal growth using a thin tube inserted through the airways. Our research involved observing 18 patients treated this way. They were mostly middle-aged, with equal numbers of men and women. Their lung function was moderately impaired, and we followed them for an average of 3.6 years. We found that giving antifungal drugs before the debulking procedure helped reduce the size of the cavities. After treatment, almost all patients remained free of symptoms and signs of recurrence. This study highlights the importance of starting antifungal therapy before bronchoscopic debulking and offers a promising option for patients who can't have surgery. [ABSTRACT FROM AUTHOR]

This collaborative article presents a review of chronic pulmonary aspergillosis (CPA) from the perspective of a multidisciplinary team comprising of respiratory physicians, radiologists, mycologists, dietitians, pharmacists, physiotherapists and palliative care specialists. The review synthesises current knowledge on CPA, emphasising the intricate interplay between clinical, radiological, and microbiological aspects. We highlight the importance of assessing each patient as multidisciplinary team to ensure personalised treatment strategies and a holistic approach to patient care. [ABSTRACT FROM AUTHOR]

An aspergilloma is a conglomeration of Aspergillus hyphae, fibrin, mucus, and cellular debris, typically found within a pulmonary cavity or ectatic bronchus. Computerized tomography (CT) scans often depict a cavity containing a solid mass and a notable crescent sign. Though these signs are indicative of aspergilloma, the European Respiratory Society emphasizes the need for a more detailed diagnostic criteria. A patient with a history of hemoptysis was initially diagnosed with an aspergilloma based on CT chest findings, showing a cavitary lesion in the left upper lobe with an intracavitary lobular opacity. Post resection, histological examination contradicted the initial diagnosis, revealing lung cancer instead. This case underscores the importance of tissue diagnosis from the outset or employing a multifaceted diagnostic criteria encompassing radiological findings, serology and microbiology tests. In the absence of an initial tissue diagnosis, rigorous follow-up, including early interval scanning, is crucial.

A 37-year-old man presented with chronic cavitary pulmonary aspergillosis and hemoptysis refractory to systemic antifungal therapy with voriconazole and bronchial artery embolization. Surgical excision was unfeasible due to the patient's refusal of blood transfusions. Ten sessions of intracavitary instillation of amphotericin B via flexible bronchoscopy were then performed. Hemoptysis cessation and aspergilloma resolution were achieved, with no toxicity or side effects, and the clinical benefits were sustained at six months of follow-up.

Congenital Pulmonary Airway Malformation (CPAM) is an uncommon condition in adults, which typically presents as acute fever and lung abscesses caused by bacterial infections. We present a case of a 39-year-old female with a CPAM in the upper lobe of the right lung, complicated by an aspergilloma, who presented with a history of hemoptysis. The patient underwent an upper lobectomy and is symptom-free in follow-up. 2012 Elsevier Ltd. All rights reserved.

Introduction: Autopsies are routinely useful in establishing the cause and time of death. The Coronavirus Disease-2019 (COVID-19), a pandemic viral infectious disease, has affected many countries worldwide. In developing countries like India, infectious lung pathology has been a significant cause of death even before the COVID-19 era. However, the emergence of COVID-19, there has been an increase in lung infections due to factors such as prolonged hospital stays, assisted ventilation, lung damage, and immune suppression, affecting both morbid patients and survivors. Aim: To describe the histopathological spectrum of infective lesions of lung in autopsy during Pre COVID-19 and COVID-19 era in a tertiary care hospital of Tirunelveli, Tamil Nadu, India. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology at Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India, between January 2018 and December 2021. Data including age, sex, COVID-19 status, clinical history, histomorphological patterns, and identification of infectious agents, were collected from clinico-pathological and autopsy documents. A total of 627 lung specimens were available, with 41 specimens being autolyzed, leaving 586 specimens for inclusion in the study. Gross morphology and microscopic features were documented, and diagnoses were made based on these findings. Results: The study included a total of 586 specimens, of which 76 (12.9%) were reported as infective pathology. Among these cases, 29 (38.1%) cases were reported in the pre COVID19 period, and 47 (61.9%) were reported during the COVID19 period. Of the 76 cases, 41 (53.95%) were male, and 35 (46.05%) were female. The number of cases reported during the post COVID-19 period (47 cases, 61.84%) was higher than the number reported during the pre COVID-19 period (29 cases, 38.16%). In both periods, the majority of cases (10 cases, 13.1% in the pre COVID-19 period; 13 cases, (17.1%) in the post COVID-19 period) were observed in individuals aged 60 years and above, followed by those in the age group of 50 to 59 years (7 cases, 9.2%). Similarly, in the pre COVID-19 period; 10 cases, 13.2% in the post COVID-19 period). Among the 76 cases, interstitial pneumonia (9 cases, 11.8%) was the most common finding in the pre COVID-19 period, followed by bronchopneumonia (seven cases, 9.2%). In the COVID-19 period, Tuberculosis (TB) was the most common finding (17 cases, 22.4%), followed by pneumonia with consolidation (10 cases, 13.2%). Additionally, the number of cases diagnosed with pulmonary TB during the COVID-19 period (17 cases, 22.4%) was higher than that during the pre COVID-19 period (6 cases, 7.9%). During the post COVID-19 period, there has been a drastic increase in the number of pneumonia cases compared to the pre COVID-19 era, and this increase is statistically significant with a p-value of 0.04. Conclusion: Pneumonia (lobar pneumonia, interstitial pneumonia, and bronchopneumonia) is the most common histopathological lung lesion in the present study. Compare to pre COVID-19 era, there is increased number of infective lesions during COVID-19 era. There was a drastic increase in pathological findings of Kochs lesion during COVID-19 era.

Several cases reported in the literature have confirmed the link between pulmonary aspergillosis and various malignant diseases. Furthermore, it has been observed that the correlation between carcinoid tumor and lung adenocarcinoma is quite uncommon. The etiopathogenic mechanisms underlying these correlations remain poorly defined. We present the case of a patient with three of these diseases: a lung adenocarcinoma with a lepidic pattern, a typical carcinoid, and pulmonary aspergillosis. An additional noteworthy aspect of this case pertains to the timely detection of both lung malignancies. Thus, the necessity for further investigation to ascertain the pathogenic connection among the three diseases is underscored. The ultimate objective is to enhance the prognosis of individuals diagnosed with lung cancer, which is a prevailing malignant disease on a global scale.

Cardiac aspergillomas are rare and associated with high mortality. We present a case of right ventricular cardiac aspergilloma in an asymptomatic renal transplant recipient. Intracavitary aspergilloma is an important consideration in evaluation of an intracardiac mass in an immunocompromised patient. (Level of Difficulty: Advanced.).

Objective: In developing countries like India where tuberculosis is highly prevalent, the incidence of pulmonary aspergilloma is also high. Mortality and morbidity associated with surgical treatment of aspergilloma in previous studies has discouraged surgeons from taking up surgery as the preferred treatment. This study focuses on the clinical outcome of patients with pulmonary aspergilloma and its surgical management. Methods: Fifty-one patients who underwent thoracotomy for pulmonary aspergilloma from 2015 to 2017 were studied retrospectively by reviewing their medical records. Results: The most common clinical presentation of pulmonary aspergilloma was hemoptysis, which occurred in 76.0% of patients. Tuberculosis was the most common pre-existing disease (72%). High resolution computed tomography of chest, showed the typical "air-crescent" sign in all patients. Systemic antifungal therapy neither palliated the clinical symptoms nor eradicated the aspergilloma, and transarterial embolisation was also unsuccessful. Surgery offered the only chance of cure for both unilateral and bilateral disease. Procedures varied from segmentectomy to pneumonectomy with most (75%) undergoing lobectomy. There was no death following surgery and postoperative complications occurred in 5 patients. Postoperatively, most of the patients were symptom-free. Conclusion: Symptomatic pulmonary aspergilloma patients are best treated by early surgical intervention with good results in experienced centers.

Congenital Pulmonary Airway Malformation (CPAM) is an uncommon condition in adults, which typically presents as acute fever and lung abscesses caused by bacterial infections. We present a case of a 39-year-old female with a CPAM in the upper lobe of the right lung, complicated by an aspergilloma, who presented with a history of hemoptysis. The patient underwent an upper lobectomy and is symptom-free in follow-up. 2012 Elsevier Ltd. All rights reserved. [ABSTRACT FROM AUTHOR]

Introduction: Autopsies are routinely useful in establishing the cause and time of death. The Coronavirus Disease-2019 (COVID-19), a pandemic viral infectious disease, has affected many countries worldwide. In developing countries like India, infectious lung pathology has been a significant cause of death even before the COVID-19 era. However, the emergence of COVID-19, there has been an increase in lung infections due to factors such as prolonged hospital stays, assisted ventilation, lung damage, and immune suppression, affecting both morbid patients and survivors. Aim: To describe the histopathological spectrum of infective lesions of lung in autopsy during Pre COVID-19 and COVID-19 era in a tertiary care hospital of Tirunelveli, Tamil Nadu, India. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology at Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India, between January 2018 and December 2021. Data including age, sex, COVID-19 status, clinical history, histomorphological patterns, and identification of infectious agents, were collected from clinico-pathological and autopsy documents. A total of 627 lung specimens were available, with 41 specimens being autolyzed, leaving 586 specimens for inclusion in the study. Gross morphology and microscopic features were documented, and diagnoses were made based on these findings. Results: The study included a total of 586 specimens, of which 76 (12.9%) were reported as infective pathology. Among these cases, 29 (38.1%) cases were reported in the pre COVID19 period, and 47 (61.9%) were reported during the COVID19 period. Of the 76 cases, 41 (53.95%) were male, and 35 (46.05%) were female. The number of cases reported during the post COVID-19 period (47 cases, 61.84%) was higher than the number reported during the pre COVID-19 period (29 cases, 38.16%). In both periods, the majority of cases (10 cases, 13.1% in the pre COVID-19 period; 13 cases, (17.1%) in the post COVID-19 period) were observed in individuals aged 60 years and above, followed by those in the age group of 50 to 59 years (7 cases, 9.2%). Similarly, in the pre COVID-19 period; 10 cases, 13.2% in the post COVID-19 period). Among the 76 cases, interstitial pneumonia (9 cases, 11.8%) was the most common finding in the pre COVID-19 period, followed by bronchopneumonia (seven cases, 9.2%). In the COVID-19 period, Tuberculosis (TB) was the most common finding (17 cases, 22.4%), followed by pneumonia with consolidation (10 cases, 13.2%). Additionally, the number of cases diagnosed with pulmonary TB during the COVID-19 period (17 cases, 22.4%) was higher than that during the pre COVID-19 period (6 cases, 7.9%). During the post COVID-19 period, there has been a drastic increase in the number of pneumonia cases compared to the pre COVID-19 era, and this increase is statistically significant with a p-value of 0.04. Conclusion: Pneumonia (lobar pneumonia, interstitial pneumonia, and bronchopneumonia) is the most common histopathological lung lesion in the present study. Compare to pre COVID-19 era, there is increased number of infective lesions during COVID-19 era. There was a drastic increase in pathological findings of Kochs lesion during COVID-19 era. [ABSTRACT FROM AUTHOR]

Introduction: Aspergillus is one of the most ubiquitous airborne saprophytic fungi. Humans constantly inhale numerous conidia of this fungus. The conidia are normally eliminated in the immunocompetent host by innate immune mechanisms. With increase in the number of immunocompromised patients, there has been a dramatic increase in severe and fatal invasive aspergillosis (IA). The present study was aimed to know the clinico-mycological profile of suspected pulmonary aspergillosis cases. Methods: The present study was a prospective study conducted over a period of 1 year in the department of microbiology in admitted cases with clinical suspicion of pulmonary aspergillosis. Samples such as sputum, bronchoalveolar lavage, endotracheal secretions, fine-needle aspiration or biopsy and blood (for serological analysis) were collected and processed as per standard protocol. Results: Over a period of 1 year, 89 cases were included in the study. Their mean age was 58.7 years. Majority were male (60.6%). The most common presentation was cough (89.9%), followed by chest pain (57.3%) and fever (56.2% most common chest X-ray finding was homogeneous haziness (40.4%). Fungal smear was positive in 55.1% and 61.8% showed fungal growth. Galactomannan (GM) and (1-3)-β-D glucan positivity were 56% and 83.3%, respectively. The mortality was observed in 21.4% of patients. Conclusions: The study demonstrated that GM assay and (1-3)-β-D glucan assay are useful diagnostic modalities with a high sensitivity and specificity for the detection of pulmonary aspergillosis in high-risk patients along with positive fungal culture. Thus, these tests are early markers for IA. [ABSTRACT FROM AUTHOR]

Pulmonary aspergillosis has always been considered as a disease that occurs in patients with certain risk factors for its development. The COVID-19 pandemic has shown that fungal complications are common in patients without aspergillosis risk factors. Thus, invasive aspergillosis is a common complication of COVID-19. There are rare reports of aspergilloma that developed after a severe coronavirus infection in individuals who did not previously have cavitary lesions in the lungs. Development of aspergilloma as an expected long-term complication after COVID-19 may be due to damage of lung structure caused by coronavirus infection, oxygen therapy and mechanical ventilation. This article describes a case report of aspergilloma in a patient with confirmed severe COVID-19 and background chronic diseases without risk factors for fungal infection. A review of publications on the development of aspergilloma in patients following COVID-19 is also presented.

Introduction: Aspergillus is one of the most ubiquitous airborne saprophytic fungi. Humans constantly inhale numerous conidia of this fungus. The conidia are normally eliminated in the immunocompetent host by innate immune mechanisms. With increase in the number of immunocompromised patients, there has been a dramatic increase in severe and fatal invasive aspergillosis (IA). The present study was aimed to know the clinico-mycological profile of suspected pulmonary aspergillosis cases. Methods: The present study was a prospective study conducted over a period of 1 year in the department of microbiology in admitted cases with clinical suspicion of pulmonary aspergillosis. Samples such as sputum, bronchoalveolar lavage, endotracheal secretions, fine-needle aspiration or biopsy and blood (for serological analysis) were collected and processed as per standard protocol. Results: Over a period of 1 year, 89 cases were included in the study. Their mean age was 58.7 years. Majority were male (60.6%). The most common presentation was cough (89.9%), followed by chest pain (57.3%) and fever (56.2% most common chest X-ray finding was homogeneous haziness (40.4%). Fungal smear was positive in 55.1% and 61.8% showed fungal growth. Galactomannan (GM) and (1-3)-β-D glucan positivity were 56% and 83.3%, respectively. The mortality was observed in 21.4% of patients. Conclusions: The study demonstrated that GM assay and (1-3)-β-D glucan assay are useful diagnostic modalities with a high sensitivity and specificity for the detection of pulmonary aspergillosis in high-risk patients along with positive fungal culture. Thus, these tests are early markers for IA.

Abstract 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.

Objective: To determine the frequency of aspergilloma in clinically diagnosed and undiagnosed patients of cavitatory pulmonary tuberculosis. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology, and Imaging Rawalpindi Pakistan, from May to Oct 2019. Methodology: Total of 236 patients with clinically diagnosed or having suspicion of cavitatory pulmonary tuberculosis were included. High-resolution computed tomography showing a single or multiple well defined cavities within consolidation with cavities having aspergilloma, nodules with tree in bud configuration in upper lobes of lung or superior segments of lower lobes were recorded. Results: Out of these 236 patients, 140(59.32%) were males and 96(40.68%) were females. The age of patients ranged from 18- 70 years with mean age of 43.56±10.13 years. In our study, aspergilloma in clinically diagnosed and undiagnosed patients of cavitatory pulmonary tuberculosis was found in 27(11.44%) patients. Conclusion: This study revealed that incidence of aspergilloma in clinically diagnosed and undiagnosed patients of cavitatory pulmonary tuberculosis is quite high.

Invasive fungal diseases are an important cause of mortality in immunocompromised patients and in patients with chronic illnesses. Multiple studies in Bangladesh have documented the frequency of fungal infections in our country and results varied. However, better understanding of the invasive fungal infection includes learning about the epidemiology, clinical features, and diagnostic method which is integral part of improving outcomes. In this review, we discuss the common invasive fungal infection that are prevalent in our country along with the clinical pictures, diagnosis, and treatment. It is hoped that this article will highlight the burden of fungal infections on public health and promote effective diagnosis and therapy. [ABSTRACT FROM AUTHOR]

Despite the ubiquity of Aspergillus species, and the fact that a person may inhale hundreds of conidia daily, only a small proportion of patients develop an infectious disease. Aspergillus spp. can cause a wide spectrum of diseases, depending on the patient’s underlying immune function; these range from an allergic syndrome, (which does not represent a true infection), a hypersensitivity reaction (ABPA), a chronic process (CPA) or invasive aspergillosis (IA). All diseases associated with Aspergillus spp. have the potential to be misdiagnosed because symptoms and/or clinical findings overlap with each other, or with other non-fungal conditions. Greater clinical recognition of the different pulmonary syndromes is needed to identify those patients who could benefit from an appropriate therapeutic approach. Multidisciplinary management is required, where the role of antifungal therapy is only established for symptomatic and/or progressive disease management, ta-king into account the potential for azole resistance, which adds to the complexity of treatment and, in some cases, limits therapeutic options.

An aspergilloma is a conglomeration of Aspergillus hyphae, fibrin, mucus, and cellular debris, typically found within a pulmonary cavity or ectatic bronchus. Computerized tomography (CT) scans often depict a cavity containing a solid mass and a notable crescent sign. Though these signs are indicative of aspergilloma, the European Respiratory Society emphasizes the need for a more detailed diagnostic criteria. A patient with a history of hemoptysis was initially diagnosed with an aspergilloma based on CT chest findings, showing a cavitary lesion in the left upper lobe with an intracavitary lobular opacity. Post resection, histological examination contradicted the initial diagnosis, revealing lung cancer instead. This case underscores the importance of tissue diagnosis from the outset or employing a multifaceted diagnostic criteria encompassing radiological findings, serology and microbiology tests. In the absence of an initial tissue diagnosis, rigorous follow-up, including early interval scanning, is crucial. [ABSTRACT FROM AUTHOR]

Background: Interferon-gamma (IFN-γ) down-regulates plasma procalcitonin (PCT), marker of inflammation. Chronic pulmonary aspergillosis (CPA) is associated with low IFN-γ levels. Thus, plasma PCT may be elevated in CPA and could have a role in diagnosing and monitoring treatment response in CPA. Herein, we investigate the diagnostic performance of plasma PCT in CPA. Methods: We extracted the demographic, clinical, radiological, treatment outcomes, and plasma PCT levels of CPA subjects and controls (previously treated pulmonary tuberculosis with radiological abnormalities on CT chest [diseased controls] and treatment naïve active pulmonary tuberculosis [PTB]). We treated CPA subjects with six months of oral itraconazole. We took 0.25 ng/mL as a cut-off value for PCT. The study’s primary objective was to ascertain the diagnostic performance of PCT in diagnosing CPA. The key secondary outcome was to study the change in the plasma PCT levels after itraconazole therapy. Results: We included 190 CPA cases and 40 controls (diseased controls [n = 20] and active PTB [n = 20]). PCT was elevated (≥0.25 ng/mL) in only 7 (3.7%) subjects with CPA. The sensitivity and specificity of PCT (≥0.25 ng/mL) were 3.7% (1.5–7.4%) and 100 (91.2–100%), respectively. The area under the curve for plasma PCT was 0.48 (95% confidence interval, 0.39–0.58). The plasma PCT values were available in 93 subjects at six months. There was a significant decline in the median plasma levels of PCT after treatment; however, the PCT levels either increased or remained the same in 45% of the subjects. Conclusion: Plasma procalcitonin has poor performance in diagnosing and following subjects with CPA.

Abstract Background Hemoptysis is a life-threatening complication due to bleeding either from hypertrophied bronchial arteries or enlarged non-bronchial systemic collaterals, having multiple etiologies. Bronchial artery embolization (BAE) is a minimally invasive modality of management that can effectively manage moderate-to-severe hemoptysis. Case presentation We report the case of a 25-year-old female with moderate-to-severe hemoptysis. There was prior history of tuberculosis and treatment with anti-tubercular therapy 6 months back. There was also a background of tetralogy of Fallot(TOF) with symptoms of chronic breathlessness and palpitations. Imaging evaluation with X-ray and HRCT thorax revealed a cavity in the left upper lobe with dependent soft tissue, implying a diagnosis of aspergilloma in an old tubercular cavity. TOF and right-sided aortic arch were noted. CT bronchial angiography showed dilated and tortuous left bronchial artery, as well as non-bronchial systemic collaterals from the ipsilateral internal mammary artery. Endovascular management was achieved by super-selective catheterization and embolization of the involved branch of the left bronchial artery and selective embolization of non-bronchial systemic collaterals from the ipsilateral internal mammary artery. Conclusions BAE has a high clinical success rate and is recommended as first-line therapy in the management of massive hemoptysis. The CT pulmonary angiography, as well as the pre-embolization angiogram, is very important to detect the source of hemoptysis from the non-bronchial systemic circulation, increasing the success rate and decreasing the incidence of recurrence. BAE is effective even in presence of underlying vascular anomalies such as Fallot of Tetralogy.

Pulmonary aspergilloma is commonly associated with tuberculosis. Pulmonary aspergilloma is found in residual tuberculosis cavities and potential for other pathogens’ infections due to its sufficient oxygen and necrotizing tissue. A 48-year-old woman came with shortness of breath and cough for 7 months. She was diagnosed with pulmonary tuberculosis 9 months ago and was still under anti-tuberculosis drug therapy. She also suffered from type II diabetes mellitus. Chest examination showed vesicular sound decreased in third to fourth left intercostal spaces. A chest x-ray revealed a thick-walled cavity with the air-crescent sign in the left upper lobe lung leads to aspergilloma and active pulmonary tuberculosis. This finding was confirmed by the contrast-enhanced CT scan of the chest and continued to lobectomy. Histological examination confirmed the presence of a granuloma formation, necrosis, hyphae structure with the conclusion of Aspergillus sp. infection.

Background: Aspergillosis is a fungal infection that can lead to development of an aspergilloma, especially in patients with a history of cavitary lung disease. It is generally managed with antifungal therapy followed by surgical intervention. There are, however, limited options for the nonsurgical patient. Microwave ablation is already an effective, minimally invasive treatment being used in some lung malignancies and may be an alternative and definitive treatment in the inoperable patient. Methods: Two patients were considered for microwave ablation following their diagnoses of aspergillosis with hemoptysis. We sought to evaluate the efficacy of CT-guided microwave ablation of an aspergilloma in these patients who were not good candidates for surgical intervention. Results: Two male patients presented with hemoptysis and were found to have an aspergilloma. Case 1 was initially treated with antifungals and did not improve. He proceeded with VATS, and the procedure was aborted intraoperatively secondary to a frozen chest cavity. The patient subsequently elected to undergo CT-guided microwave ablation. He did not experience any immediate complications but was hospitalized for hemoptysis several weeks later. He developed alveolar hemorrhage and ultimately succumbed to PEA arrest.Case 2 was without hemoptysis at follow up and chose to pursue microwave ablation for definitive treatment. Case 2 developed post ablation pneumothorax requiring chest tube placement. Follow-up CT chest imaging was consistent with resolution of the aspergilloma. Conclusion: Microwave ablation is a safe and effective therapeutic approach in the treatment of lung malignancy with no severe or death related complications. There are almost no absolute contraindications. Microwave ablation may be utilized as a therapeutic option in the treatment of an aspergilloma in the non-surgical patient. This novel application may challenge the current gold standard of surgical intervention.

Introduction. Intracavitary aspergilloma is the consequence of a saprophytic infection of the lung with cavitary disease. Pulmonary tumorlet are nodular proliferations of the neuroendocrine cells less than 5 mm in diameter. Both aspergilloma in the bronchiectatic cavity of the lung and pulmonary tumorlet has rare been seen. Case outline. We present a 71-year-old woman with a medical history of recurrent pneumonia complicated with cough and hemoptysis. Computed tomography (CT) scan of the chest showed pulmonary soft tissue mass in the right lower lobe of the lung 42 × 50 mm in diameter. Direct microscopy of the specimens of bronchioalveolar lavage showed spores of Aspergillus. Galactoman Ag test was also positive. Right lower lobectomy and mediastinal lymph node sampling was performed via thoracotomy. Pathohistological findings showed aspergilloma with the presence of pulmonary tumourlet and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) in the lymphovascular spaces. Five years follow up showed no abnormalities on the CT scan, and the patient remained alive without medical problems. Conclusion. The concomitant occurrence of bronchiectasis, aspergilloma, and precancerous lesions such as pulmonary tumourlet and DIPNECH is rare and further increases the risk of developing malignant tumors as well as recurrent infections. Therefore, surgical treatment can prevent the development of premalignant lesions and the occurrence of recurrent infections accompanied by dyspnea and hemoptysis as the main symptoms. The question of the connection between pulmonary tumourlet and chronic inflammatory lung diseases is raised. We hope that future researches will provide answers to this question.

Chronic pulmonary aspergillosis (CPA) is a recognized complication of pulmonary tuberculosis (TB). In 2015, the World Health Organization reported 2.2 million new cases of nonbacteriologically confirmed pulmonary TB; some of these patients probably had undiagnosed CPA. In October 2016, the Global Action Fund for Fungal Infections convened an international expert panel to develop a case definition of CPA for resource-constrained settings. This panel defined CPA as illness for >3 months and all of the following: 1) weight loss, persistent cough, and/or hemoptysis; 2) chest images showing progressive cavitary infiltrates and/or a fungal ball and/or pericavitary fibrosis or infiltrates or pleural thickening; and 3) a positive Aspergillus IgG assay result or other evidence of Aspergillus infection. The proposed definition will facilitate advancements in research, practice, and policy in lower- and middle-income countries as well as in resource-constrained settings.

Chronic pulmonary aspergillosis (CPA) is a severe disease that develops mainly in patients without obvious immune disorders. Computed tomography is the main instrumental method in the diagnosis of CPA, which is necessary to determine the form of the disease, to choose treatment policy, to combat complications, and to monitor therapy. This makes it important for a radiologist to understand the main aspects of timely and differential diagnosis. There are insufficient Russian studies on this problem. This paper analyzes the 2014–2020 Russian and foreign publications available in PubMed, Web of Science, Elsevier, and eLibrary electronic databases. When searching for information, the following keywords were used: “computed tomography”, “chronic pulmonary aspergillosis”, “aspergilloma”, “air-crescent symptom”, “differential diagnosis”.

Abstract Background In recent years, the incidence of pulmonary aspergilloma has increased. The harm of aspergilloma is life-threatening massive hemoptysis, and the conventional treatment is surgical treatment. However, whether the antifungal treatment after surgery is required and the course of treatment before and after surgery are still unclear. Methods In this study, patients with pulmonary aspergilloma confirmed pathologically after surgery will be selected as subjects to conduct a single-center, randomized, parallel grouping, prospective, 2-year clinical study. Through regular visits, the recurrence of aspergillus infection, quality of life, lung function indicators, safety of antifungal therapy and other indicators were recorded to evaluate the recurrence risk of aspergillus infection and safety of antifungal agents. Cox proportional risk regression model was used to analyze the influencing factors of antifungal therapy on aspergillus infection recurrence after aspergillus bulbectomy. Cox multiple regression model was used for optimal model fitting, and regression coefficient (β), relative risk (RR) and 95% confidence interval of RR were calculated. Discussion The study will explore whether antifungal therapy could improve the quality of life, reduce the recurrence of aspergillus infection, and ultimately improve the prognosis of patients with aspergilloma. The study results will provide high-quality evidence-based medical evidence for the formulation, revision and optimization of international and domestic clinical guidelines and expert consensus on chronic aspergillus lung disease, effectively improve the clinical treatment effect of aspergilloma, and form the latest concept of diagnosis and treatment of aspergilloma. Trial registration: The trial was registered on the Chinese Clinical Trial Registry website ( https://www.chictr.org.cn/showprojen.aspx?proj=33231 ). Registration number: ChiCTR1800019990.

Abstract 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.

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]

Chronic pulmonary aspergillosis (CPA) treatment in Africa remains unexplored. We present a 23-year-old Ugandan male, previously treated thrice for pulmonary tuberculosis, developing CPA. Imaging showed lung fibrosis, bronchiectasis, and a fungal ball. He received weekly 600mg (10mg/kg) of liposomal amphotericin B for six weeks, leading to marked clinical improvement. Weekly liposomal amphotericin B may be a viable treatment option for CPA in resource-limited settings., Competing Interests: All authors declare that they have no conflict of interest., (© 2024 The Authors.)

We report a case of an Aspergillus fungal ball in a transplant graft kidney presenting as obstructive nephropathy. This is a rare manifestation considering the usual presentations of Aspergillus infection, which are pulmonary, rhino-cerebral, and disseminated forms. Imaging showed hydronephrosis with an echogenic material in the transplant renal pelvis, which was further found to be the fungal ball. The patient underwent a graft nephrectomy due to severe sepsis, and following that, his condition improved., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, T et al.)

We report a coexistence of Mounir-Kuhn syndrome and aspergilloma in a 69-year-old male presented with hemoptysis, cough, shortness of breath and fever. This patient has a history of recurrent hospital admissions for infective exacerbations of chronic obstructive pulmonary disease. Diagnostic imaging revealed the presence of aspergilloma and marked dilatation of the trachea and main bronchi, leading to a diagnosis of Mounier-Kuhn syndrome. Given the frequent association of Mounier-Kuhn syndrome with recurrent respiratory infections, we recommend that clinicians consider this syndrome when evaluating patients with recurrent pneumonia., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

In the COVID-19 pandemic era, an increasing number of cases of mucormycosis have been associated with COVID-19. Mucormycosis is an invasive fungal infection in the background of immunosuppression state. COVID-19 and its treatment cause immunosuppression in patients. Mucormycosis commonly causes necrosis in the nose, paranasal sinuses, and facial bones and may also spread into the brain and lungs. A 58-year-old male, who was a known case of diabetes mellitus, was admitted with COVID-19 reverse transcription–polymerase chain reaction positive and B/L GGO with 50% lung involvement in computed tomography (CT) chest, treated as per protocol, and discharged. After 2 weeks of discharge patient presented with hemoptysis, cough with expectoration and breathlessness. Patient was admitted and stabilized. CT chest taken showed right (Rt) upper lobe and lower lobe mucormycosis and left (Lt) upper lobe and lower lobe aspergilloma. Fiberoptic bronchoscopy was done and bronchial wash taken then sent for fungal KOH and culture.fungal culture report showed mixed fungal infection like mucormycosis and aspergilloma. Patient treated with tablet posaconazole and other supportive measures and discharged. Patient asked to review every month. Followup CT chest taken at 1 month and end of 5 months. CT chest revealed partial resolution of Rt upper and lower lobe mucormycosis and persistence of Lt upper and lower lobe aspergilloma lesions. The patient persistently had hemoptysis and hence was referred to cardiothoracic surgery for surgical management of aspergilloma. COVID-19 and treatment of COVID-19 cause underlying immunosuppression that leads to fungal infections such as mucormycosis and aspergilloma. Early identification and treatment of fungal infection reduce morbidity and mortality.

Tuberculosis (TB) constitutes a significant burden of infectious diseases worldwide. TB and human immunodeficiency virus (HIV) coinfection potentiate each other, which has a negative impact on the disease progression. Aspergillus colonizing a preexisting parenchymal tubercular cavity is referred to as aspergilloma. Aspergilloma occurring in a patient with active TB is unusual. We report the case of a 50-year-old male who presented to us with complaints of cough and recurrent hemoptysis for 3 months. Clinical and radiological examination revealed right upper lobe aspergilloma. A right upper lobectomy was done and a histopathological examination showed evidence of active TB. The patient was started on antitubercular therapy (ATT) followed by antiretroviral therapy (ART). The presence of active TB should not be overlooked in a patient with aspergilloma, especially in immune-compromised individuals such as people living with HIV, as definitive treatment with surgical resection, and ATT along with ART has better outcomes.

Background: Hemoptysis is a life-threatening complication due to bleeding either from hypertrophied bronchial arteries or enlarged non-bronchial systemic collaterals, having multiple etiologies. Bronchial artery embolization (BAE) is a minimally invasive modality of management that can effectively manage moderate-to-severe hemoptysis. Case presentation: We report the case of a 25-year-old female with moderate-to-severe hemoptysis. There was prior history of tuberculosis and treatment with anti-tubercular therapy 6 months back. There was also a background of tetralogy of Fallot(TOF) with symptoms of chronic breathlessness and palpitations. Imaging evaluation with X-ray and HRCT thorax revealed a cavity in the left upper lobe with dependent soft tissue, implying a diagnosis of aspergilloma in an old tubercular cavity. TOF and right-sided aortic arch were noted. CT bronchial angiography showed dilated and tortuous left bronchial artery, as well as non-bronchial systemic collaterals from the ipsilateral internal mammary artery. Endovascular management was achieved by super-selective catheterization and embolization of the involved branch of the left bronchial artery and selective embolization of non-bronchial systemic collaterals from the ipsilateral internal mammary artery. Conclusions: BAE has a high clinical success rate and is recommended as first-line therapy in the management of massive hemoptysis. The CT pulmonary angiography, as well as the pre-embolization angiogram, is very important to detect the source of hemoptysis from the non-bronchial systemic circulation, increasing the success rate and decreasing the incidence of recurrence. BAE is effective even in presence of underlying vascular anomalies such as Fallot of Tetralogy. [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]

Cardiac lipoma is a rare tumor and usually presents as lipomatous hypertrophy of the septum. Cardiac mass in the RV usually occurs due to thrombus from venous thromboembolism or cardiac tumor or vegetation. We present a case of cardiac lipoma in an elderly female who presented with dyspnea on exertion and aspergilloma in the lung, with echocardiogram revealing a cardiac mass. Endomyocardial biopsy identified the mass as lipoma. Multimodality approach may help in identifying the correct diagnosis in case of cardiac tumors. Cardiac tumors should be kept as a differential diagnosis in an undiagnosed right ventricular mass not responding to anticoagulation.

Abstract 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 Background Aspergillus infection is more common among premature infants in neonatal intensive care units, who have decreased qualitative immune defenses and need various invasive treatment procedures. It is rare in normal full-term neonates, especially in newborn babies from the community. Moreover, the white blood cell (WBC) count and C-reactive protein (CRP) level may be normal or slightly changed in fungal infections, but the neonate reported in this study had significant increases in WBC and CRP. To the best of our knowledge, this is the first report on a full-term neonate from the community with aspergillus infection accompanied by significant increases in WBC and CRP levels. Case presentation A 28-day-old infant, who received empirical antibiotic treatment for 10 days because of neonatal pneumonia, was referred to our neonatal department from the local hospital. The infant had persistent infection and multiple organ failure syndromes. Bronchoscopy and deep sputum smear were performed to identify the pathogen, which confirmed aspergillus infection in the sputum. Fluconazole was immediately administered, but the baby died after three days. Thereafter, an autopsy was performed with parental consent. There were multiple necrotic areas in the lungs and liver, and pathological examination revealed aspergillus. Conclusions The present case emphasized that community-sourced aspergillus infection can exist in full-term neonates, with significantly increased WBC count and CRP level. Advanced antibiotics were not effective in this case, and fungal infections should have been considered earlier.

Background:Tuberculosis (TB) is a common disease in developing countries. About 2 billion persons are affected by TB that equals to around one Fourth of the World’s population, India leads the group & elderly patients suffer the most.Material and Methods:We included 100 elderly pulmonary TB patients in this study which was conducted in Department of Respiratory Medicine at RBM Hospital in Govt. Medical College, Bharatpur, Rajasthan. The duration of study was over a period of one year from December 2020 to December 2021.Results:In this study we included total 100 cases. Among all 71% male & 29% were female. We included elderly cases in this study as they have lots of complications & comorbidity, age ranged from 61-90 age groups. Predominantly, 66% cases had cough, 31% developed fever, Shortness of breath on exertion (61%), weakness (75%), hemoptysis(17%), Loss of appetite (35%) & Chest pain (21%), altered sensorium in 4%. Chief radiological features were consolidation, cavitations, Fibrocavitary disease, silicotuberculosis& aspergilloma, apart from others. In this study, we initiated RHEZ in 48 new cases & in 19 cases categorized retreatment with RHEZ. 11 cases had to be started on alternative regimen i.e. SEQ (Sm, Ethambutol, Quinolone), due to liver problems and 8 cases were started on dose modified regimen (due to renal reasons). Shorter injectable MDR regimen was started in 13 cases and Bedaquilline containing regimen was given in 1 case. Conclusion:We conclude that radiological features are very common, extensive and crucial in diagnosing & managing pulmonary TB patients especially the older age group even in absence of relevant clinical & microbiological evidence which needs to be addressed in totality. [ABSTRACT FROM AUTHOR]

Sphenoid sinus aspergilloma (SSA) with visual loss has rarely been reported. Timely recognition and prompt surgical intervention are crucial to avoid permanent neurological consequences.

Introduction: Aspergillosis is a fungal disease caused by the Aspergillus fumigatus. Until now, the management of aspergilloma is still controversial, and there is no consensus among experts. Hamartoma is a benign tumor that can be found in the lung. We report a case of pulmonary aspergilloma coincidentally with hamartoma in pulmonary tuberculosis (TB) patients. Aspergilloma and hamartoma diagnoses are challenging because of various clinical symptoms. Case report: A 46 years old man came to emergency unit with complaints shortness of breath, cough, and chest tightness. He also has a red-black blood streak and terrible odor sputum. He had a history of two episodes of pulmonary TB. Holistic physical and additional examinations were done. Patient was diagnosed with aspergillosis infection in post pulmonary TB. The patient was then undergoing surgery. From the pathology of lung tissue, we found hamartoma features. Antifungal, antibiotic, and supported therapy were given, and his condition improved after a month of hospitalization. Conclusion: Pulmonary aspergilloma and hamartoma coincidence are rare diseases. Aspergilloma diagnosis is made based on clinical symptoms, radiological, and serological examination. Pulmonary hamartoma is generally asymptomatic. In this case, hamartoma was incidentally found in pathology examination. Prompt and precise diagnosis with good therapeutic management yield favorable outcomes.

Tuberculosis (TB) constitutes a significant burden of infectious diseases worldwide. TB and human immunodeficiency virus (HIV) coinfection potentiate each other, which has a negative impact on the disease progression. Aspergillus colonizing a preexisting parenchymal tubercular cavity is referred to as aspergilloma. Aspergilloma occurring in a patient with active TB is unusual. We report the case of a 50-year-old male who presented to us with complaints of cough and recurrent hemoptysis for 3 months. Clinical and radiological examination revealed right upper lobe aspergilloma. A right upper lobectomy was done and a histopathological examination showed evidence of active TB. The patient was started on antitubercular therapy (ATT) followed by antiretroviral therapy (ART). The presence of active TB should not be overlooked in a patient with aspergilloma, especially in immune-compromised individuals such as people living with HIV, as definitive treatment with surgical resection, and ATT along with ART has better outcomes. [ABSTRACT FROM AUTHOR]

Background: In recent years, the incidence of pulmonary aspergilloma has increased. The harm of aspergilloma is life-threatening massive hemoptysis, and the conventional treatment is surgical treatment. However, whether the antifungal treatment after surgery is required and the course of treatment before and after surgery are still unclear.Methods: In this study, patients with pulmonary aspergilloma confirmed pathologically after surgery will be selected as subjects to conduct a single-center, randomized, parallel grouping, prospective, 2-year clinical study. Through regular visits, the recurrence of aspergillus infection, quality of life, lung function indicators, safety of antifungal therapy and other indicators were recorded to evaluate the recurrence risk of aspergillus infection and safety of antifungal agents. Cox proportional risk regression model was used to analyze the influencing factors of antifungal therapy on aspergillus infection recurrence after aspergillus bulbectomy. Cox multiple regression model was used for optimal model fitting, and regression coefficient (β), relative risk (RR) and 95% confidence interval of RR were calculated.Discussion: The study will explore whether antifungal therapy could improve the quality of life, reduce the recurrence of aspergillus infection, and ultimately improve the prognosis of patients with aspergilloma. The study results will provide high-quality evidence-based medical evidence for the formulation, revision and optimization of international and domestic clinical guidelines and expert consensus on chronic aspergillus lung disease, effectively improve the clinical treatment effect of aspergilloma, and form the latest concept of diagnosis and treatment of aspergilloma.Trial Registration: The trial was registered on the Chinese Clinical Trial Registry website ( https://www.chictr.org.cn/showprojen.aspx?proj=33231 ). Registration number: ChiCTR1800019990. [ABSTRACT FROM AUTHOR]