95 results on '"Pulmonary Aspergillosis etiology"'
Search Results
2. Aspergillus and the Lung.
- Author
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Janssens I, Lambrecht BN, and Van Braeckel E
- Subjects
- Humans, Aspergillus, Aspergillus fumigatus, Lung, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis drug therapy, Pulmonary Aspergillosis etiology
- Abstract
The filamentous fungus Aspergillus causes a wide spectrum of diseases in the human lung, with Aspergillus fumigatus being the most pathogenic and allergenic subspecies. The broad range of clinical syndromes that can develop from the presence of Aspergillus in the respiratory tract is determined by the interaction between host and pathogen. In this review, an oversight of the different clinical entities of pulmonary aspergillosis is given, categorized by their main pathophysiological mechanisms. The underlying immune processes are discussed, and the main clinical, radiological, biochemical, microbiological, and histopathological findings are summarized., Competing Interests: None declared. E.V.B. is chair of the Chronic Pulmonary Aspergillosis Network (CPAnet)., (Thieme. All rights reserved.)
- Published
- 2024
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3. Feasibility and safety of uniportal thoracoscopy for chronic pulmonary aspergillosis.
- Author
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Wang B, Yao L, Sheng J, Liu X, Jiang Y, Shen L, Xu F, Liu Q, Gao C, and Dai X
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- Humans, Male, Middle Aged, Female, Thoracic Surgery, Video-Assisted methods, Retrospective Studies, Feasibility Studies, Antifungal Agents therapeutic use, Voriconazole therapeutic use, Postoperative Complications etiology, Lung Neoplasms surgery, Pulmonary Aspergillosis drug therapy, Pulmonary Aspergillosis surgery, Pulmonary Aspergillosis etiology
- Abstract
Surgery plays a crucial role in the treatment of patients with chronic pulmonary aspergillosis (CPA). However, there is currently limited information available regarding the use of uniportal thoracoscopy (Uni-VATS) in CPA patients. To address this gap, we conducted a retrospective analysis of surgical procedures performed at a single center, aiming to demonstrate the feasibility and safety of Uni-VATS for patients with CPA. We collected basic information and surgical data from patients who underwent surgery for CPA at our hospital between January 2018 and June 2022. All patients received voriconazole antifungal medication for 3-6 months post-surgery and were monitored for a minimum of 6 months. A total of 110 patients, comprising 59 cases in the traditional open chest incision group and 51 cases in the Uni-VATS group, met the inclusion criteria. Among those who underwent surgery, 70% were male (77/110). The median age (IQR) of all enrolled patients was 55 (46-62) years. There were no statistically significant differences in general information, such as age, sex, comorbidities, BMI, FEV1, FVC, clinical symptoms, location of the disease, and duration of voriconazole antifungal medication, between the OS group and the Uni-VATS group (p > 0.05). The postoperative complication rates were 40.7% (24/59) for the traditional open chest incision group and 17.6% (9/51) for the Uni-VATS group. Through univariate analysis, we identified sex and operative approach as risk factors for postoperative complications. Multivariate logistic analysis confirmed that male and OS procedures were the independent risk factors for postoperative complications. There were statistically significant differences in operative time, intraoperative blood loss volume, postoperative drainage volume, pain scores, postoperative drainage tube removal time, postoperative hospital stay time between the OS group and the Uni-VATS group (p < 0.05). Uni-VATS is a feasible and safe surgical procedure for patients with CPA, and we recommend it as a preferred option for selected patients with CPA., (© 2023. Springer Nature Limited.)
- Published
- 2023
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4. Superinfections in COVID-19 patients receiving extracorporeal membrane oxygenation support.
- Author
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Andersen HV, Jørgensen VRL, Steensen M, Pedersen FM, and Helleberg M
- Subjects
- Humans, Male, Middle Aged, Female, Retrospective Studies, COVID-19 complications, COVID-19 therapy, Extracorporeal Membrane Oxygenation adverse effects, Superinfection etiology, Pulmonary Aspergillosis etiology, Cytomegalovirus Infections etiology
- Abstract
Background: The risk of superinfections and associations with mortality among patients with corona virus disease 2019 (COVID-19) receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) is poorly elucidated., Method: We identified all patients with COVID-19 treated with VV-ECMO >24 h at Rigshospitalet, Denmark from March 2020 to December 2021. Data were obtained by review of medical files. Associations between superinfections and mortality were assessed by logistic regression analyses adjusted for sex and age., Results: Fifty patients, median age 53 years (interquartile range [IQR] 45-59), 66% male, were included. Median time on VV-ECMO was 14.5 days (IQR 6.3-23.5), 42% were discharged from hospital alive. Bacteremia, ventilator associated pneumonia (VAP), invasive candidiasis, pulmonary aspergillosis, herpes simplex virus, and cytomegalovirus (CMV) were detected in 38%, 42%, 12%, 12%, 14%, and 20% of patients, respectively. No patients with pulmonary aspergillosis survived. CMV was associated with increased risk of death, odds ratio 12.6 (95% confidence interval 1.9-257, p = .05), whereas we found no associations between other superinfections and risk of death., Conclusion: Bacteremia and VAP are common but does not seem to affect mortality, whereas pulmonary aspergillosis and CMV are associated with poor prognosis among COVID-19 patients treated with VV-ECMO., (© 2023 CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)
- Published
- 2023
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5. SARS-CoV-2 Associated Immune Dysregulation and COVID-Associated Pulmonary Aspergilliosis (CAPA): A Cautionary Tale.
- Author
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Worku DA
- Subjects
- Antifungal Agents therapeutic use, Biomarkers, COVID-19 virology, Disease Management, Humans, Immunocompromised Host, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis therapy, Reproducibility of Results, Serologic Tests methods, Serologic Tests standards, Treatment Outcome, COVID-19 complications, COVID-19 immunology, Disease Susceptibility immunology, Host-Pathogen Interactions immunology, Pulmonary Aspergillosis etiology, SARS-CoV-2 immunology
- Abstract
As the global SARS-CoV-2 pandemic continues to plague healthcare systems, it has become clear that opportunistic pathogens cause a considerable proportion of SARS-CoV-2-associated mortality and morbidity cases. Of these, Covid-Associated Pulmonary Aspergilliosis (CAPA) is a major concern with evidence that it occurs in the absence of traditional risk factors such as neutropenia and is diagnostically challenging for the attending physician. In this review, we focus on the immunopathology of SARS-CoV-2 and how this potentiates CAPA through dysregulation of local and systemic immunity as well as the unintended consequences of approved COVID treatments including corticosteroids and IL-6 inhibitors. Finally, we will consider how knowledge of the above may aid in the diagnosis of CAPA using current diagnostics and what treatment should be instituted in probable and confirmed cases.
- Published
- 2022
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6. Thoracic Air Leak Syndrome, Pulmonary Aspergillosis, and COVID-19 Pneumonia After Allogeneic Stem Cell Transplantation in a Child With Myelodysplastic Syndrome.
- Author
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Sever T, Kaya Z, Kirkiz S, Celik A, Akdulum I, Gürsoy TR, Aslan AT, Deniz M, Tapisiz A, and Kocak U
- Subjects
- Adolescent, COVID-19 virology, Female, Graft vs Host Disease etiology, Humans, Myelodysplastic Syndromes pathology, Pneumonia, Viral etiology, Prognosis, Pulmonary Aspergillosis etiology, Pulmonary Emphysema etiology, Risk Factors, SARS-CoV-2 isolation & purification, COVID-19 complications, Graft vs Host Disease pathology, Hematopoietic Stem Cell Transplantation adverse effects, Myelodysplastic Syndromes therapy, Pneumonia, Viral pathology, Pulmonary Aspergillosis pathology, Pulmonary Emphysema pathology
- Abstract
Thoracic air leak syndromes (TALS) are very rare among the noninfectious pulmonary complications (PCs). They can either be idiopathic or have several risk factors such as allogeneic hematopoietic stem cell transplantation (allo-HSCT), graft versus host disease and rarely pulmonary aspergillosis. We present a 14-year-old girl with hypoplastic myelodysplastic syndrome who developed graft versus host disease on day 60, TALS on day 150, bronchiolitis obliterans syndrome on day 300, pulmonary aspergillosis on day 400 and COVID-19 pneumonia on day 575 after allo-HSCT. This is the first report of a child who developed these subsequent PCs after allo-HSCT. Therefore, the manifestations of these unfamiliar PCs like TALS and COVID-19 pneumonia, and concomitant pulmonary aspergillosis with management options are discussed., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2022
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7. COVID-19-Associated Pulmonary Aspergillosis in a Series of Complete Autopsies from the Brazilian Amazon.
- Author
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Farias ME, Santana MF, Ferreira L, Borba M, Silva-Neto J, Brito-Sousa JD, Baía-da-Silva DC, João GP, Val F, Simão M, Souza JV, Naveca F, Melo G, Monteiro W, and Lacerda M
- Subjects
- Adult, Aged, Autopsy, Brazil epidemiology, Confidence Intervals, Humans, Incidence, Male, COVID-19 complications, COVID-19 microbiology, Pulmonary Aspergillosis epidemiology, Pulmonary Aspergillosis etiology, SARS-CoV-2
- Abstract
Between April and July 2020, and, therefore, prior to the broad recommendation of corticosteroids for severe COVID-19, a total of 50 full autopsies were performed in Manaus. We confirmed two invasive cases of aspergillosis through histopathology and gene sequencing (4%) in our autopsy series. The confirmed invasive aspergillosis incidence seems much lower than expected based on the "probable and possible" definitions, and an individualized approach should be considered for each country scenario. Interestingly, a prolonged length of stay in the intensive care unit was not observed in any of the cases. Timely diagnosis and treatment of fungal infection can reduce mortality rates.
- Published
- 2022
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8. Case Report: Chronic Cavitatory Pulmonary Aspergillosis after COVID-19.
- Author
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Chaurasia S, Thimmappa M, and Chowdhury S
- Subjects
- Chronic Disease, Humans, Male, Middle Aged, Pulmonary Aspergillosis diagnostic imaging, Tomography, X-Ray Computed, COVID-19 complications, Pulmonary Aspergillosis etiology
- Abstract
Chronic pulmonary aspergillosis can present in four distinct clinical syndromes, one of which is chronic cavitary pulmonary aspergillosis (CCPA). CCPA is generally associated with a mildly immunosuppressed state or, in immunocompetent patients, with structural lung damage. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with reactivation of previous quiescent infections such as tuberculosis and invasive fungal infections, but CCPA in a patient with COVID-19 is rarely reported. Here we present the case of a 57-year-old man with CCPA associated with COVID-19 infection in whom latent aspergilloma was most likely activated after SARS-CoV-2 infection. The patient presented with severe COVID and, after initial response to treatment, started to deteriorate due to reactivation of latent aspergilloma to a more aggressive CCPA form. After confirmation of the diagnosis, the patient was initiated on treatment with voriconazole. He showed a good response to treatment with clinicoradiological response. This case also depicts one of the common causes of clinical deterioration in otherwise recovering COVID-19 patients.
- Published
- 2021
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9. Invasive pulmonary aspergillosis after liver transplantation: lessons from successfully treated cases and review of the literature.
- Author
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Abe K, Shinoda M, Uno S, Obara H, Kitago M, Abe Y, Hishida T, Yagi H, Hasegawa Y, and Kitagawa Y
- Subjects
- Clinical Decision-Making, Female, Humans, Incidence, Liver Failure, Acute, Male, Middle Aged, Pneumonectomy, Postoperative Complications etiology, Pulmonary Aspergillosis etiology, Retrospective Studies, Risk Factors, Tissue Donors, Treatment Outcome, Liver Transplantation adverse effects, Postoperative Complications epidemiology, Postoperative Complications therapy, Pulmonary Aspergillosis epidemiology, Pulmonary Aspergillosis surgery, Voriconazole administration & dosage
- Abstract
Purpose: Invasive pulmonary aspergillosis (IPA) after liver transplantation (LT) is most often fatal. We analyzed the outcomes of IPA in a single center., Methods: We reviewed, retrospectively, the medical records of recipients of living donor LT (LDLT) or deceased donor LT (DDLT) performed between 1995 and 2019 at our institute. We analyzed the incidence of IPA and assessed the treatment courses of patients treated successfully and those not treatment successfully., Results: Among 326 recipients, IPA was diagnosed in 6 (1.8%). The incidence of IPA was significantly higher in patients with acute liver failure (ALF, 9.8%) than in those without ALF (0.4%), after DDLT (8.8%) than after LDLT (1.0%), and in recipients who received preoperative steroid pulse therapy (16.0%) than in those who did not (0.7%). Complete cure of IPA was achieved in the most recent three patients, by administering voriconazole immediately after the diagnosis of IPA and performing lung resection, while the IPA lesion was single and localized., Conclusions: Patients with risk factors for IPA must be monitored closely. Our three successfully treated cases demonstrate that initiating immediate voriconazole treatment and making a calculated decision about lung resection can contribute to a favorable outcome., (© 2021. Springer Nature Singapore Pte Ltd.)
- Published
- 2021
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10. Proven Aspergillus flavus pulmonary aspergillosis in a COVID-19 patient: A case report and review of the literature.
- Author
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Salehi M, Khajavirad N, Seifi A, Salahshour F, Jahanbin B, Kazemizadeh H, Hashemi SJ, Dehghan Manshadi SA, Kord M, Verweij PE, and Khodavaisy S
- Subjects
- Aged, Aspergillus flavus isolation & purification, Humans, Male, Pulmonary Aspergillosis diagnostic imaging, Pulmonary Aspergillosis microbiology, Radiography, Thoracic, Tomography, X-Ray Computed, Aspergillus flavus pathogenicity, COVID-19 complications, Pulmonary Aspergillosis etiology, SARS-CoV-2
- Abstract
Severe COVID-19 patients complicated with aspergillosis are increasingly reported. We present a histopathological proven case of fatal COVID-19-associated pulmonary aspergillosis (CAPA), due to Aspergillus flavus. This report and existing published literature indicate diagnostic challenges and poor outcomes of CAPA in ICU patients., (© 2021 Wiley-VCH GmbH.)
- Published
- 2021
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11. Clinical study of invasive pulmonary aspergillosis following influenza A H1N1.
- Author
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Liu Y, Xie ZZ, Wang X, Zhu ZH, and Yang C
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- Adult, Aged, Aspergillus fumigatus drug effects, Aspergillus fumigatus pathogenicity, Bronchoalveolar Lavage Fluid, Chi-Square Distribution, China, Female, Humans, Influenza A Virus, H1N1 Subtype drug effects, Influenza A Virus, H1N1 Subtype pathogenicity, Male, Middle Aged, Prospective Studies, Pulmonary Aspergillosis diagnosis, Retrospective Studies, Tomography, X-Ray Computed methods, Influenza, Human complications, Pulmonary Aspergillosis etiology
- Abstract
Abstract: This study to analyze the clinical characteristics of patients with invasive pulmonary aspergillosis (IPA) following influenza A (H1N1) infection.We retrospectively analyzed 10 cases with IPA following H1N1 infection. The clinical manifestations, laboratory examination results, chest computed tomography, and treatments were analyzed.Clinical manifestations: all 10 cases had typical flu-like symptoms at the onset of the disease, among which 7 patients developed dyspnea in the late stage, and 8 patients had hemoptysis. Laboratory examination: the absolute and percentage of peripheral blood lymphocytes in all 10 patients were declined, among which 5 cases were with decreased CD3+ CD4+ T cells/lymphocytes; 9 cases with increased bronchoalveolar lavage fluid galactomannan; 6 cases with increased serum galactomannan; 1 case with bronchoalveolar lavage fluid cultured aspergillus fumigatus; and 2 cases with aspergillus by second-generation sequencing. Chest computed tomography: all patients showed multiple diffused ground-glass opacities at the beginning, along with linear or reticular interstitial changes. Two cases had multiple subarachnoid nodules with halo signs, 3 cases had consolidation in multiple segments of both lungs, 2 cases had cavities, and 4 cases were with pleural effusion. Treatment: 10 patients were treated with antiviral and anti-Aspergillus drugs after admission. Four patients received respiratory support. All 10 cases were cured and discharged.Early diagnosis of IPA in influenza A (H1N1) patients is the key to successful treatment., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2021
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12. Accuracy of galactomannan testing on tracheal aspirates in COVID-19-associated pulmonary aspergillosis.
- Author
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Roman-Montes CM, Martinez-Gamboa A, Diaz-Lomelí P, Cervantes-Sanchez A, Rangel-Cordero A, Sifuentes-Osornio J, Ponce-de-Leon A, and Gonzalez-Lara MF
- Subjects
- Adult, Antifungal Agents therapeutic use, Diabetes Complications complications, Female, Galactose analogs & derivatives, Humans, Male, Middle Aged, Obesity complications, Pulmonary Aspergillosis drug therapy, Pulmonary Aspergillosis etiology, Pulmonary Aspergillosis mortality, Sensitivity and Specificity, Trachea microbiology, COVID-19 complications, Mannans analysis, Pulmonary Aspergillosis diagnosis, Trachea chemistry
- Abstract
Objective: Our aim was to evaluate the performance of two galactomannan (GM) assays (Platelia Aspergillus EIA, Bio-Rad
® , and Aspergillus GM LFA, IMMY® ) in tracheal aspirate (TA) samples of consecutive critically ill patients with COVID-19., Methods: We included critically ill patients, performed GM-EIA and GM-Lateral Flow Assay (GM-LFA) in TA and followed them until development of COVID-19-associated pulmonary aspergillosis (CAPA) or alternate diagnosis. CAPA was defined according to the modified AspICU criteria in patients with SARS-CoV-2 infection. We estimated sensitivity, specificity, positive and negative predictive values for GM-EIA, GM-LFA, the combination of both or either positive results for GM-EIA and GM-LFA. We explored accuracy using different breakpoints, through ROC analysis and Youden index to identify the optimal cut-offs. We described antifungal treatment and 30-day mortality., Results: We identified 14/144 (9.7%) patients with CAPA, mean age was 50.35 (SD 11.9), the median time from admission to CAPA was 8 days; 28.5% received tocilizumab and 30-day mortality was 57%. ROC analysis and Youden index identified 2.0 OD as the best cut-off, resulting in sensitivity and specificity of 57.1% and 81.5% for GM-EIA and 60% and 72.6% for GM-LFA, respectively., Conclusions: The diagnostic performance of GM in tracheal aspirates improved after using a cut-off of 2 OD. Although bronchoalveolar lavage testing is the ideal test, centres with limited access to bronchoscopy may consider this approach to identify or rule out CAPA., (© 2020 Wiley-VCH GmbH.)- Published
- 2021
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13. COVID-19-associated pulmonary aspergillosis: a prospective single-center dual case series.
- Author
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Meijer EFJ, Dofferhoff ASM, Hoiting O, and Meis JF
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- Aged, COVID-19 diagnosis, Cohort Studies, Female, Humans, Intensive Care Units, Male, Netherlands epidemiology, Polymerase Chain Reaction, Prospective Studies, Pulmonary Aspergillosis complications, Pulmonary Aspergillosis etiology, Pulmonary Aspergillosis mortality, Respiration, Artificial, Respiratory Insufficiency etiology, Respiratory Insufficiency therapy, SARS-CoV-2 genetics, COVID-19 complications, Pulmonary Aspergillosis epidemiology, SARS-CoV-2 isolation & purification
- Abstract
Background: COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as an invasive fungal disease, often affecting previously immunocompetent, mechanically ventilated, intensive care unit (ICU) patients. Incidence rates of 3.8%-33.3% have been reported depending on the geographic area, with high (47%) mortality., Objectives: Here, we describe a single-centre prospective case series with CAPA cases from both the first (March-May, n = 5/33) and second (mid-September through mid-December, n = 8/33) COVID-19 wave at a 500-bed teaching hospital in the Netherlands., Patients/methods: In the first COVID-19 wave, a total of 265 SARS-CoV-2 PCR-positive patients were admitted to our hospital of whom 33 needed intubation and mechanical ventilation. In the second wave, 508 SARS-CoV-2 PCR-positive patients were admitted of whom 33 needed mechanical ventilation. Data were prospectively collected., Results: We found a significant decrease in COVID-19 patients needing mechanical ventilation in the ICU in the second wave (p < .01). From these patients, however, a higher percentage were diagnosed with CAPA (24.2% vs 15.2%), although not significant (p = .36). All CAPA patients encountered in the second wave received dexamethasone. Mortality between both groups was similarly high (40%-50%). Moreover, we found environmental TR
34 /L98H azole-resistant Aspergillus fumigatus isolates in two separate patients., Conclusions: In this series, 19.7% (n = 13/66) of mechanically ventilated SARS-CoV-2 patients were diagnosed with CAPA. In addition, we found a significant reduction in COVID-19 patients needing mechanical ventilation on the ICU in the second wave. Numbers are too small to determine whether there is a true difference in CAPA incidence in mechanically ventilated patients between the two waves, and whether it could be attributed to dexamethasone SARS-CoV-2 therapy., (© 2021 The Authors. Mycoses published by Wiley-VCH GmbH.)- Published
- 2021
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14. Successful treatment with nivolumab in a patient with lung adenocarcinoma complicated by pulmonary aspergilloma.
- Author
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Furuya N, Kojima K, Marushima H, Kakinuma K, Tsunoda A, Koda E, Tsuruoka H, Nishida K, Inoue T, Saji H, and Mineshita M
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- Humans, Immune Checkpoint Inhibitors pharmacology, Male, Middle Aged, Nivolumab pharmacology, Pulmonary Aspergillosis pathology, Adenocarcinoma of Lung complications, Adenocarcinoma of Lung drug therapy, Immune Checkpoint Inhibitors therapeutic use, Nivolumab therapeutic use, Pulmonary Aspergillosis etiology
- Abstract
Immune checkpoint inhibitors (ICIs) are the key drugs used in patients with non-small cell lung cancer (NSCLC). However, anti-PD-1 therapy might worsen chronic infection by reactivating the immune response to infectious diseases. Here, we describe a case of successful treatment with nivolumab in a patient with NSCLC complicated by pulmonary aspergilloma, which was safely treated by surgical resection before administration of nivolumab. In conclusion, to safely treat patients with locally limited chronic pulmonary aspergillosis (CPA), surgical resection should be considered before ICI therapy., (© 2020 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.)
- Published
- 2020
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15. A complex COVID-19 case with rheumatoid arthritis treated with tocilizumab.
- Author
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Cai S, Sun W, Li M, and Dong L
- Subjects
- Aged, Anti-Bacterial Agents therapeutic use, Antifungal Agents therapeutic use, Antirheumatic Agents therapeutic use, Arthritis, Rheumatoid complications, Aspergillosis, Aspergillus fumigatus, Betacoronavirus, COVID-19, Coronavirus Infections complications, Coronavirus Infections diagnostic imaging, Coronavirus Infections physiopathology, Cough etiology, Cytokine Release Syndrome etiology, Deprescriptions, Disease Progression, Dyspnea etiology, Female, Glucocorticoids adverse effects, Humans, Hydroxychloroquine therapeutic use, Immunocompromised Host, Immunosuppressive Agents adverse effects, Immunosuppressive Agents therapeutic use, Interleukin-6 blood, Leflunomide adverse effects, Leflunomide therapeutic use, Lung diagnostic imaging, Lymphohistiocytosis, Hemophagocytic diagnosis, Lymphohistiocytosis, Hemophagocytic etiology, Lymphohistiocytosis, Hemophagocytic immunology, Methylprednisolone therapeutic use, Oxygen Inhalation Therapy, Pandemics, Pneumocystis carinii, Pneumonia, Pneumocystis drug therapy, Pneumonia, Pneumocystis etiology, Pneumonia, Pneumocystis immunology, Pneumonia, Viral complications, Pneumonia, Viral diagnostic imaging, Pneumonia, Viral physiopathology, Pulmonary Aspergillosis drug therapy, Pulmonary Aspergillosis etiology, Pulmonary Aspergillosis immunology, Recurrence, SARS-CoV-2, Tomography, X-Ray Computed, Antiviral Agents therapeutic use, Arthritis, Rheumatoid drug therapy, Coronavirus Infections therapy, Glucocorticoids therapeutic use, Pneumonia, Pneumocystis diagnosis, Pneumonia, Viral therapy, Pulmonary Aspergillosis diagnosis
- Abstract
Recurrences of COVID-19 were observed in a patient with long-term usage of hydroxychloroquine, leflunomide, and glucocorticoids due to her 30-year history of rheumatoid arthritis (RA). Tocilizumab was applied and intended to target both COVID-19 and RA. However, disease of this patient aggravated after usage of tocilizumab. After the discussion of a multiple disciplinary team (MDT) including rheumatologists, antimicrobial treatments were applied to target the potential opportunistic infections (Pneumocystis jirovecii and Aspergillus fumigatus), which were authenticated several days later via high throughput sequencing. As an important cytokine in immune responses, IL-6 can be a double-edged sword: interference in the IL-6-IL-6 receptor signaling may save patients from cytokine release storm (CRS), but can also weaken the anti-infectious immunity, particularly in rheumatic patients, who may have received a long-term treatment with immunosuppressive/modulatory agents. Thus, we suggest careful considerations before and close monitoring in the administration of tocilizumab in rheumatic patients with COVID-19. Besides tocilizumab, several disease-modifying antirheumatic drugs (DMARDs) can also be applied in the treatment of COVID-19. Therefore, we also reviewed and discussed the application of these DMARDs in COVID-19 condition.
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- 2020
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16. Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern.
- Author
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Bongomin F
- Subjects
- Chronic Disease epidemiology, Humans, Public Health, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis epidemiology, Tuberculosis, Pulmonary diagnosis, Pulmonary Aspergillosis etiology, Tuberculosis, Pulmonary complications
- Abstract
Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2020
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17. Pulmonary aspergillosis as a late complication after surgery for locally advanced non-small cell lung cancer treated with induction chemoradiotherapy.
- Author
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Sugimoto S, Soh J, Suzawa K, Miyoshi K, Otani S, Yamamoto H, Okazaki M, Yamane M, Oto T, Kanazawa S, Kiura K, and Toyooka S
- Subjects
- Aged, Chronic Disease, Combined Modality Therapy adverse effects, Early Diagnosis, Humans, Male, Middle Aged, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis mortality, Pulmonary Aspergillosis therapy, Retrospective Studies, Survival Rate, Carcinoma, Non-Small-Cell Lung therapy, Chemoradiotherapy, Adjuvant adverse effects, Lung Neoplasms therapy, Pneumonectomy, Postoperative Complications etiology, Pulmonary Aspergillosis etiology, Radiotherapy adverse effects
- Abstract
Purpose: Some long-term survivors after surgery for locally advanced non-small cell lung cancer (NSCLC) treated with induction chemoradiotherapy (trimodality treatment) develop chronic pulmonary aspergillosis (CPA). The aim of our study was to assess the characteristics and outcomes of CPA that develops after trimodality treatment., Methods: We retrospectively reviewed the data of 187 NSCLC patients who underwent trimodality treatment between 1999 and 2018., Results: Six male ever-smoker patients developed CPA. All 6 patients had undergone extended resection for NSCLC and had a history of either adjuvant chemotherapy (n = 3) or radiation pneumonitis (n = 4). Among the 4 patients with CPA localized in a single lung, 3 patients were treated surgically (completion pneumonectomy or cavernostomy) and 1 patient was treated with antifungal therapy alone. Both treatments led to the improved control of CPA. In contrast, patients with CPA in both lungs were not candidates for surgery, and died of CPA. The survival rates after trimodality treatment in the CPA group and the group without CPA were comparable (10-year survival rate, 50.0% vs. 57.6%, P = 0.59)., Conclusion: The early diagnosis of CPA localized in a single lung after NSCLC surgery is critical to improving control and survival in patients with CPA.
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- 2020
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18. Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion.
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Verweij PE, Rijnders BJA, Brüggemann RJM, Azoulay E, Bassetti M, Blot S, Calandra T, Clancy CJ, Cornely OA, Chiller T, Depuydt P, Giacobbe DR, Janssen NAF, Kullberg BJ, Lagrou K, Lass-Flörl C, Lewis RE, Liu PW, Lortholary O, Maertens J, Martin-Loeches I, Nguyen MH, Patterson TF, Rogers TR, Schouten JA, Spriet I, Vanderbeke L, Wauters J, and van de Veerdonk FL
- Subjects
- Antifungal Agents therapeutic use, Bronchoalveolar Lavage Fluid chemistry, Bronchoalveolar Lavage Fluid microbiology, COVID-19, Galactose analogs & derivatives, Humans, Mannans analysis, Pandemics, SARS-CoV-2, Aspergillus isolation & purification, Betacoronavirus, Coronavirus Infections complications, Influenza, Human complications, Intensive Care Units, Pneumonia, Viral complications, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis etiology, Pulmonary Aspergillosis prevention & control
- Abstract
Purpose: Invasive pulmonary aspergillosis is increasingly reported in patients with influenza admitted to the intensive care unit (ICU). Classification of patients with influenza-associated pulmonary aspergillosis (IAPA) using the current definitions for invasive fungal diseases has proven difficult, and our aim was to develop case definitions for IAPA that can facilitate clinical studies., Methods: A group of 29 international experts reviewed current insights into the epidemiology, diagnosis and management of IAPA and proposed a case definition of IAPA through a process of informal consensus., Results: Since IAPA may develop in a wide range of hosts, an entry criterion was proposed and not host factors. The entry criterion was defined as a patient requiring ICU admission for respiratory distress with a positive influenza test temporally related to ICU admission. In addition, proven IAPA required histological evidence of invasive septate hyphae and mycological evidence for Aspergillus. Probable IAPA required the detection of galactomannan or positive Aspergillus culture in bronchoalveolar lavage (BAL) or serum with pulmonary infiltrates or a positive culture in upper respiratory samples with bronchoscopic evidence for tracheobronchitis or cavitating pulmonary infiltrates of recent onset. The IAPA case definitions may be useful to classify patients with COVID-19-associated pulmonary aspergillosis (CAPA), while awaiting further studies that provide more insight into the interaction between Aspergillus and the SARS-CoV-2-infected lung., Conclusion: A consensus case definition of IAPA is proposed, which will facilitate research into the epidemiology, diagnosis and management of this emerging acute and severe Aspergillus disease, and may be of use to study CAPA.
- Published
- 2020
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19. Fatal Invasive Aspergillosis and Coronavirus Disease in an Immunocompetent Patient.
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Blaize M, Mayaux J, Nabet C, Lampros A, Marcelin AG, Thellier M, Piarroux R, Demoule A, and Fekkar A
- Subjects
- Aged, COVID-19, Coronavirus Infections mortality, Humans, Immunocompetence, Male, Pandemics, Pneumonia, Viral mortality, Pulmonary Aspergillosis mortality, SARS-CoV-2, Betacoronavirus, Coronavirus Infections complications, Pneumonia, Viral complications, Pulmonary Aspergillosis etiology
- Abstract
Invasive pulmonary aspergillosis is a complication in critically ill patients with acute respiratory distress syndrome, especially those with severe influenza pneumonia. We report a fatal case of invasive pulmonary aspergillosis in an immunocompetent patient in France who had severe coronavirus disease-associated pneumonia.
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- 2020
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20. Multiple fungus balls in rheumatoid arthritis-associated honeycomb lung.
- Author
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Okazaki A, Shiba Y, Shibata K, and Kasahara K
- Subjects
- Aged, Aspergillus isolation & purification, Fatal Outcome, Female, Humans, Lung Diseases, Interstitial diagnostic imaging, Pulmonary Aspergillosis diagnostic imaging, Tomography, X-Ray Computed, Arthritis, Rheumatoid complications, Lung Diseases, Interstitial etiology, Pulmonary Aspergillosis etiology
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- 2020
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21. Impact of Aspergillus precipitating antibody test results on clinical outcomes of patients with Mycobacterium avium complex lung disease.
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Shirai T, Furuuchi K, Fujiwara K, Nakamoto K, Tanaka Y, Ishii H, Yoshiyama T, Yoshimori K, Takizawa H, Sasaki Y, Kurashima A, Ohta K, and Morimoto K
- Subjects
- Aged, Biomarkers blood, Cohort Studies, Comorbidity, Female, Humans, Lung Diseases, Interstitial epidemiology, Male, Middle Aged, Mycobacterium avium-intracellulare Infection complications, Mycobacterium avium-intracellulare Infection epidemiology, Prognosis, Pulmonary Aspergillosis epidemiology, Pulmonary Aspergillosis mortality, Pulmonary Emphysema epidemiology, Retrospective Studies, Sex Factors, Antibodies, Fungal blood, Aspergillus immunology, Mycobacterium avium Complex, Mycobacterium avium-intracellulare Infection diagnosis, Mycobacterium avium-intracellulare Infection mortality, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis etiology, Serologic Tests methods
- Abstract
Background and Objective: Chronic pulmonary aspergillosis (CPA) is associated with mortality in patients with Mycobacterium avium complex lung disease (MAC-LD). However, the clinical significance of the positivity of Aspergillus precipitating antibody (APAb), a serodiagnostic test for pulmonary aspergillosis (PA), at the time of MAC-LD diagnosis is unknown. The objective of this study was to investigate the effects of APAb test results on the clinical outcomes of patients with MAC-LD., Methods: We retrospectively analyzed patients who were newly diagnosed as having MAC-LD between 2007 and 2014 in our hospital and checked for APAb at the time of diagnosis., Results: We enrolled 131 patients in this study. Of these patients, 20 (15.3%) tested positive for APAb at the diagnosis of MAC-LD. The APAb-positive patients were more frequently male (70.0% vs. 37.8%, P = 0.013) and more frequently had pulmonary emphysema (60.0% vs. 13.5%, P < 0.001) and interstitial pneumonia (15.0% vs. 1.8%, P = 0.025) compared with the APAb-negative patients. During a median follow-up period of 4.0 years, PA developed in 12 of the APAb-positive patients (60.0%, CPA: 9 and allergic bronchopulmonary aspergillosis: 3) and 12 APAb-negative patients (10.8%, CPA: 12) (P < 0.001). The APAb-positive patients had a significantly higher rate of mortality than did the APAb-negative patients (P = 0.004). A multivariate analysis indicated that older age, lower albumin, fibrocavitary or fibrocavitary and nodular/bronchiectatic radiographic features, and APAb positivity were negative prognostic factors., Conclusions: APAb-positive patients with MAC-LD more frequently develop PA and may have an unfavorable prognosis., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)
- Published
- 2020
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22. Prospective study of the serum Aspergillus-specific IgG, IgA and IgM assays for chronic pulmonary aspergillosis diagnosis.
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Ma X, Wang K, Zhao X, Liu Y, Li Y, Yu X, Li C, Denning DW, and Xie L
- Subjects
- Adult, Aged, Antibodies, Fungal blood, Aspergillus immunology, Chronic Disease, Enzyme-Linked Immunosorbent Assay methods, Female, Galactose analogs & derivatives, Humans, Male, Mannans blood, Middle Aged, Prospective Studies, Pulmonary Aspergillosis blood, Pulmonary Aspergillosis etiology, ROC Curve, Sensitivity and Specificity, Immunoglobulin Isotypes blood, Pulmonary Aspergillosis diagnosis
- Abstract
Background: Chronic pulmonary aspergillosis (CPA) is an underdiagnosed and misdiagnosed disease and now increasingly recognised. However, the diagnosis of CPA remains challenging. In this study, we aimed to investigate the diagnostic values of serum Aspergillus-specific IgG, IgA and IgM antibodies in patients with CPA., Methods: The prospective study was performed at Chinese People's Liberation Army General Hospital in Beijing, from January 2017 to December 2017. Adult patients with lung lesions presented as cavity, nodule, mass, bronchiectasis or severe fibrotic destruction with at least two lobes in CT imaging were enrolled. One hundred healthy persons were also enrolled as additional controls. The serum levels of Aspergillus-specific IgG, IgA and IgM antibodies and galactomannan (GM) levels were measured simultaneously by plate ELISA kit., Results: A total of 202 patients were enrolled in this study, including 42 CPA patients, 60 non-CPA patients and 100 healthy persons. The most common underlying lung diseases in CPA patients were bronchiectasis (28.6%) and COPD (19.0%). The most common symptoms in the CPA patients were cough (76.2%), sputum (71.4%), and fever (45.2%); chest pain (4.8%) was infrequent. Receiver operating characteristic (ROC) curve analysis revealed that the optimal CPA diagnostic cut-off of Aspergillus-specific IgG, IgA and IgM assays and GM test were 89.3 AU/mL, 8.2 U/mL, 73.3 AU/mL and 0.5μg/L, respectively. The serum levels of Aspergillus-specific IgG and IgA in CPA patients were higher than these in non-CPA patients or healthy persons. The sensitivities and specificities of Aspergillus-specific IgG, IgA, IgM tests and GM test were 78.6 and 94.4%, 64.3 and 89.4%, 50.0 and 53.7% and 71.4 and 58.1%, respectively., Conclusions: The sensitivity and specificity of serum Aspergillus-specific IgG assay are satisfactory for diagnosing CPA, while the performance of Aspergillus-specific IgA assay is moderate. Aspergillus-specific IgM assay and serum GM test have limited value for CPA diagnosis., Trial Registration: NCT03027089 . Registered 20 January 2017.
- Published
- 2019
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23. Pulmonary aspergillosis in a Crohn's disease patient receiving adalimumab and steroid therapy.
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Ferrer Bradley I, Maroto Arce N, Mora Escrig M, and Hinojosa Del Val J
- Subjects
- Adalimumab therapeutic use, Adrenal Cortex Hormones therapeutic use, Adult, Anti-Inflammatory Agents therapeutic use, Antifungal Agents therapeutic use, Cilastatin therapeutic use, Crohn Disease complications, Diagnosis, Differential, Disease Susceptibility, Humans, Imipenem therapeutic use, Immunocompromised Host, Immunosuppressive Agents therapeutic use, Male, Opportunistic Infections diagnosis, Opportunistic Infections drug therapy, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis drug therapy, Tomography, X-Ray Computed, Tuberculosis, Pulmonary diagnosis, Adalimumab adverse effects, Adrenal Cortex Hormones adverse effects, Anti-Inflammatory Agents adverse effects, Crohn Disease drug therapy, Immunosuppressive Agents adverse effects, Opportunistic Infections etiology, Pulmonary Aspergillosis etiology
- Published
- 2019
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24. Allergic Bronchopulmonary Mycosis due to fungi other than Aspergillus.
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Deepak D, Singh Rajput M, Sharma B, and Chowdhary A
- Subjects
- Antibodies, Fungal blood, Cross-Sectional Studies, Fungi immunology, Humans, Pulmonary Aspergillosis immunology, Reproducibility of Results, Schizophyllum immunology, Sensitivity and Specificity, Antibodies, Fungal immunology, Precipitin Tests methods, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis etiology, Skin Tests methods
- Abstract
Summary: Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi that colonize the airways. Early diagnosis and treatment with systemic corticosteroids is the key in preventing the progression of the disease to irreversible lung fibrosis. Although Aspergillus has progressively gained recognition as a causative agent in past few decades, other fungi, that have been reported to cause ABPM, are not yet widely evaluated. We studied hundred and two patients with asthma for occurrence of ABPM. Patients were tested for cutaneous hypersensitivity and serum precipitin to 12 common fungal antigens. The positive cases were further evaluated for ABPM using standard criteria. Out of 102 asthma patients screened, 18 patients had either skin prick test (SPT) and/or serum precipitin positive. While 14 patients were SPT positive for one or more fungal antigen, two patients were serum precipitin positive for one or more fungi. Two patients had both serum precipitin positive as well as SPT positive. Six (5.8%) patients were diagnosed as ABPM as they fulfilled the criteria. Three of these were because of Aspergillus sp. Two were because of fungi other than Aspergillus namely Schizophyllum and Curvularia. One patient had ABPM because of both Aspergillus and Curvularia. In our study absolute eosinophil count (AEC), total IgE, serum precipitin and SPT had sensitivity of 100%, 100% 50% and 83.3% respectively for diagnosing ABPM. The specificity of these tests was 44.79%, 64.58% 98.96% and 88.54% respectively. Specfic IgE was positive in 50% of patients with either serum precipitin or SPT positivity. SPT or serum precipitin followed by specific IgE had sensitivity of 100% and specificity of 96.88% for diagnosing ABPM. SPT alone followed by Specific IgE had a sensitivity of 83.33% and specificity of 96.88% for diagnosing ABPM. We found that fungi other than Aspergillus such as schizophyllum, and curvularia, can be implicated in ABPM. Multiple fungal agents may be responsible for ABPM in an individual. There is a subset of patients of BA who have fungal sensitization but do not fulfil the criteria for ABPM. SPT was the single most sensitive and specific test, AEC >350 and total IgE more than 417IU were most sensitive tests and SPT followed by specific IgE was most effective strategy for diagnosing ABPM.
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- 2019
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25. Aspergillus prevalence in air conditioning filters from vehicles: Taxis for patient transportation, forklifts, and personal vehicles.
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Viegas C, Moreira R, Faria T, Caetano LA, Carolino E, Gomes AQ, and Viegas S
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- Humans, Prevalence, Air Conditioning instrumentation, Aspergillus isolation & purification, Motor Vehicles, Occupational Exposure, Pulmonary Aspergillosis epidemiology, Pulmonary Aspergillosis etiology
- Abstract
The frequency and importance of Aspergillus infections is increasing worldwide. This study aimed to assess the occupational exposure of forklifts and taxi drivers to Aspergillus spp. Nineteen filters from air conditioning system of taxis, 17 from forklifts and 37 from personal vehicles were assessed. Filters extract were streaked onto MEA, DG18 and in azole-supplemented media. Real-time quantitative PCR amplification of selected Aspergillus species-complex was also performed. Forklifts filter samples presented higher median values. Aspergillus section Nigri was the most observed in forklifts filters in MEA (28.2%) and in azole-supplemented media. DNA from Aspergillus sections Fumigati and Versicolores was successfully amplified by qPCR. This study enlightens the added value of using filters from the air conditioning system to assess Aspergillus spp. occupational exposure. Aspergillus azole resistance screening should be included in future occupational exposure assessments.
- Published
- 2019
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26. Aspergillus Sternomyelitis Developed from Chronic Pulmonary Aspergillosis as a Late Complication to Lobectomy for Lung Cancer.
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Uehara Y, Kasai H, Nakajima T, Tanabe N, Tatsumi K, and Yoshino I
- Subjects
- Aged, Anti-Bacterial Agents therapeutic use, Humans, Lung Neoplasms pathology, Male, Myelitis, Transverse etiology, Pneumonectomy adverse effects, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis etiology, Treatment Outcome, Voriconazole therapeutic use, Lung Diseases, Fungal complications, Lung Diseases, Fungal therapy, Lung Neoplasms complications, Lung Neoplasms surgery, Myelitis, Transverse drug therapy, Myelitis, Transverse surgery, Pulmonary Aspergillosis drug therapy, Pulmonary Aspergillosis surgery
- Abstract
Progressive fibrobullous changes in the residual lobes are sometimes observed after lobectomy. Aspergillus osteomyelitis is an uncommon infection that rarely occurs sternally. A 70-year-old man who had undergone lobectomy 12 years earlier was admitted to our hospital for chest pain. He was diagnosed with Aspergillus sternomyelitis based on sternal bone culture after an ultrasound-guided percutaneous needle biopsy. The fibrosis and right residual lung apex volume loss had gradually progressed over 12 years, and therefore, chronic pulmonary aspergillosis (CPA) with direct invasion sternal from the CPA was considered. Aspergillus sternomyelitis can develop from CPA as a late complication of lobectomy.
- Published
- 2018
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27. Risk stratification for the development of chronic pulmonary aspergillosis in patients with Mycobacterium avium complex lung disease.
- Author
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Furuuchi K, Ito A, Hashimoto T, Kumagai S, and Ishida T
- Subjects
- Aged, Aged, 80 and over, Chronic Disease epidemiology, Female, Humans, Incidence, Japan epidemiology, Lung microbiology, Male, Middle Aged, Multivariate Analysis, Mycobacterium avium Complex isolation & purification, Mycobacterium avium-intracellulare Infection blood, Mycobacterium avium-intracellulare Infection complications, Mycobacterium avium-intracellulare Infection microbiology, Pulmonary Aspergillosis blood, Pulmonary Aspergillosis etiology, ROC Curve, Retrospective Studies, Risk Assessment, Serum Albumin analysis, Mycobacterium avium-intracellulare Infection epidemiology, Pulmonary Aspergillosis epidemiology, Pulmonary Emphysema epidemiology
- Abstract
Background: The number of patients with pulmonary nontuberculous mycobacterial disease complicated by chronic pulmonary aspergillosis (CPA) has been increasing. Additionally, CPA is reportedly associated with mortality in patients with Mycobacterium avium complex lung disease (MAC-LD). In the present study, we aimed to identify risk factors for developing CPA and stratify the risk for CPA development in patients with MAC-LD., Methods: We retrospectively examined 361 patients newly diagnosed with MAC-LD. Risk factors for CPA development were examined using multivariate Cox proportional hazards regression analyses. A risk stratification system was established using the risk factors and receiver operating characteristic curve analyses., Results: CPA developed in 20 (5.5%) of the 361 patients. Independent risk factors for CPA development included the presence of pulmonary emphysema, baseline steroid use, a serum albumin level <3.5 g/dL, and the presence of MAC-LD cavities. A 4-point scoring system was established to stratify patients into low-risk (0-1 point) and high-risk (2-4 points) groups. The 5-year incidence rates of CPA were 2.2% and 31% in the low- and high-risk groups, respectively (P < 0.001)., Conclusions: We identified independent predictors of CPA development and established a simple risk stratification system for identifying patients with MAC-LD who were at a high risk of developing CPA., (Copyright © 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2018
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28. Prognosis of chronic pulmonary aspergillosis in patients with pulmonary non-tuberculous mycobacterial disease.
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Naito M, Kurahara Y, Yoshida S, Ikegami N, Kobayashi T, Minomo S, Tachibana K, Tsuyuguchi K, Hayashi S, and Suzuki K
- Subjects
- Adrenal Cortex Hormones adverse effects, Adult, Aged, Aged, 80 and over, Biomarkers blood, C-Reactive Protein, Chronic Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mycobacterium Infections, Nontuberculous microbiology, Mycobacterium Infections, Nontuberculous mortality, Mycobacterium avium Complex pathogenicity, Mycobacterium kansasii pathogenicity, Prognosis, Pulmonary Aspergillosis diagnosis, Retrospective Studies, Risk Factors, Tuberculosis, Pulmonary microbiology, Tuberculosis, Pulmonary mortality, Mycobacterium Infections, Nontuberculous complications, Pulmonary Aspergillosis etiology, Tuberculosis, Pulmonary complications
- Abstract
Background: Pulmonary non-tuberculous mycobacterial disease (PNTM) is a known risk factor for chronic pulmonary aspergillosis (CPA). However, few studies have focused on the prognosis of PNTM-associated CPA. In the present investigation, we aimed to elucidate the clinical course and prognostic factors of CPA in patients with PNTM., Methods: We retrospectively investigated the medical records of 62 patients with CPA and a history of PNTM who were admitted to Kinki-chuo Chest Medical Center between 2010 and 2015. Co-morbidities, causative microorganisms, radiological findings, and outcomes were evaluated., Results: The patients' median age was 69.5 years, and the median follow-up period was 4.2 years. The major underlying diseases, other than PNTM and CPA, were old pulmonary tuberculosis, chronic obstructive pulmonary disease, and interstitial pneumonia. The most common causative NTM species were Mycobacterium avium complex (MAC; 37 patients; 59.7%) and Mycobacterium kansasii (20 patients; 32.3%). Survival was 83% after 1 year and 61% after 5 years. Use of systemic corticosteroids (hazard ratio: 3.32, 95% confidence interval: 1.23-9.51; P=0.00177) and C-reactive protein levels ≥ 5.0 mg/dL (hazard ratio: 8.96, 95% confidence interval: 2.15-62.9; P=0.0014) at the time of CPA diagnosis were associated with increased over-all mortality., Conclusions: CPA frequently developed in patients with MAC and M. kansasii PNTM. The treatment course of PNTM was not associated with all-cause mortality. However, systemic corticosteroid use and high CRP levels were negative prognostic factors of CPA in patients with PNTM. Since the prognosis is poor, early diagnosis and treatment of CPA are important in patients with PNTM., (Copyright © 2018 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)
- Published
- 2018
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29. Pulmonary sarcoidosis.
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Spagnolo P, Rossi G, Trisolini R, Sverzellati N, Baughman RP, and Wells AU
- Subjects
- Biopsy, Bronchoscopy, Fatigue etiology, Female, Humans, Hypertension, Pulmonary etiology, Male, Pulmonary Aspergillosis etiology, Severity of Illness Index, Sex Distribution, Tomography, X-Ray Computed, Ultrasonography, Disease Progression, Lung diagnostic imaging, Sarcoidosis, Pulmonary complications, Sarcoidosis, Pulmonary diagnosis, Sarcoidosis, Pulmonary pathology, Sarcoidosis, Pulmonary therapy
- Abstract
Sarcoidosis is a granulomatous disease of unknown cause, occurs worldwide and has a highly variable prevalence. The disease is typically dominant in the lungs, although it can affect virtually any organ and is unpredictable in its clinical course. The severity of pulmonary sarcoidosis ranges from incidentally discovered radiographic abnormalities in asymptomatic patients to a chronic progressive disease that is refractory to treatment. Mortality from sarcoidosis appears to have increased in the past three decades, with respiratory failure being the most common cause of sarcoidosis-related death. Pulmonary fibrosis, extensive disease on high-resolution chest CT, impaired lung function, and pulmonary hypertension are well established predictors of poor clinical outcomes. In patients who need systemic therapy to control their disease, corticosteroids are the most commonly used first-line treatment, with antimetabolites generally representing an alternative for patients who are unresponsive to corticosteroids or who cannot tolerate them. Indeed, corticosteroid therapy is associated with toxic effects that correlate with both the cumulative dose and duration of treatment. The scarcity of truly effective therapies and shortage of reliable predictors of the unpredictable development of disease in individual patients greatly contribute to making sarcoidosis such a difficult disease to manage., (Copyright © 2018 Elsevier Ltd. All rights reserved.)
- Published
- 2018
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30. Aspergillus -induced pneumonia in adult without obvious immunodeficiency: test the burst!
- Author
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Flament H, Granger V, Vezinet C, Marzaioli V, Kannengiesser C, de Chaisemartin L, Hurtado-Nedelec M, Litvinova E, Messika J, Adam N, Gougerot-Pocidalo MA, Dang PM, Monteiro R, El Benna J, Langeron O, Chollet-Martin S, and Monsel A
- Subjects
- Aspergillus fumigatus, Granulomatous Disease, Chronic complications, Humans, Male, Pulmonary Aspergillosis etiology, Young Adult, Granulomatous Disease, Chronic diagnosis, Pulmonary Aspergillosis diagnosis, Respiratory Burst
- Abstract
Competing Interests: Conflict of interest: None declared.
- Published
- 2018
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31. Aspergillus Pneumonia in a Patient With Adult-Onset Still Disease Successfully Treated With Anakinra.
- Author
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Bilgin E, Erden A, Kilic L, Sari A, Armagan B, Kalyoncu U, and Karadag Ö
- Subjects
- Antifungal Agents administration & dosage, Antirheumatic Agents administration & dosage, Aspergillus fumigatus isolation & purification, Bronchoscopy methods, Humans, Male, Middle Aged, Tomography, X-Ray Computed methods, Treatment Outcome, Amphotericin B administration & dosage, Interleukin 1 Receptor Antagonist Protein administration & dosage, Lung diagnostic imaging, Lung microbiology, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis drug therapy, Pulmonary Aspergillosis etiology, Pulmonary Aspergillosis physiopathology, Still's Disease, Adult-Onset blood, Still's Disease, Adult-Onset complications, Still's Disease, Adult-Onset diagnosis, Still's Disease, Adult-Onset drug therapy
- Published
- 2018
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32. [Post-traumatic pulmonary aspergilloma].
- Author
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Isnard M, Hullo E, Robert Y, Piolat C, Durand C, Lantuejoul S, Garnaud C, and Pin I
- Subjects
- Adolescent, Female, Granuloma, Foreign-Body microbiology, Humans, Lung diagnostic imaging, Lung microbiology, Lung pathology, Lung Diseases, Fungal etiology, Lung Injury microbiology, Pulmonary Aspergillosis etiology, Recurrence, Trees, Accidental Falls, Granuloma, Foreign-Body complications, Granuloma, Foreign-Body diagnosis, Lung Diseases, Fungal diagnosis, Lung Injury complications, Pulmonary Aspergillosis diagnosis
- Abstract
Introduction: Aspergillomas occur due to colonization of a pre-existing pulmonary, bronchial or pleural cavity by Aspergillus spp. Often asymptomatic, this pathology can reveal itself by recurrent haemoptysis or when bacterial superinfections occur. Aspergillomas occurring in post-traumatic cavities are rare and their management is poorly codified., Case Report: A child suffered from a chest wound at the age of 13 years. Two years later, investigation of recurrent haemoptysis revealed a residual pneumatocele in the right lower lobe colonized by Aspergillus spp. Initial treatment with systemic azole antifungals was unsuccessful because of digestive and ophthalmological intolerance. Surgical treatment by right lower lobectomy was finally decided on by the multidisciplinary team. This revealed an intrabronchial foreign body of vegetal type with cellulosic reinforcement, causing a polymorphic granulomatous reaction around, and associated with a proliferation of filamentous fungi including Aspergillus fumigatus. Surgery was followed by liposomal amphotericin B treatment for three weeks with a favourable outcome., Conclusions: This clinical case illustrates the benefits of surgical management of post-traumatic aspergillomas, even in children, in order to eradicate the aspergillus implant and to remove any foreign body to prevent recurrence., (Copyright © 2018 SPLF. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2018
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33. Causes of Hemoptysis in Renal Transplant Patients.
- Author
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Serifoglu I, Er Dedekarginoglu B, Ayvazoglu Soy EH, Ulubay G, and Haberal M
- Subjects
- Adult, Female, Hemoptysis chemically induced, Hemoptysis diagnosis, Hospitals, University, Humans, Male, Medical Records, Pneumonia diagnosis, Pulmonary Aspergillosis diagnosis, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Turkey, Hemoptysis etiology, Immunosuppressive Agents adverse effects, Kidney Transplantation adverse effects, Pneumonia etiology, Pulmonary Aspergillosis etiology
- Abstract
Objectives: Hemoptysis is a symptom that can be caused by airway disease, pulmonary parenchymal disease, or pulmonary vascular disease, or it can be idiopathic. Infection is the most common cause of hemoptysis, accounting for 60% to 70% of cases. Hemoptysis is also an initial symptom of diffuse alveolar hemorrhage syndrome, although it may be absent at presentation in one-third of patients. Diffuse alveolar hemorrhage is characterized by disruption of the alveolar-capillary basement membranes because of either injury or inflammation of the arterioles, venules, or capillaries, resulting in bleeding in alveolar spaces. To date, no study in the literature has investigated the cause of hemoptysis in renal transplant patients. In this retrospective study, we aimed to investigate the causes of hemoptysis in renal recipients., Materials and Methods: The data included in this study were obtained from 352 renal transplant patients who were consulted by the pulmonology department regarding hemoptysis between 2011 and 2017 at Baskent University. Patient medical records were reviewed for demographic, clinical, radiographic, bronchoscopic features, and microbiology data. Immunosuppressive drugs and clinical outcome data were also noted., Results: This study included 352 renal transplant patients (139 male patients with mean age of 34.9 ± 7 years and 113 female patients with mean age of 31.1 ± 5 years). Hemoptysis was detected in 17 patients (4.8%),with 3 (0.85%) having massive hemoptysis as a result of diffuse alveolar hemorrhage syndrome. Fourteen of our patient group (4%) had pneumonia, and Aspergillus species was detected in 5 patients (1.4%). The only reason for diffuse alveolar hemorrhage was immunosuppressive agents, including sirolimus and mycophenolate mofetil., Conclusions: Hemoptysis is an important respiratory symptom in renal transplant patients. Although community- or hospital-acquired pneumonia may result in hemoptysis, drug-induced diffuse alveolar hemorrhage and Aspergillus infection should be considered for causes in renal transplant patients.
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- 2018
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34. [Chronic pulmonary aspergillosis].
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Davidsen JR, Rosenvinge FS, Assing K, and Laursen CB
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- Adult, Aged, Antifungal Agents therapeutic use, Chronic Disease, Female, Humans, Male, Risk Factors, Tomography, X-Ray Computed, Pulmonary Aspergillosis classification, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis drug therapy, Pulmonary Aspergillosis etiology
- Abstract
Chronic pulmonary aspergillosis (CPA) is an overlooked disease category in which delay of diagnosis and treatment is associated with increased mortality. A prerequisite for prognostic optimization of CPA is an increased focus on predisposing factors and patients at risk. Diagnosis of CPA is challenging and requires a systematic approach to assessment and interpretation of findings, both of which are necessary for correct disease classification and selection of targeted antifungal treatment and duration.
- Published
- 2018
35. X-linked agammaglobulinemia complicated with pulmonary aspergillosis.
- Author
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Nishi K, Kawai T, Kubota M, Ishiguro A, and Onodera M
- Subjects
- Adolescent, Agammaglobulinemia microbiology, Genetic Diseases, X-Linked microbiology, Humans, Male, Pulmonary Aspergillosis diagnosis, Agammaglobulinemia complications, Genetic Diseases, X-Linked complications, Pulmonary Aspergillosis etiology
- Published
- 2018
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36. Host immune status-specific production of gliotoxin and bis-methyl-gliotoxin during invasive aspergillosis in mice.
- Author
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Sugui JA, Rose SR, Nardone G, Swamydas M, Lee CR, Kwon-Chung KJ, and Lionakis MS
- Subjects
- Animals, Aspergillosis mortality, Aspergillosis pathology, Disease Models, Animal, Granulomatous Disease, Chronic complications, Mice, Mice, Knockout, Neutropenia complications, Pulmonary Aspergillosis etiology, Pulmonary Aspergillosis metabolism, Pulmonary Aspergillosis mortality, Pulmonary Aspergillosis pathology, Risk Factors, Steroids pharmacology, Aspergillosis etiology, Aspergillosis metabolism, Aspergillus immunology, Gliotoxin biosynthesis, Host-Pathogen Interactions immunology
- Abstract
Delayed diagnosis in invasive aspergillosis (IA) contributes to its high mortality. Gliotoxin (GT) and bis-methyl-gliotoxin (bmGT) are secondary metabolites produced by Aspergillus during invasive, hyphal growth and may prove diagnostically useful. Because IA pathophysiology and GT's role in virulence vary depending on the underlying host immune status, we hypothesized that GT and bmGT production in vivo may differ in three mouse models of IA that mimic human disease. We defined temporal kinetics of GT and bmGT in serum, bronchoalveolar lavage fluid (BALF) and lungs of A. fumigatus-infected chronic granulomatous disease (CGD), hydrocortisone-treated, and neutropenic mice. We harvested lungs for assessment of fungal burden, histology and GT/bmGT biosynthetic genes' mRNA induction. GT levels were higher in neutropenic versus CGD or steroid-treated lungs. bmGT was persistently detected only in CGD lungs. GT, but not bmGT, was detected in 71% of sera and 50% of BALF of neutropenic mice; neither was detected in serum/BALF of CGD or steroid-treated mice. Enrichment of GT in Aspergillus-infected neutropenic lung correlated with fungal burden and hyphal length but not induction of GT biosynthetic genes. In summary, GT is detectable in mouse lungs, serum and BALF during neutropenic IA, suggesting that GT may be useful to diagnose IA in neutropenic patients.
- Published
- 2017
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37. Necrotizing fasciitis resulting in fatal lung aspergillosis: Uncommon pathogenesis. A case report.
- Author
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Mammadli T, Kim BS, Rennekampff HO, and Pallua N
- Subjects
- Debridement, Fasciitis, Necrotizing microbiology, Fasciitis, Necrotizing surgery, Fatal Outcome, Humans, Male, Middle Aged, Multiple Organ Failure microbiology, Multiple Organ Failure pathology, Opportunistic Infections microbiology, Opportunistic Infections pathology, Opportunistic Infections surgery, Pulmonary Aspergillosis microbiology, Pulmonary Aspergillosis pathology, Pulmonary Aspergillosis surgery, Sepsis microbiology, Sepsis pathology, Fasciitis, Necrotizing complications, Pulmonary Aspergillosis etiology
- Abstract
We present a fatal case of Aspergillus-associated lung failure in a patient with necrotizing fasciitis. The cause of the fasciitis was a retroperitoneal perforation of a colon carcinoma. Being already a rare condition, the fasciitis did not manifest as Fournier's gangrene like similar described cases illustrate, but instead travelled along the fasciae and subcutaneous fat tissue cranially into the thoracic cavity, ultimately leading to a disseminated infection of the lungs. The lethal outcome was thus caused by respiratory failure at a time when the primary focus was already successfully treated, contrary to typical cases of necrotizing fasciitis. This case report depicts the importance of acknowledging opportunistic fungal infections in the practice of emergency surgery. Contributing factors, pathogenesis and possible prevention measures are discussed., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)
- Published
- 2017
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38. An African American Man in His Late 30s With Lung Cancer Presenting With Persistent Cough and Hemoptysis.
- Author
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Aron A, Manchanda-Aron U, and Sinclair SE
- Subjects
- Adult, Antineoplastic Agents administration & dosage, Bronchoscopy methods, Chemoradiotherapy methods, Cough diagnosis, Cough etiology, Diagnosis, Differential, Hemoptysis diagnosis, Hemoptysis etiology, Humans, Lymph Nodes diagnostic imaging, Lymph Nodes pathology, Male, Mediastinum, Neoplasm Staging, Tomography, X-Ray Computed methods, Carcinoma, Large Cell pathology, Carcinoma, Large Cell physiopathology, Carcinoma, Large Cell therapy, Carcinoma, Small Cell pathology, Carcinoma, Small Cell physiopathology, Carcinoma, Small Cell therapy, Lung diagnostic imaging, Lung Neoplasms pathology, Lung Neoplasms physiopathology, Lung Neoplasms therapy, Lymphadenopathy pathology, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis etiology, Pulmonary Aspergillosis physiopathology
- Abstract
Case Presentation: An African American man in his late 30s was referred to the pulmonary clinic for evaluation of a persistent cough of several weeks' duration. Cough was productive of mucopurulent sputum mixed with blood. He also noted generalized weakness and dyspnea with minimal exertion., (Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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39. Diagnostic Performance of Contrast Enhanced Pulmonary Computed Tomography Angiography for the Detection of Angioinvasive Pulmonary Aspergillosis in Immunocompromised Patients.
- Author
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Henzler C, Henzler T, Buchheidt D, Nance JW, Weis CA, Vogelmann R, Benck U, Viergutz T, Becher T, Boch T, Klein SA, Heidenreich D, Pilz L, Meyer M, Deckert PM, Hofmann WK, Schoenberg SO, and Reinwald M
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Antifungal Agents, Child, Child, Preschool, Contrast Media, Female, Humans, Male, Middle Aged, Neutropenia etiology, Neutropenia pathology, Pulmonary Aspergillosis drug therapy, Pulmonary Aspergillosis etiology, Pulmonary Aspergillosis microbiology, ROC Curve, Reproducibility of Results, Retrospective Studies, Young Adult, Computed Tomography Angiography methods, Computed Tomography Angiography standards, Immunocompromised Host, Pulmonary Aspergillosis diagnosis, Radiographic Image Enhancement
- Abstract
Invasive pulmonary aspergillosis (IPA) is one of the major complications in immunocompromised patients. The mainstay of diagnostic imaging is non-enhanced chest-computed-tomography (CT), for which various non-specific signs for IPA have been described. However, contrast-enhanced CT pulmonary angiography (CTPA) has shown promising results, as the vessel occlusion sign (VOS) seems to be more sensitive and specific for IPA in hematologic patients. The aim of this study was to evaluate the diagnostic accuracy of CTPA in a larger cohort including non-hematologic immunocompromised patients. CTPA studies of 78 consecutive immunocompromised patients with proven/probable IPA were analyzed. 45 immunocompromised patients without IPA served as a control group. Diagnostic performance of CTPA-detected VOS and of radiological signs that do not require contrast-media were analyzed. Of 12 evaluable radiological signs, five were found to be significantly associated with IPA. The VOS showed the highest diagnostic performance with a sensitivity of 0.94, specificity of 0.71 and a diagnostic odds-ratio of 36.8. Regression analysis revealed the two strongest independent radiological predictors for IPA to be the VOS and the halo sign. The VOS is highly suggestive for IPA in immunocompromised patients in general. Thus, contrast-enhanced CTPA superior over non-contrast_enhanced chest-CT in patients with suspected IPA.
- Published
- 2017
- Full Text
- View/download PDF
40. Respiratory Complications Lead to the Diagnosis of Chronic Granulomatous Disease in Two Adult Patients.
- Author
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Colin de Verdière S, Noel E, Lozano C, Catherinot E, Martin M, Rivaud E, Couderc LJ, Salvator H, Bustamante J, and Martin T
- Subjects
- Biomarkers, Female, Humans, Male, Middle Aged, Neutrophils immunology, Neutrophils metabolism, Pulmonary Aspergillosis drug therapy, Tomography, X-Ray Computed, Granulomatous Disease, Chronic complications, Granulomatous Disease, Chronic diagnosis, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis etiology
- Abstract
Chronic granulomatous disease (CGD) is a primary immunodeficiency associated to multiple life-threatening bacterial and fungal infections, beginning in childhood. There are rare cases of diagnosis in adulthood. We describe here two cases of late diagnosis in adults: a 45-year-old woman and 59-year-old-man. CGD diagnosis should be considered in adult patients with unexplained infectious diseases with tissue granuloma.
- Published
- 2017
- Full Text
- View/download PDF
41. Development of Aspergillosis in a cohort of non-neutropenic, non-transplant patients colonised by Aspergillus spp.
- Author
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Barberán J, García-Pérez FJ, Villena V, Fernández-Villar A, Malmierca E, Salas C, Giménez MJ, Granizo JJ, and Aguilar L
- Subjects
- Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Invasive Pulmonary Aspergillosis etiology, Male, Middle Aged, Neutropenia complications, Organ Transplantation, Pulmonary Aspergillosis diagnosis, Pulmonary Disease, Chronic Obstructive microbiology, Retrospective Studies, Risk Factors, Time Factors, Aspergillus pathogenicity, Pulmonary Aspergillosis etiology, Pulmonary Disease, Chronic Obstructive complications
- Abstract
Background: A previous study explored factors discriminating colonization and true infection among non-transplant, non-neutropenic patients with repeated Aspergillus spp. isolation from lower respiratory samples. The present study explored the evolution of patients with Aspergillus colonization in that study to determine the percentage of cases progressing to aspergillosis and time to development., Methods: Clinical records were retrospectively reviewed (for each patient from his end date in the past study) and data from all respiratory processes suffered by patients up to April 2015 were recorded. Comparisons of variables were performed between colonized patients that developed aspergillosis and those that did not. A Kaplan-Meier curve was used to describe time to development of aspergillosis in chronic obstructive pulmonary disease (COPD) patients for II-IV stages of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification., Results: Sixty seven colonized patients were followed, 12 of them (17.9%) developed aspergillosis. Diagnoses included six tracheobronchitis (4 invasive, 2 simple tracheobronchitis), four pulmonary disease (2 invasive pulmonary aspergillosis, 2 chronic pulmonary aspergillosis), one allergic bronchopulmonary aspergillosis and one pulmonary aspergilloma. Up to 47 (70.4%) of the study patients presented COPD. Among patients developing aspergillosis COPD was more frequent (100%) than among those that did not develop aspergillosis (35 out of 55; 63.6%) (p = 0.012), as well as GOLD IV patients were more frequent among COPD patients developing aspergillosis than among COPD patients that did not (50.0 vs. 26.1%, p = 0.046). Mean time to development of aspergillosis was 18.4 months (median: 8.5) with a wide range (1-58). Overtime, the percentage of patients developing aspergillosis was significantly higher among GOLD IV patients than among GOLD II-III patients (p = 0.032)., Conclusions: The high percentage of cases progressing to aspergillosis among colonized patients, especially among those with COPD (25.5%), stresses the importance of colonization as risk factor, and creates awareness of the possible change from colonization to invasive disease in GOLD IV patients.
- Published
- 2017
- Full Text
- View/download PDF
42. Triazole resistance in Aspergillus fumigatus isolates from patients with cystic fibrosis in Italy.
- Author
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Prigitano A, Esposto MC, Biffi A, De Lorenzis G, Favuzzi V, Koncan R, Lo Cascio G, Barao Ocampo M, Colombo C, Pizzamiglio G, Romanò L, and Tortorano AM
- Subjects
- Adolescent, Adult, Antifungal Agents pharmacology, Child, Drug Resistance, Fungal genetics, Environment, Female, Humans, Italy epidemiology, Male, Microbial Sensitivity Tests methods, Point Mutation, Prevalence, Aspergillus fumigatus drug effects, Aspergillus fumigatus genetics, Aspergillus fumigatus isolation & purification, Cystic Fibrosis complications, Cystic Fibrosis epidemiology, Cystic Fibrosis microbiology, Cytochrome P-450 Enzyme System genetics, Fungal Proteins genetics, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis drug therapy, Pulmonary Aspergillosis epidemiology, Pulmonary Aspergillosis etiology, Triazoles pharmacology
- Abstract
Background: Aspergillus fumigatus is frequently recovered from respiratory secretions of cystic fibrosis (CF) patients. Azole resistance has been increasingly reported., Objectives: To assess the prevalence of azole resistance in A. fumigatus isolates from patients followed by two CF centers of northern Italy., Methods: 423 isolates (220 patients) were screened for azole resistance. Resistance was confirmed with the EUCAST method and cyp51A gene sequencing. Microsatellite genotyping was performed and results were compared with those of environmental resistant isolates., Results: No resistance was detected in one center, while 8.2% of the patients of the other center harbored resistant isolates. The TR
34 /L98H alteration in the cyp51A gene, present in seven cases, resulted associated with poor in-vitro activity of all tested azoles., Conclusions: The environmental origin of the resistance seems to be probable since azole resistance was found also in naïve patients and an identical microsatellite genotype in clinical and environmental isolates was observed., (Copyright © 2016 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)- Published
- 2017
- Full Text
- View/download PDF
43. Aspergillosis complicating a microwave ablation cavity.
- Author
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Singh S, Bandula S, Brown J, Whelan J, and Illing R
- Subjects
- Antifungal Agents therapeutic use, Female, Humans, Itraconazole therapeutic use, Lung microbiology, Lung Neoplasms radiotherapy, Lung Neoplasms secondary, Microwaves, Middle Aged, Nerve Sheath Neoplasms drug therapy, Pulmonary Aspergillosis drug therapy, Radiotherapy methods, Ablation Techniques adverse effects, Antineoplastic Combined Chemotherapy Protocols adverse effects, Pulmonary Aspergillosis etiology, Radiotherapy adverse effects
- Abstract
We present a case of a patient who following chemotherapy developed semi-invasive pulmonary aspergillosis and an aspergilloma in a lung cavity previously formed by microwave ablation (MWA). A 55-year-old woman presented with cough and shortness of breath after finishing three cycles of chemotherapy for a metastatic nerve sheath tumour. She had been treated by MWA for pulmonary metastases 2 years previously which resulted in a residual right apical lung cavity. Postchemotherapy imaging showed that this cavity had enlarged, developed a thicker wall and contained lobulated soft tissue with a crescent sign on coronal reformats. In addition, the patient's Aspergillus-specific IgG was markedly raised. Treatment with itraconazole improved the symptoms and reduced the cavity size and wall thickness. This case shows that persisting lung cavities after MWA are a potential site for semi-invasive aspergillosis and has implications for the timing of chemotherapy in patient with metastatic lung disease., (2016 BMJ Publishing Group Ltd.)
- Published
- 2016
- Full Text
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44. Aspergillus infections in cystic fibrosis.
- Author
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King J, Brunel SF, and Warris A
- Subjects
- Aspergillosis, Allergic Bronchopulmonary etiology, Aspergillosis, Allergic Bronchopulmonary immunology, Aspergillosis, Allergic Bronchopulmonary therapy, Aspergillus fumigatus isolation & purification, Aspergillus fumigatus pathogenicity, Chronic Disease, Cystic Fibrosis immunology, Cystic Fibrosis Transmembrane Conductance Regulator genetics, Cystic Fibrosis Transmembrane Conductance Regulator metabolism, Humans, Immunity, Innate, Lung microbiology, Lung physiopathology, Phenotype, Pulmonary Aspergillosis etiology, Pulmonary Aspergillosis immunology, Pulmonary Aspergillosis therapy, Aspergillosis, Allergic Bronchopulmonary microbiology, Cystic Fibrosis complications, Cystic Fibrosis microbiology, Pulmonary Aspergillosis microbiology
- Abstract
Patients with cystic fibrosis (CF) suffer from chronic lung infection and airway inflammation. Respiratory failure secondary to chronic or recurrent infection remains the commonest cause of death and accounts for over 90% of mortality. Bacteria as Staphylococcus aureus, Pseudomonas aeruginosa and Burkholderia cepacia complex have been regarded the main CF pathogens and their role in progressive lung decline has been studied extensively. Little attention has been paid to the role of Aspergillus spp. and other filamentous fungi in the pathogenesis of non-ABPA (allergic bronchopulmonary aspergillosis) respiratory disease in CF, despite their frequent recovery in respiratory samples. It has become more apparent however, that Aspergillus spp. may play an important role in chronic lung disease in CF. Research delineating the underlying mechanisms of Aspergillus persistence and infection in the CF lung and its link to lung deterioration is lacking. This review summarizes the Aspergillus disease phenotypes observed in CF, discusses the role of CFTR (cystic fibrosis transmembrane conductance regulator)-protein in innate immune responses and new treatment modalities., (Copyright © 2016. Published by Elsevier Ltd.)
- Published
- 2016
- Full Text
- View/download PDF
45. Two cases of endobronchial aspergilloma complicated with primary and metastatic lung cancer: A case report and literature review.
- Author
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Hirano T, Yamada M, Igusa R, Tanno A, Numakura T, Sakamoto K, Kikuchi T, and Ichinose M
- Subjects
- Aged, Aged, 80 and over, Aspergillus growth & development, Bronchi diagnostic imaging, Bronchi microbiology, Bronchi pathology, Humans, Lung Neoplasms diagnosis, Male, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis microbiology, Pulmonary Aspergillosis pathology, Radiography, Thoracic, Tomography, X-Ray Computed, Lung Neoplasms complications, Pulmonary Aspergillosis etiology
- Abstract
Endobronchial aspergilloma is a rare and unusual presentation of lung aspergilloma; the natural history for such rare diseases is poorly understood. This report presents two cases of endobronchial aspergilloma complicated by primary and metastatic lung cancer, and summarizes previous reports that suggest that an endobronchial lung cancer lesion may promote the colonialization and growth of Aspergillus species in the bronchus. Therefore, if endobronchial aspergilloma is found, the complication of primary or metastatic endobronchial lung cancer should be carefully considered., (Copyright © 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
46. [Preoperative Arterial Embolization with N-butyl-2 Cyanoacrylate for Chronic Cavitary Pulmonary Aspergillosis with Trauma Induced Type Ⅰ Diabetes Mellitus].
- Author
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Nakanishi Y, Kojima F, Kamo M, Wakejima R, Okura M, Jinta T, Chonabayashi N, and Bando T
- Subjects
- Diabetes Mellitus, Type 1 etiology, Humans, Male, Middle Aged, Pancreas injuries, Pulmonary Aspergillosis etiology, Thoracic Injuries complications, Diabetes Mellitus, Type 1 complications, Embolization, Therapeutic methods, Enbucrilate therapeutic use, Pulmonary Aspergillosis therapy
- Abstract
A 50-year-old man with hemoptysis, given a diagnosis of left upper lobe pulmonary aspergilloma with cavity and fungus ball by computed tomography. He has a history of typeⅠ diabetes mellitus due to traumatic injury of pancreas and underwent diaphragm plasty. Despite of systemic anti-fungal medication, symptom and radiological findings were not progressed and surgical intervention was planned. Before surgery we performed intercostal artery embolization, in order to minimize bleeding on dissecting adhesion between the chest wall and the lobe with aspergilloma. Left upper lobectomy with muscle-flap prombage was done safely with a blood loss of 450 ml. Postoperative course was favorable. Intercostal artery embolization with N-butyl-2cyanoacrylate is an effective way to minimize hemorrhage during surgical resection for pulmonary aspergillosis with sever adhesion.
- Published
- 2016
47. Clinical characteristics of patients with Aspergillus species isolation from respiratory samples: Comparison of chronic pulmonary aspergillosis and colonization.
- Author
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Ohara S, Tazawa Y, Tanai C, Tanaka Y, Noda H, Horiuchi H, and Usui K
- Subjects
- Adult, Aged, Aged, 80 and over, Aspergillus classification, Aspergillus growth & development, Asthma complications, Body Mass Index, Chronic Disease, Cohort Studies, Female, Humans, Male, Malnutrition complications, Middle Aged, Prevalence, Pulmonary Aspergillosis etiology, Pulmonary Aspergillosis mortality, Retrospective Studies, Survival Rate, Thoracic Surgical Procedures adverse effects, Thoracic Surgical Procedures statistics & numerical data, Tuberculosis, Pulmonary complications, Tuberculosis, Pulmonary epidemiology, Aspergillus isolation & purification, Pulmonary Aspergillosis microbiology, Respiratory System microbiology
- Abstract
Background: With advancements in anti-fungal drugs, it has become more important to correctly diagnose chronic pulmonary aspergillosis (CPA); however, it is not easy to distinguish CPA from colonization when Aspergillus species are isolated from respiratory samples. The aim of the study was to clarify the particular clinical characteristics of patients with CPA vs. those with colonization., Methods: We retrospectively reviewed the medical records of 110 patients with Aspergillus species isolation from respiratory samples, to analyze and compare the differences between CPA and colonization of the Aspergillus species., Results: The median age of all analyzed was 71 years (range: 31-92 years); 64 were female (58%). The most frequently cultured Aspergillus species was Aspergillus fumigatus (48.3%), followed by A. niger (29.2%). Thirty patients (27.4%) were diagnosed with CPA, vs. 75 (68.2%) with colonization and 5 (4.5%) with allergic bronchopulmonary aspergillosis. Compared with the colonization group, the CPA group included more males (CPA vs. colonization: 49.3% vs. 13.3%) and subjects with a low body mass index (18.45 kg/m2 vs. 21.09 kg/m2). As for the underlying pulmonary diseases, the patients with CPA showed a significantly higher prevalence of sequelae of pulmonary tuberculosis (40% vs. 8%) and a history of thoracic surgery (43% vs. 13%) than those with colonization. Asthma was less frequent in the CPA group than in the colonization group (0% vs. 20%). We found no significantly important underlying extrapulmonary diseases., Conclusions: Patients with CPA display clinical characteristics distinct from those seen in subjects with colonization., (Copyright © 2015 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
48. Chronic pulmonary aspergillosis as a sequel to lobectomy for lung cancer.
- Author
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Tamura A, Suzuki J, Fukami T, Matsui H, Akagawa S, Ohta K, Hebisawa A, and Takahashi F
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Incidence, Japan epidemiology, Male, Middle Aged, Postoperative Period, Pulmonary Aspergillosis diagnosis, Pulmonary Aspergillosis epidemiology, Retrospective Studies, Risk Factors, Surgical Wound Infection diagnosis, Surgical Wound Infection epidemiology, Survival Rate trends, Tomography, X-Ray Computed, Young Adult, Lung Neoplasms surgery, Pneumonectomy adverse effects, Pulmonary Aspergillosis etiology, Surgical Wound Infection etiology
- Abstract
Objectives: Chronic pulmonary aspergillosis (CPA) is an emerging complication after lobectomy for lung cancer. This retrospective study aimed to determine the incidence, main risk factors and clinical features of postoperative CPA in lung cancer patients., Methods: This study included lung cancer patients treated by lobectomy and with no previous history of thoracic surgery or coexistent aspergillosis at the time of surgery. The cumulative incidence of CPA was determined using death as a competing risk. Furthermore, the identified lung cancer patients were divided into CPA and non-CPA groups to compare their preoperative clinical features and to identify the risk factors of postoperative CPA by univariable and multivariable analyses. We also analysed the clinical features of CPA patients after diagnosis., Results: We included 475 lung cancer patients. Of these, 17 patients (3.6%) developed CPA after the lobectomy. The cumulative postoperative incidence rate of CPA was 2.3% [95% confidence interval (CI), 0.8-3.8%] at 5 years and 7.9% (95% CI, 3.0-13.0%) at 10 years. There were significantly more men (P = 0.007), smokers (P = 0.002) and comorbid chronic obstructive pulmonary disease (COPD) (P = 0.008) and interstitial lung disease (ILD) (P = 0.009) patients in the CPA group than in the non-CPA group. Multivariable analysis identified comorbid COPD (P = 0.0019) and ILD (P = 0.0003) as significant risk factors. An antifungal treatment response was obtained in 6 patients (35%). The 1-year survival rate was 47% (follow-up periods, interquartile range: 3-78 months), and 5 of the total of 11 deaths were due to CPA., Conclusions: Through the present retrospective study, CPA seems to be a common sequel to lobectomy in lung cancer patients, and COPD and ILD represent strong risk factors of postoperative CPA. Because of the poor clinical outcome of lung cancer patients who develop CPA after lobectomy, careful follow-up using several examinations and chest radiographs to make CPA diagnosis may be essential., (© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
49. Recall of provision of sun protection measures to patients with cystic fibrosis being prescribed voriconazole.
- Author
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Cunningham L, Moran M, Keating C, McKone E, Gallagher C, and Lally A
- Subjects
- Adult, Carcinoma, Squamous Cell etiology, Cystic Fibrosis complications, Dermatitis, Phototoxic etiology, Dermatitis, Phototoxic prevention & control, Female, Humans, Male, Middle Aged, Pulmonary Aspergillosis etiology, Pulmonary Aspergillosis prevention & control, Skin Neoplasms etiology, Sunburn etiology, Sunburn prevention & control, Sunlight adverse effects, Young Adult, Antifungal Agents adverse effects, Carcinoma, Squamous Cell prevention & control, Patient Education as Topic, Skin Neoplasms prevention & control, Voriconazole adverse effects
- Published
- 2015
- Full Text
- View/download PDF
50. [Excavated persistent pulmonary opacities during a granulomatosis with polyangiitis: think of aspergillosis].
- Author
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Mahfoudhi M and Turki S
- Subjects
- Antibodies, Antineutrophil Cytoplasmic blood, Antifungal Agents therapeutic use, Biopsy, Granulomatosis with Polyangiitis immunology, Granulomatosis with Polyangiitis pathology, Hemoptysis etiology, Humans, Immunocompromised Host, Male, Maxillary Sinusitis complications, Maxillary Sinusitis microbiology, Middle Aged, Pulmonary Aspergillosis drug therapy, Pulmonary Aspergillosis etiology, Pulmonary Aspergillosis microbiology, Voriconazole therapeutic use, Aspergillus fumigatus isolation & purification, Granulomatosis with Polyangiitis complications, Pulmonary Aspergillosis diagnostic imaging, Tomography, X-Ray Computed
- Published
- 2015
- Full Text
- View/download PDF
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