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PubMed1995

Allergic bronchopulmonary aspergillosis: a case report.

Aspergillus-associated pulmonary diseases are aspergilloma, invasive aspergillosis, and allergic bronchopulmonary aspergillosis. Allergic bronchopulmonary aspergillosis is caused by a complex of immunologic reactions to the presence of the Aspergillus species colonizing the bronchial trees. The disease is not common in Taiwan. The major diagnostic criteria for allergic bronchopulmonary aspergillosis are 1) bronchial asthma, 2) pulmonary infiltration, 3) peripheral eosinophilia, 4) positive skin test to Aspergillus fumigatus, 5) serum precipitin to Aspergillus fumigatus, 6) elevated serum Ig E, and 7) central bronchiectasis. We report a case who has had a chronic asthmatic-like cough for 5 years. He worked in a silo for two years before he was troubled by the disease. He was admitted to hospitals four times in the past, and received five bronchoscopic examinations and one open lung biopsy without definite diagnosis. Sputum eosinophilia directed our attention to the differentiation of eosinophilic lung diseases. A bronchogram which revealed central brochiectasis helped us to make the diagnosis of allergic bronchopulmonary aspergillosis, despite negative sputum culture for Aspergillus fumigatus and negative serum precipitin to Aspergillus fumigatus.

Aspergillosis, Allergic Bronchopulmonary↗
PubMed1994

Adjuvant itraconazole in the treatment of destructive sphenoid aspergillosis.

Paranasal aspergillosis is a potentially progressive continuum of disease, classically described as having four forms: allergic, non-invasive, invasive, and fulminant. The first two have been considered together as extramucosal disease whilst the latter two are both variants of tissue-invasive disease. Sphenoid aspergillosis, given its anatomical location is a more aggressive disease than that found affecting the other paranasal sinuses, even when non-invasive, and may be fatal. This is compounded by the fact that diagnosis is difficult and so may be made late when aspergillosis is consequently more advanced. Intracranial extension may occur via the direct spread of invasive disease or along communicating veins despite intact sinus walls and lack of fungal mucosal penetration. Once this occurs mortality is high. We have successfully treated three cases of destructive sphenoid aspergillosis, two of which had intracranial extension, with surgery and adjuvant anti-fungal chemotherapy including itraconazole. We recommend the use of post-operative itraconazole in all cases of sphenoid sinus aspergillosis. Additionally, when there is evidence of spread to the brain or other adjacent structures we would advocate an initial course of intravenous amphotericin B followed by long-term oral itraconazole.

Adult↗
PubMed1976

IgE antibodies in bronchopulmonary aspergillosis.

Total serum IgE and serum IgE antibodies to A. fumigatus were quantitated in 143 patients with different forms of bronchopulmonary aspergillosis. Total serum IgE levels were elevated in all patients with allergic bronchopulmonary aspergillosis but also in some other forms of bronchopulmonary aspergillosis, thus limiting the diagnostic value of total serum IgE determination in this type of pulmonary mycotic infection. Specific IgE antibodies to A. fumigatus could be demonstrated in all patients with allergic bronchopulmonary aspergillosis, at least during an acute episode of their disease. Only two patients with a different form of bronchopulmonary aspergillos had slightly elevated levels of specific antibodies. Measurement of IgE antibodies specific to A. fumigatus by means of the RAST method, using high quantities of antigen coupled to cellulose discs so that inhibitory factors may not interfere, is a useful aid in the diagnosis of allergic bronchopulmonary aspergillosis.

Aspergillosis↗
PubMed1994

[Aspergillosis in acquired immunodeficiency syndrome].

From 1983 to 1991 only isolated cases of aspergillosis in AIDS patients were reported; since 1991, an increasing number of cases have been reported suggesting a recent emergence of this fungal infection. Aspergillosis occurs about 10 to 25 months after AIDS diagnosis in patients with CD4 below 50/mm3. Neutropenia and/or steroid therapy, which are known as predisposing factors in aspergillosis, are noticed in about one half of the patients. Previous pulmonary infection, especially pneumocystosis, are very common. Clinical signs are typical of an invasive pulmonary aspergillosis: constant fever, cough, dyspnea, frequent thoracic pains and haemoptysis. Radiologic signs frequently indicate an interstitial infiltration. Nodular and cavitating lesions, pleural effusions, thoracic lymph node enlargement are often present. Diagnosis procedures are realised on bronchoalveolar lavage by direct examination, culture and antigen detection. Aspergillus fumigatus is the most usually species detected. Post-mortem diagnosis is frequent. Invasive bronchial aspergillosis, localised infections (aspergilloma, otitis, sinusitis) or disseminated infections (nervous system, heart, kidney, lymph nodes, thyroid) are also described. Prognosis is poor even with treatment (amphotericin B or itraconazole). An earlier diagnosis and treatment of the bronchial colonization could probably improve this prognosis.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Detection of Aspergillus fumigatus DNA by polymerase chain reaction in the clinical samples from individuals with pulmonary aspergillosis].

Aspergillosis is a disastrous cause of mortality and morbidity in patients in an immunocompromised state and old lung tuberculosis. However, the diagnosis of aspergillosis remains unsettled. In the present study, we developed a test to detect the Aspergillus fumigatus DNA using polymerase chain reaction (PCR) in clinical samples including sputum and bronchial aspirations from the patients with aspergillosis. We selected 2 pairs of oligonucleotide primers and the DNA for the small subunit ribosomal RNA of aspergillus fumigatus and they were significantly amplified. Although isolation of Aspergillus DNA may reflect contamination and colonization without infection, no aspergillus DNA was found in sputum or bronchial aspirations from the patients with lung cancer or interstitial lung diseases except a case of pulmonary fibrosis associated with rheumatoid arthritis chronically received 20 mg of corticosteroid. There was a 100% correlation between the culture results and the nested PCR results in the patients with pulmonary aspergillosis. These findings indicate that PCR detection of aspergillus fumigatus might be valuable for the diagnosis of aspergillosis.

Aged↗
PubMed1996

[Isolated invasive sphenoid aspergillosis].

Isolated aspergillosis of the sphenoid sinus is a difficult diagnosis because the often misleading clinical manifestations of this rare disease develop late. We report a case of invasive aspergillosis uniquely involving the sphenoid sinus revealed by clinical features suggesting pseudotumor of the pituitary in an immunocompetent man. A 71-year-old man presented sudden onset palsy of the abductor nerve of the left eye. Neuroimaging suggested a pseudotumor of the pituitary. Sphenoid sinusitis was discovered at surgery. The diagnosis of aspergillosis was provided by the histology examination of the sphenoid mucosa. Despite medical treatment with itraconazol alone then in combination with amphotericine B, the infectious process progressed to the pituitary, the cavernous sinus, the upper orbital fissue and the optic canal. Cure was finally achieved after a second surgical procedure to drain and aerate the sphenoid sinus. Aspergillosis of the sphenoid sinus is usually discovered due to neurological signs such as a cavernous sinus syndrome, pseudotumor of the pituitary or the orbit. Diagnosis is often made intraoperatively or at histology examination. Invasive forms almost always are seen in immunosuppressed subjects. In our case, the patient was immunocompetent and had no past history of sinusitis. The invasive sphenoid aspergillosis invaded bone tissue, the cavernous sinus and the meninges.

Aged↗
PubMed1996

Changes in the natural history of invasive pulmonary aspergillosis in neutropenic leukemic patients.

We describe five patients with acute leukemia who during the period of chemotherapy-induced neutropenia developed invasive pulmonary aspergillosis. Amphotericin B was initiated early in the febrile neutropenic episode at a dose of 1-1.5 mg/kg per day. Four of the five patients had normal chest films at the time amphotericin B was started and only later developed infiltrates, which subsequently progressed to cavitation formation with resolution of the infiltrates around the cavitations. This is compatible with primary aspergilloma or invasive pulmonary aspergillosis. The patients experienced partial (2 patients) or complete resolution (3 patients) of the process, and none died of the fungal infection. In the past, infection with invasive aspergillosis carried a high mortality. We believe that this positive outcome constitutes a change in the natural history of invasive pulmonary aspergillosis in neutropenic patients as a result of the early initiation of high dose amphotericin B. We recommend the early empiric use of amphotericin B therapy in febrile neutropenic patients not responding to broad-spectrum antibiotics, and that the minimal initial dose be 1 mg/kg per day especially in institutions carrying a high incidence of aspergillosis.

Adult↗
PubMed1998

[Management of hemoptysis in invasive pulmonary aspergillosis].

Invasive pulmonary aspergillosis is an opportunistic infection occurring in a background of severe immune depression. The majority of cases occur in patients who have malignant hematologic disease, particularly during chemotherapy induction or consolidations phases for acute non-lymphocytic leukemia. The principal risk factors are profound (PN < 500 per mm3) and prolonged (very high risk beyond 20 days) neutropenia, perturbed phagocyte function and cellular immune deficiency (AIDS, immunosuppressive treatment in organ and bone marrow recipients). Clinically, invasive pulmonary aspergillosis presents as acute non-specific pneumonia with cough, chest pain and fever. The severe infection rapidly becomes life-threatening. The development of massive hemoptysis is a major risk. We report four cases of invasive pulmonary aspergillosis in patients who had hemoptysis. All four patients developed non-specific pneumonia resistant to broad-spectrum antibiotics during post-chemotherapy aplasia. Computed tomography of the thorax and bronchoscopy with bronchoalveolar lavage was performed due to the occurrence of hemoptysis. In the first two cases, the patients were recovering from aplasia. The thoracic CT scan showed evidence of a cavitating mass with peripheral vessels. Bronchoscopy findings suggested mucosal lesions. The patients were managed surgically. Pathology confirmed the diagnosis of invasive pulmonary aspergillosis with the presence of ischemic necrosis of the pulmonary parenchyma harboring numerous aspergillus filaments. Outcome was favorable and chemotherapy was re-initiated in one case. These two patient died from their hematological disease a few months later. The other two patients remained in aplasia. A CT of the thorax showed multifocal infiltration with vascular contact. Bronchoscopy was again suggestive. One patient developed massive hemoptysis with respiratory distress. Embolization was performed but the patient died two days after onset of hemoptysis. In the last case, embolization was successful and outcome was favorable enabling a bone marrow allograft; the patient died a few months later from the hematological disease. The potential gravity of hemoptysis in the course of invasive pulmonary aspergillosis should lead to early treatment with emergency CT scan and, if possible, bronchoscopy with bronchoalveolar lavage to establish the therapeutic strategy based on surgical excision or embolization of the pulmonary or bronchial arteries.

Adult↗
PubMedDate not supplied

[Clinical and radiological findings in two cases of aspergillosis of the central nervous system in children].

INTRODUCTION: Aspergillosis is the second fungemia after candidiasis that affects the central nervous system of immunodeppresed and immunocompetent humans. The literature reports nearly always compromised adults. CASE REPORTS: Two pediatric cases of central nervous system aspergillosis with different clinical course are presented. The first of them, is a immunocompetent person in whom a granulomatous disease of the central nervous system was suspected. The cultivation of stereotaxic biopsy reported thin septated hyphae. After 42 days of treatment with itraconazol the patient recovered completely. The second patient, had an acute lymphoblastic leukemia and developed a widespread aspergillosis including the central nervous system. In spite of antifungic treatment for 63 days, he died of heart failure. CONCLUSIONS: Diagnosis of aspergillosis is difficult because of the poor specificity of the neuroimages, cerebrospinal fluid and complementary labs. The images are indistinguishable from acute ischemia infarcts and later those images change to abscesses. Direct KOH staining and the cultivation of biopsed samples confirmed the diagnosis of aspergillosis. An aggressive treatment with amphotericin B and itraconazol is recommended, but high mortality is suspected. Diagnosis, neuroimaging, clinical evolution and treatment are discussed.

Adult↗
PubMed2004

[Complex respiratory aspergillosis: diagnostic and therapeuthic difficulties].

INTRODUCTION: Respiratory aspergillosis with different physiopathologic mechanisms can be associated in one patient in rare occasions. CASE REPORT: We review three cases associating an allergic bronchopulmonary aspergillosis (ABPA) and an other form of aspergillosis: aspergilloma, chronic necrotizing pulmonary aspergillosis and we present a review of literature. CONCLUSION: Such associations result in diagnostic and therapeutic difficulties. Corticosteroid treatment used for ABPA can increase the risk of severe infections. Such cases are a good indication of systemic antifungal therapy.

Aged↗
PubMed1980

Serologic immunodiagnosis of of invasive aspergillosis.

Two sensitive methods, counterimmunoelectrophoresis (CIE) and enzyme-linked immunosorbent assay (ELISA), for detecting antibodies to Aspergilus were used to study serial specimens from patients with histologically proven invasive aspergillosis for measurement of conversion from negative to positive immunoprecipitin reactions and changes in ELISA titers during immunosuppression. Sera from 12 granulocytopenic patients without invasive aspergillosis served as controls. Positive CIE reactions were demonstrated in 70% of patients with clinically suspected aspergillosis. In addition to a greater sensitivity (80%) of ELISA, the serial determination of antibody response by Elisa allowed for separation of seropositive patients into two groups. A serial rise in ELISA titer appeared to correlate with histologically documented recovery from infection, whereas those with declining or persistently intermediate titers were found to have disseminated aspergillosis at autopsy. Thus, serial antibody determination by ELISA was valuable as both a diagnostic and prognostic tool.

Antibodies, Fungal↗
PubMed1992

Comparison of azoles against aspergilli in vitro and in an experimental model of pulmonary aspergillosis.

Current treatment modalities for bronchopulmonary aspergillosis are not very satisfying. We determined the in vitro activity of recently available azoles against Aspergillus fumigatus, Aspergillus flavus and Aspergillus niger. Subsequently, these agents were evaluated in an animal model of bronchopulmonary aspergillosis using A. fumigatus as test organism. In vitro, detectable activity was only found for itraconazole (all minimal inhibitory concentrations, MICs, less than or equal to 3.2 micrograms/ml). The MICs for SCH39304 were greater than or equal to 12.8 micrograms/ml and greater than or equal to 25.6 micrograms/ml for ketoconazole and fluconazole. In vivo, amphotericin B was the most active agent tested, and SCH39304 was the most active azole in terms of survival and reduction in lung weight, followed by itraconazole. Ketoconazole and fluconazole did not improve survival nor reduce the lung weight of infected animals. We conclude, (1) that in vitro activity of azoles against aspergilli does not always correlate with in vivo activity; (2) that in vivo, SCH39304 was the most active azole tested, followed by itraconazole; (3) that for those agents for which data about effectiveness in human pulmonary aspergillosis are available (amphotericin B, ketoconazole, itraconazole) antifungal activity in our model corresponds to activity as seen in human beings, and (4) that SCH39304 and itraconazole are rational choices for clinical trials in human pulmonary aspergillosis.

Amphotericin B↗
PubMed2002

The clinical spectrum of pulmonary aspergillosis.

Aspergillus is a ubiquitous fungus that causes a variety of clinical syndromes in the lung, ranging from aspergilloma in patients with lung cavities, to chronic necrotizing aspergillosis in those who are mildly immunocompromised or have chronic lung disease. Invasive pulmonary aspergillosis (IPA) is a severe and commonly fatal disease that is seen in immunocompromised patients, while allergic bronchopulmonary aspergillosis is a hypersensitivity reaction to Aspergillus antigens that mainly affects patients with asthma. In light of the increasing risk factors leading to IPA, such as organ transplantation and immunosuppressive therapy, and recent advances in the diagnosis and treatment of Aspergillus-related lung diseases, it is essential for clinicians to be familiar with the clinical presentation, diagnostic methods, and approach to management of the spectrum of pulmonary aspergillosis.

Aspergillosis↗
PubMed2001

[Invasive aspergillosis].

Invasive aspergillosis remains a life-threatening complication in immunocompromised patients. The pulmonary involvement by the aspergillosis is the most common setting. The dissemination of the disease is correlated with the worse prognosis. The overall improvement of the prognosis needs a global diagnostic and therapeutic strategy. In neutropenic patients (mostly at risk of invasive aspergillosis), an early diagnosis can be achieved by systematic use of thoracic CT scan to search halo sign (that seems to be quite specific of the diagnosis in this setting). The early initiation of the antifungal treatment (conventional or liposomal amphotericin or new azole compounds) could be combined with a surgical approach if necessary. This approach could be able to improve the prognosis of aspergillosis. However, the outcome of these patients remains also correlated to the underlying disease.

Amphotericin B↗
PubMed2003

[Value of Aspergillus galactomannan antigen detection in the diagnosis and follow-up of invasive aspergillosis in hematological patients].

Serum galactomannan detection is considered to be a useful test for early diagnosis and follow-up of invasive aspergillosis. From February to September 2002, adult patients hospitalized in our Hematology Unit for receiving intensive chemotherapy and/or hematopoietic stem cell transplant were prospectively studied. We analyzed a total of 760 samples obtained from 100 patients. Eleven patients (11%) having a positive result (OD index >1.5 ng/ml) in two consecutive Platelia Aspergillus tests were considered galactomannan-positive cases. On the other hand, 12 patients (12%) were diagnosed of proven or probable invasive aspergillosis. Sensitivity (66.6%), specificity (95.5%), positive predictive value (72.7%) and negative predictive value (96.7%) were comparable to those of larger series. Galactomannan positivity allowed also to anticipate invasive aspergillosis diagnosis (from two to 17 days before radiographic findings and from two to 15 days before mycological culture). Moreover, kinetics of antigenemia could be useful for assessing therapeutic response. Once accepted galactomannan test as a diagnostic criterium for invasive aspergillosis knowing potential causes of false positive results is of paramount importance.

Adult↗
PubMed1988

[The computed tomographic spectrum of pulmonary aspergillosis].

The authors describe the CT findings in 10 cases of pulmonary aspergillosis which include allergic bronchopulmonary aspergillosis, aspergilloma and invasive pulmonary aspergillosis. CT reveals a more distinct radiologic-pathologic correlation than plain films and shows suggestive features of pulmonary aspergillosis earlier and in a more detailed fashion. Thus the use of CT in the appropriate clinical setting should allow earlier diagnosis than conventional radiography.

Aspergillosis↗
PubMed1978

Unusual manifestations of pulmonary aspergillosis.

Pulmonary aspergillosis is being diagnosed with increasing frequency, particularly in larger referral centers. The spectrum of lung pathology can be classified into 3 major groups: A) non-invasive mycetoma; B) allergic bronchopulmonary aspergillosis and C) invasive aspergillosis. Five patients with pulmonary aspergillosis are presented, illustrating unusual features of each major group. Transthoracic needle aspiration biopsy was diagnostic in 3 patients. It is important to differentiate a mycetoma developing in a pre-existing cavity from a cavitating Aspergillus abscess. The radiologic appearances may be similar, but evolution of the 2 lesions is entirely different.

Adult↗
PubMed1996

CT manifestations of pulmonary aspergillosis.

The clinical and radiologic manifestations of pulmonary aspergillosis depend on the underlying status of the patients' lung parenchyma and the patients' immunologic response to the infecting agent, most commonly Aspergillus fumigatus. Thus, many different manifestations of pulmonary aspergillosis have been described, with distinct clinical, pathological, and radiological characteristics. Aspergillomas (mycetomas) result from Aspergillus colonization of preexisting lung cavities. Allergic bronchopulmonary aspergillosis results from a hypersensitivity reaction to the fungus in asthmatic patients. Invasive aspergillosis occurs in immunocompromised patients and can take one of many forms, depending on the degree and etiology of the patients' immunosuppression. CT is currently the best imaging modality for the assessment of pulmonary parenchymal disease. In the correct clinical setting, the CT findings frequently suggest a specific diagnosis. The aim of this review is to discuss and illustrate the various CT manifestations of pulmonary aspergillus infection.

Aspergillosis↗