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PubMed1992

Invasive aspergillosis of the sphenoethmoidal sinuses in an immunocompetent host.

Fungal infections of the nose and paranasal sinuses are uncommon; Aspergillus is the most frequently isolated fungal pathogen. Invasive aspergillosis is commonly seen as an opportunistic infection in the immunocomprised, debilitated host. Whereas fulminant infection in the otherwise healthy patient is rare, in the immunocompetent host with persistent signs and symptoms of sinusitis despite appropriate medical management, aspergillosis should be considered. Treatment of paranasal sinus aspergillosis requires correction of immunologic deficits, if possible; aggressive surgical debridement to provide adequate drainage and aeration of the sinuses; and adjunctive antifungal chemotherapy. The authors present an unusual case of invasive aspergillosis of the paranasal sinuses in an immunocompetent host.

Adult↗
PubMed2003

[Severe Legionnaire's disease revealing an invasive aspergillosis in an apparently immunocompetent patient].

INTRODUCTION: Invasive aspergillosis, a sever disease, usually occurs in immuno-depressed patients. However, it may also develop in presumably immuno-competent patients. OBSERVATION: A 54-year-old man, smoker, was hospitalised for hypoxemia of the right lung and septic shock, rapidly requiring mechanical ventilation combined with administration of vasopressors, and followed by dialysis because of the rapid worsening of an acute kidney failure. The diagnosis of pulmonary Legionnaire's disease was made on the second day in view of the positivity of the urinary legionella antigen. The progression of the disease was marked by the discovery of a histologically documented gastric aspergillosis and three abscessed intracerebral lesions within the context of a strongly positive aspergillus antigenemia. The disease worsened and the patient died on D 17, despite the antibiotic and anti-aspergillus treatments, haemodynamic support and dialysis. DISCUSSION: To our knowledge, the association of invasive aspergillosis and severe Legionnaire's disease has never been described in an presumably immunocompetent patient. This clinical case suggests the existence, other than the usual risk factors of invasive aspergillosis that characterise profound states of immunodepression, of more subtle alterations in the immune system that may enhance this type of infection.

Acute Kidney Injury↗
PubMedDate not supplied

Invasive pulmonary aspergillosis: A study of 39 cases at autopsy.

BACKGROUND: Aspergillus is a common cause of invasive mycosis, especially in immunocompromised or immunosuppressed individuals. AIMS: To study the incidence of invasive pulmonary aspergillosis and evaluate the predisposing factors and clinico-pathological manifestations. SETTINGS AND DESIGN: Retrospective analysis of autopsy material from a tertiary care hospital. MATERIAL AND METHODS: All autopsies performed over a 12-year period were reviewed and cases with invasive aspergillosis were analysed with respect to their clinical presentation, predisposing factors, gross and histological features, complications and causes of death. RESULTS: Among a total of 20475 autopsies performed in 12 years, 39 patients (0.19 %) had invasive pulmonary aspergillosis. There were 28 males and 11 females. Their ages ranged from five months to 67 years. Dyspnoea, fever, cough with mucopurulent expectoration, chest pain and haemoptysis were commonly encountered symptoms. Forty-one per cent of the patients had no respiratory symptoms. Fungal aetiology was not entertained clinically in any of the patients. The major underlying conditions were prolonged antibiotic therapy, steroid therapy, and renal transplantation, often associated with underlying lung diseases. Pneumonia, abscesses, vascular thrombosis and infarction were common findings at autopsy. Antecedent tuberculosis, mucormycosis, Pneumocystis carinii pneumonia and Cytomegalovirus infection were also present. In most cases, death was related to extensive pulmonary involvement or fungal dissemination. CONCLUSION: A diagnosis of invasive pulmonary aspergillosis should always be borne in mind whenever one is dealing with recalcitrant lung infections even with subtle immunosuppression. Radiological investigations and serologic markers can be utilised for confirmation and prompt therapy.

Adolescent↗
PubMed2003

[Early diagnosis of invasive aspergillosis in neutropenic patients with bi-weekly serial screening of circulating galactomannan by Platelia Aspergillus].

UNLABELLED: The diagnosis of invasive aspergillosis in neutropenic individuals is difficult and lengthy since non-invasive diagnostic tests lack sensitivity and specificity. The diagnosis of invasive aspergillosis in 154 prolonged neutropenic patients was prospectively bi-weekly validated by screening circulating galactomannan. The global sensitivity was 73% and specificity was 96%. The positive and negative predictive values were 73% and 98% respectively. False positive reactions occurred at a rate of 2%. Antigenemia was detected before clinical suspicion of invasive aspergillosis (median, 6 days before) in 30% of patients and anticipated the onset of radiologic signs 9 days in 60% of patients. CONCLUSION: the prospective screening of galactomannan is a sensitive and non-invasive tool for early diagnosis of invasive aspergillosis in high-risk adult hematology patients.

Adult↗
PubMedDate not supplied

[Aspergillosis of the central nervous system (clinical observation and review of literature)].

Aspergillosis of the central nervous system presents a challenge faced with the problems arising from the establishing the diagnosis, the low efficiency of treatment, and high mortality rates (about 95% as shown by some data). This paper presents a clinical case of a patient with aspergillosis-induced central nervous system lesion verified by autopsy. Possible errors in the diagnosis and treatment of the patient are analyzed. The literature data including clinical cases, etiopathogenesis, and clinical manifestations and its possible complications are presented. Groups of patients at risk for invasive aspergillosis are considered. The paper gives the data available in the foreign literature on the methods and efficiency of treatment and mortality rates in different groups of patients. The urgency of the problem in the diagnosis and treatment of cerebral aspergillosis rises with the increased number of patients with immunological disorders due to infectious diseases (HIV), social (drug addiction, alcoholism), environmental, and other factors.

Adult↗
PubMed2004

[Chronic necrotizing pulmonary aspergillosis in an immunocompromised patient].

A case with chronic necrotizing pulmonary aspergillosis that was mimicking the radiomorphology of malignant tumor was reported. The patient was admitted to hospital with progression of a left upper lobe infiltrate which was known and under regular observation for 8 years, and haemoptoe. Computer tomography scan showed a spiculated abnormality in the left upper lobe with mediastinal lymphadenomegaly. Based on this finding pulmonary malignancy was suspected and, therefore, the patient was referred to surgical intervention. The post surgical histology revealed aspergillus in the specimen. Since signs of vascular invasion could not be detected microscopically and the disease developed in immunocompromised patient (due to diabetes mellitus and long term steroid treatment) the clinical condition was determined as chronic necrotizing aspergillosis. It is very likely that the pathogen infected the patient during his daily work in a bakery. The present paper also summarizes the clinical aspects, differential diagnosis and therapy of different forms of pulmonary aspergillosis with emphasis on chronic necrotizing pulmonary aspergillosis.

Adrenal Cortex Hormones↗
PubMed2005

[Clinical analysis of aspergillosis in orthotopic liver transplant recipients].

OBJECTIVE: To assess the clinical features of aspergillosis and its diagnosis, prophylaxis and treatment in patients after orthotopic liver transplantation (OLT), and to improve the prognosis of the recipients. METHODS: Medical records of consecutive patients who underwent OLT in our liver transplant center from May 2002 to May 2004 were analyzed retrospectively. Those with aspergillus infection complications were studied in detail regarding their infected organs, related factors, treatments and prognoses. RESULTS: 17 out of 207 recipients of OLT were detected with aspergillosis. The incidence was 8.21 percent. 5 patients infected with superficial aspergillus survived. Of the 12 cases with deep aspergillus infection, 3 with infection limited to the sites of their incisions survived, 2 of the 3 patients with infection in their lungs, and 1 of the 2 patients with it in their livers died, and 4 recipients with multi-organ aspergillus infection died. Among the 7 cases that died, 5 had severe hepatitis, 1 had post-hepatitis liver cirrhosis and 1 had primary liver carcinoma. CONCLUSIONS: Long-term (> or = 3 weeks) broad-spectrum antibiotics and immunosupression were involved in aspergillus infection in our OLT patients. Patients with chronic severe hepatitis had a higher risk of having aspergillus infection. Amphotericin B is still the best choice for treating aspergillosis. Prophylactic administration of anti-fungal medicine, surveillance of fungal infections as a routine, and treatment of the infection in time may help to improve the prognosis of OLT recipients with aspergillosis.

Adult↗
PubMed2005

Correlations between clinical and laboratory findings in patients investigated for aspergillosis.

We investigated 120 patients suspected clinically to have pulmonary aspergillosis with different clinical manifestations "aspergilloma (Subgroup A), allergic bronchopulmonary aspergillosis (Subgroup B) and invasive pulmonary aspergillosis (Subgroup C)" and correlated between their clinical and laboratory findings and endogenous specific aflatoxin production. They were subjected to isolation of Aspergillus strains, measurement of serum total IgE and specific Aspergillus IgG by ELISA and identification of aflatoxin producing Aspergillus strains using fluorescence analysis of spectroline. Aspergillus was isolated from 45 patients (37.5%). Subgroup A had a negative statistically non-significant correlation between clinical and laboratory findings as regard total IgE and for Aspergillus IgG (only haemoptysis &weight loss had significant correlation with aspergillus IgG). Subgroup B & Subgroup C had positive, statistically significant correlation &negative statistically non significant correlation respectively as regard all clinical findings and both total IgE & serum IgG. This study also showed that 6 Aspergillus strains out of 45(13.3%) produced endogenous aflatoxin. It is concluded that a significant correlation that exists between clinical and serological findings in allergic pulmonary aspergillosis. Aflatoxins may be produced in vivo by strains of Aspergillus and may result in manifestations similar to those caused by ingestion of aflatoxin in food.

Adolescent↗
PubMed1991

[MR imaging in paranasal and intracranial aspergillosis].

The MR findings in three patients with paranasal and intracranial aspergillosis were analyzed. Two patients had sphenoid sinus aspergillosis with mucocele, and one had aspergillosis in the maxillary sinus and pachymeningitis in the posterior fossa. In all patients with aspergillosis of the paranasal sinuses, a markedly hypointense area was present within the lesion on T2-weighted images. In the patient with pachymeningitis, contrast-enhanced MR images clearly demonstrated the extent of the lesion.

Aspergillosis↗
PubMed1991

Intranasal amphotericin B reduces the frequency of invasive aspergillosis in neutropenic patients.

PURPOSE: To retrospectively study the prophylaxis of invasive aspergillosis in neutropenic patients and to relate the frequency of this fungal disease to any causal or modifying factors that could be identified. PATIENTS AND METHODS: Between 1977 and 1988, 130 patients underwent 158 intensive treatment episodes to control acute leukemia, lymphoma, and aplastic anemia, and the frequency of complicating aspergillus infection was determined. RESULTS: Proven invasive aspergillus infections occurred in 22 cases, 12 of which were fatal. Invasive aspergillosis was suspected in a further 16 cases and all these patients recovered with amphotericin B treatment. Colonization by Aspergillus in the absence of clinically significant infection was seen in 31 treatment episodes. Invasive aspergillosis involved mainly the upper and lower respiratory tract and skin. Control of the infection was closely related to the control of the underlying disease, with subsequent return of normal marrow function and resolution of neutropenia. The incidence of aspergillus infection has decreased dramatically since 1985, most probably due to the introduction of intranasal amphotericin B. This occurred despite the persistence of aspergillus spores in the hematology ward air during the 1986 to 1988 period. CONCLUSION: Intranasal aerosolized amphotericin B may protect against invasive aspergillosis, even when neutropenic patients are cared for in conventional wards without HEPA filtration.

Administration, Intranasal↗
PubMed1991

[An operated case report of pulmonary aspergillosis by sapprophytic infection of Aspergillus candidus in congenital bronchial cyst of right lower lobe].

Aspergillosis is a mycotic disease caused by a variety of species of the dimorphic fungus aspergillosis, especially aspergillus fumigatus. But the report of pulmonary aspergillosis by aspergillus candidus is very rare. We experienced a surgical case of pulmonary aspergillosis caused by aspergillus candidus. The patient is a 18-year-old girl. Eleven years ago, she had suffered from pneumonia of rt. lower lobe, there after she often has suffered from cough and fever every year. In 1986, chest x-ray photography shows a small cavity in rt. lower lobe. In 1989, it becomes a big cavity of 8 X 8 cm in diameter with niveau. She has cough and bloody sputum of 100-150 ml daily. We have cultured aspergillus candidus from sputum, bloody pus obtained by percutaneous aspiration needle lung biopsy of the cavity and bloody pus in the cavity which was resected on March 3, 1989. But the pathological investigation could not demonstrate any fungus ball or fungus body of aspergillus candidus.

Adolescent↗
PubMed1990

[Serological diagnosis of pulmonary aspergillosis--measurement of IgG-, IgM- and IgA- antibodies against Aspergillus fumigatus by means of ELISA].

Serological diagnosis plays an important role in the diagnosis of pulmonary aspergillosis, however, precipitation-in-gel test is neither sensitive nor quantitative. Recently, several investigators have used the ELISA technique for the detection of antibodies against Aspergillus fumigatus and reported the usefulness of this method. In this report, we measured IgG-, IgM-, and IgA- antibody titers against Aspergillus fumigatus by means of ELISA in sera from patients with several different lung diseases including pulmonary aspergillosis. The results obtained were as follows: 1) Measurement of IgG-antibody titers was most useful for the diagnosis of pulmonary aspergillosis. 2) Measurement of IgG-antibody titers was more sensitive than precipitation-in-gel test. 3) IgG-antibody titer was quantitative and reflected the clinical course of pulmonary aspergillosis.

Antibodies, Fungal↗
PubMed1990

Serum immunoglobulins E and G anti-Aspergillus fumigatus antibody in patients with cystic fibrosis who have allergic bronchopulmonary aspergillosis.

Patients with cystic fibrosis frequently have pulmonary colonization with Aspergillus fumigatus (Af) and develop anti-Af immunoglobulin E (IgE) and IgG antibodies. The diagnosis of allergic bronchopulmonary aspergillosis in subjects with cystic fibrosis is difficult because of the high incidence of Af colonization, with development of humoral antibody responses. In this study, we sequentially measured serum anti-Af IgE (Af-E) and IgG (Af-G) antibodies by ELISA in subjects with cystic fibrosis. In subjects with cystic fibrosis who have allergic bronchopulmonary aspergillosis, Af-E and Af-G antibodies were significantly increased when compared with other groups of patients with cystic fibrosis who had positive skin tests or precipitins to Af (or both) (p less than 0.01, p less than 0.01, respectively). In addition, increased Af-E and Af-G levels were sometimes seen in other groups, especially subjects with cystic fibrosis who had positive Af skin tests or precipitin tests, two of whom later developed criteria diagnostic of allergic bronchopulmonary aspergillosis. Thus, serum Af-E and Af-G levels were quantitatively increased in subjects with cystic fibrosis who had allergic bronchopulmonary aspergillosis and thus adjunctive data in diagnosis. However, it also suggested that subclinical pulmonary inflammation may also occur.

Adolescent↗
PubMed1977

Renal aspergillosis: a report of two cases.

Two cases of opportunistic aspergillosis of the kidney are presented. One patient, a child with unsuspected chronic granulomatous disease of childhood, presented with a renal mass which proved to be an abscess secondary to aspergillosis. The other patient, a terminal leukemic, had a renal vein thrombosis secondary to invasion of the renal vein by aspergillosis. Aspergillosis and other fungal diseases of the kidney should be considered in debilitated patients with an abnormal urogram.

Aspergillosis↗
PubMed1989

[Serological diagnosis of pulmonary aspergillosis by ELISA].

Pulmonary aspergillosis usually develops on the basis of systemic immunosuppression and/or local impairments of respiratory system. Diagnosis of pulmonary aspergillosis has many difficulties. Chest X-ray findings of most cases are complicated with pre-existing changes due to the underlying diseases, and the detection rate of the pathogenic fungi from clinical specimens is unsatisfactorily low. Therefore, immunological or serological diagnosis is urgently required and precipitation-in-gel method has been widely applied. In this report, we compared clinical usefulness of the determination of anti-aspergillus antibodies by ELISA with that of precipitation-in-gel method. ELISA was carried out according to the method previously reported by us (Yamamoto S. et al.: Kekkaku 62: 549, 1987). About two-thirds of 45 healthy adults (control) did not show any detectable IgG anti-aspergillus antibody and mean of IgG anti-aspergillus antibody titer of the control group was 28.97. Patients, who had shown positive culture of fungus or was clinically diagnosed or strongly suspected as pulmonary aspergillosis, showed significantly high anti-aspergillus IgG antibody titer in comparison with the control group. Further, patients who were positive in precipitation-in-gel tests showed significantly higher IgG antibody titers than those who were negative in that test. IgG antibody titer determined by ELISA corresponded with clinical diagnosis much more exactly than the results of precipitation-in-gel test. Further, the results obtained by ELISA were objective and quantitative in comparison with the latter test. We concluded that ELISA was much superior to precipitation-in-gel test and that ELISA IgG antibody titers 2500 or more were confirmative and those between 570 and 2500 were strongly suggestive for the diagnosis of aspergillosis. IgM anti-aspergillus antibody titers were not different among healthy control group and patient groups, and could not be used for the diagnosis.

Adult↗
PubMed1989

[Mycetoma-like manifestations in invasive pulmonary aspergillosis].

Invasive pulmonary aspergillosis is characterized by radiological signs allowing a correct diagnosis, including differentiation from pulmonary candidiasis, when they are associated with appropriate clinical symptoms (neutropenia and fever persisting despite broad-spectrum antibiotics). In particular the formation of a pulmonary mycetoma in a previously normal lung is one of these signs. Unlike a simple fungus ball (the saprophytic form of aspergillosis), the rounded density of invasive pulmonary aspergillosis consists of sequestrum of devitalized lung tissue owing to blood vessel invasion by Aspergillus hyphae. This morphologic phenomenon is demonstrated in the present case report and is discussed together with the other roentgenological signs of the invasive aspergillosis.

Aspergillosis, Allergic Bronchopulmonary↗
PubMed1987

[Nasosinusal aspergillosis. Apropos of 35 cases].

Principal characteristics of clinical and paraclinical pictures of nasosinusal aspergillosis (NSA) in 35 patients are analyzed and allow distinction of three main types of this nasosinusal fungal lesion. Localized, non-invasive nasosinusal aspergillosis (NINSA) is frequently of dental origin and presents as a chronic maxillary sinusitis resistant to conventional treatment. Serology is negative or non-significant for Aspergillus and recovery is complete after surgery. Invasive nasosinusal aspergillosis (INSA) affects debilitated patients (diabetes, immunodepression, malignant blood disease...), and presents with bone destruction, extension to orbit, base of skull and intracranial region, following an acute or subacute course with positive serology for Aspergillus. Early, wide surgical eradication is combined with local and general antifungal therapy but prognosis is poor. Allergic nasosinusal aspergillosis (ANSA), of more recent description, combines chronic sinusitis with severe nasosinusal polyposis, and specific histologic and immunologic features. Its course is favorable with corticoid therapy but long-term results are unknown.

Adult↗
PubMed1978

[Occurrence of Aspergillus fumigatus in West Berlin - contribution to the epidemiology of aspergillosis (author's transl)].

The increasing incidence of human A. fumigatus infections particularly such of the respiratory tract has led to this study of the epidemiological situation. During the period between October 1968 and December 1977, A. fumigatus was isolated from clinical material in 425 cases. These findings which were established at the Mycology Unit, Robert Koch Institute, Federal Health Office, exhibited the following distribution by regions of the body or type of specimen: respiratory tract 277 (65.1(); venous blood 58 (13.6%); urine 3 (0.7%); stools 9 (2.1%) and others 78 (18.3%). Approximately two thirds of these findings were made during the period from October to March and about one third between April and September. The presence of A. fumigatus in the air both indoors and outdoors and also in the environment of patients suffering from aspergillosis was studied with the aid of the sedimentation-method. This method was chosen because the occurrence of A. fumigatus conidia in the air is of epidemiological interest. The number of isolations of A. fumigatus from outdoors samples was low, so the search for inhalative conidia concentrated upon sites near A. fumigatus habitats. These studies revealed that aspergillosis patients, clinical material sampled from them, decaying plant material (agriculture, horticulture), and used clothes and linen may form foci for the spread of A. fumigatus conidia. The control of aspergillosis in the hospital environment involves in particular a control of aspergillosis patients by means of culture and serology (preferably by ghe immunodiffusion test). Numerous recommendations are made on how to prevent A. fumigatus infections in hospitals, at the working site, and in the laboratory.

Air Microbiology↗