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PubMed2005

[Invasive pulmonary aspergillosis as a complication of prolonged antibiotic therapy].

In this study we present the case of 53 year old woman hospitalized in the Department of Lung Diseases and Tuberculosis in Zabrze, Silesian Medical University in Katowice, due to chronic cough and infiltration in the chest radiogram. Prior to the admission, the patient received long-lasting antibiotic ambulatory treatment leveled at laryngobronchitis. After admission the patient underwent bronchofiberoscopy during which a sample for mycological examination of bronchoalveolar lavage was taken. The result of the examination made possible to give the diagnosis--invasive pulmonary aspergillosis. Proper antifungal treatment was used and in consequence considerable improvement in both clinical and radiological state was achieved. Invasive pulmonary aspergillosis is mostly diagnosed in immunocompromised patients. The patient described in this case had none risk factors. Based on that particular case we may state a hypothesis that a prolonged antibiotic therapy is an important risk factor of invasive pulmonary aspergillosis incidence.

Anti-Bacterial Agents↗
PubMed2006

[A case of pulmonary aspergillosis presenting the pulmonary arterial supply suggested with dynamic MRI].

A 67-year-old man with a past history of pulmonary tuberculosis had been referred to our department complaining of bloody sputum. The chest radiograph on admission showed a cavity in the left upper lung field. Chest CT showed a mass-like fungus ball in the cavity. Pulmonary aspergillosis was diagnosed from the sputum mycology, serum Aspergillus antigen and antibody. Even though 150 mg per day Funguard (micafungin sodium) was given intravenously for 4 weeks, the pulmonary aspergillosis did not improve. Dynamic MRI obtained 20 seconds after intravenous injection of contrast material revealed penetrating vessels in the wall of the cavity, and dilated and proliferative vessels surrounding the cavitary lesion. On the basis of the MRI findings which suggested the risk of massive hemoptysis, we performed left upper lobectomy. The histological specimen revealed dilated pulmonary arteries in the wall of the cavity, corresponding to the penetrating vessels on MRI. This is the first report of radiologic-pathologic correlation using dynamic MRI for pulmonary aspergillosis, to the best of our knowledge.

Aged↗
PubMed2006

[Completion pneumonectomy for pulmonary aspergillosis with hyper immunoglobulin-E syndrome].

A 22-year-old man was admitted to the department of pediatrics of our institute in February 2005, because of pulmonary aspergillosis. He had been diagnosed as hyper immunoglobulin-E syndrome in infancy, and repeated pulmonary infectious desease, such as pulmonary aspergillosis. He received art of right upper lobectomy by pulmonary aspergillosis at the age of 17. In February 2005, he had hemosputum and the chest X-ray showed a giant cavity with niveau in the right lung. In spite of medical treatment by antibiotics and antimycotics, the lesion rapidly increased in size. Therefore, right completion pneumonectomy and omentopexy around the bronchial stump was done. His postoperative course was uneventful.

Adult↗
PubMed1991

[The treatment of aspergillosis, cryptococcosis and histoplasmosis in immunocompromised patients. Report of experience in the United States].

Itraconazole has emerged as an important new oral agent in the treatment of systemic fungal infections. We report a summary of available data on its use in aspergillosis, cryptococcosis and histoplasmosis compiled in the United States with particular attention to the immunocompromised host. Data has been accrued in open-label studies including 57 patients with cryptococcal disease where the overall response rate among patients with meningitis was 86%, 28 patients (seven with HIV infection) with invasive aspergillus where the overall response rates were 80% in non-AIDS and 42% in HIV patients. Data is summarized on six patients with allergic bronchopulmonary aspergillosis, all of whom improved on therapy, and twelve patients with histoplasmosis including eight with AIDS, eleven of whom responded (three newly reported cases are included). In summary, itraconazole showed activity in human studies of aspergillosis, cryptococcosis and histoplasmosis with minimal toxicity. Itraconazole offers a new oral alternative to conventional amphotericin B therapy in these infections. Comparative studies are needed to clarify its role.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Aspergillosis in gentoo penguins (Pygoscelis papua) at Edinburgh Zoo, 1964 to 1988.

Aspergillosis was the commonest cause of death in gentoo penguins (Pygoscelis papua) at Edinburgh zoo from 1964 to 1988. Chicks were the most susceptible group and 14 per cent of hatched birds died of the disease (47 per cent of post mortem diagnoses) although in two years no cases were recorded and in two other years there were outbreaks which killed more than 50 per cent of the birds hatched. There was no correlation between the size of the colony and the prevalence of the disease but the climate during the rearing and weaning periods may have influenced the prevalence. The majority of cases of aspergillosis occurred between July and September and affected two- to three-month-old chicks shortly after they had been moved from their parents to a crêche area for hand-feeding. No links were found between the occurrence of the disease and the date of hatching or the nest site, or whether the chicks were single, first or second-hatched twins, or with their weights, but the progeny of one parental pair were found to be overrepresented and more males than females died of the disease. Adult cases occurred sporadically and males were significantly more susceptible than females (P less than 0.05). Neither vaccination with a killed suspension of Aspergillus fumigatus nor therapeutic treatment with ketoconazole were effective in reducing the incidence of aspergillosis, although the late diagnosis of the disease was probably the main cause for the failure of these treatments.

Age Factors↗
PubMedDate not supplied

Aspergillus colonization of the nose and pulmonary aspergillosis in neutropenic patients: a retrospective study.

Fungal infections are definitely increasing in neutropenic patients with hematologic malignancies. In view of a previous report on a likely correlation between nose cultures positive for Aspergillus spp. and pulmonary aspergillosis, a retrospective study on 306 consecutive neutropenic patients was performed. Twenty-six patients had one or more nose cultures positive for Aspergillus: thirteen of them developed pulmonary aspergillosis. On the other hand, only twenty out of the remaining 280 patients with negative nose cultures developed this fungal pneumonia (p less than 0.00001). Even if negative results do not obviously exclude the possibility of invasive aspergillosis, nose cultures positive for Aspergillus might prove helpful in predicting this fungal infection in febrile neutropenic patients.

Agranulocytosis↗
PubMedDate not supplied

[Pseudotumoral naso-sinusal aspergillosis stabilized by itraconazole].

A 25 year-old non-immunocompromised African man showed a sino-orbital aspergillosis involving mostly the sphenoïd sinus, presenting as a growing tumour. Histopathologic study of the specimen biopsy revealed granulomata with intracellular septum branching hyphae. The electrosyneresis demonstrated serum antibodies to Aspergillus flavus. Initial treatment consisted of only surgical debridement in association of standard antifungal therapy (miconazole). After 14 months, a recurrence of the aspergillosis was stopped by the administration of itraconazole, an oral triazole antifungal. This treatment was performed during a period of 12 months and marked clinical improvement was observed. No adverse effects were noted. Itraconazole may be useful in therapy for extra-pulmonary aspergillosis when standard therapy has failed.

Adult↗
PubMed1989

[A case of omental pedicle flap plombage for fungus ball type pulmonary aspergillosis].

The usual surgical treatment for fungus ball type pulmonary aspergillosis is lobectomy, but in cases of aspergillosis located in a post-lobectomy space a second lobectomy is difficult because of the accompanying inflammatory process. A 53-year-old male underwent left upper lobectomy for pulmonary tuberculosis eight years ago. Six year postoperatively, he developed fungus ball type aspergillosis in the post-lobectomy space with bronchopleural fistula and recurrent hemoptysis. We performed an omental pedicle flap plombage via the post-sternal route to resect the pleural cavity fungus ball. The post operative course was uneventful and clinically the bronchopleural fistula was closed.

Aspergillosis↗
PubMed1989

[Fatal cerebral aspergillosis in acute megakaryoblastic leukemia].

A 13 year-old girl was diagnosed as having acute megakaryoblastic leukemia. A serious infectious syndrome appeared during the chemotherapy, not improved by broad spectrum antibiotic therapy. A pulmonary aspergillosis was diagnosed one month later by a second bronchoalveolar lavage. A treatment with Itraconazole, a new antifungal triazole, was started. Despite this treatment, the child died after 3 days. Death was due to multiple aspergillus abscesses disseminated in the brain leading to coma and transtentorial herniation. Autopsy confirmed the cerebral aspergillus abscesses and showed also the dramatic dissemination of aspergillosis in the body. Diagnosis and treatment to aspergillosis in immunosuppressed patients should be made early to improve prognosis.

Adolescent↗
PubMed1989

[Prevalence of bronchopulmonary aspergillosis at the pulmonological hospital].

The prevalence and the character of aspergillous infection were studied among 64 patients (33 men and 31 women) seen at the pulmonological hospital. Ten patients of that group were diagnosed to have bronchopulmonary aspergillosis. In all the cases, the disease was regarded as secondary one: 2 patients suffered from chronic aspergillous pneumonia and 8 patients from different patterns of aspergillous bronchitis. The risk factors of the disease development are described. The data obtained indicate that secondary bronchopulmonary aspergillosis occurs not infrequently. The estimation of the risk factors, careful clinical examination, and specific mycologic and serologic tests allow an early diagnosis of bronchopulmonary aspergillosis followed by institution of adequate treatment.

Adult↗
PubMed1989

[Immunological diagnosis of aspergillosis in patients with pulmonary tuberculosis].

The informative value of a number of immunological tests, such as the routine tests of lymphocyte blast cell transformation and indirect hemagglutination, and the original tests of cytotoxic effect and neutrophil damage was studied in diagnosis of aspergillosis. 94 patients with fibro-cavernous tuberculosis and 18 patients with lung aspergillosis along with tuberculosis were examined. It was shown that the tests provided diagnosis of aspergillosis in the tuberculosis patients. The diagnostic efficiency of the tests was studied. The test of neutrophil damage proved to be the most informative. Diagnostic tables for interpretation of the immunological examination results were developed.

Adolescent↗
PubMed1988

Unusual clustering of allergic bronchopulmonary aspergillosis in children with cystic fibrosis.

Allergic bronchopulmonary aspergillosis has been recognized in association with cystic fibrosis in children since 1965. Since then, however, there have been a paucity of reports of pediatric cystic fibrosis complicated by allergic bronchopulmonary aspergillosis, and, in most cases, these have been diagnosed retrospectively. A cluster of five acute cases seen during a 4-month period in a single cystic fibrosis center with a systemic illness and deterioration in respiratory status are described. In all five patients, reversible bronchoconstriction and infiltrative changes on x-ray films suggested the diagnosis. This was confirmed by the presence of (1) peripheral blood eosinophilia, (2) elevated total IgE and Aspergillus fumigatus-specific IgE, and (3) circulating serum precipitins against A fumigatus in all cases. All children tested had positive type 1 immediate hypersensitivity to skin tests for A fumigatus, in sputum eosinophilia, and Aspergillus cultured from sputum. Only three of five children were previously noted to be atopic and none had severe advanced suppurative lung disease. All children had previously received bronchodilator therapy and appropriate antibiotics. Following treatment with corticosteroids, acute symptoms and radiologic changes resolved for 1 to 5 months. To date, no children have had recurrence of their allergic bronchopulmonary aspergillosis while receiving alternate-day steroid treatment for 6 months.

Adolescent↗
PubMed1987

[Disseminated invasive aspergillosis associated with Mycoplasma pneumoniae infection].

Disseminated aspergillosis is rare in patients not suffering from haematological disorders and myelo-suppression. We report a case of pulmonary cardiac and renal aspergillosis diagnosed at autopsy in a patient with chronic respiratory failure dying in the intensive care unit during an acute exacerbation. The role of risk factors associated with invasive aspergillosis in patients not suffering from myelosuppression is discussed (steroid therapy, chronic respiratory disease, concomitant viral or bacterial infection). The discovery in this patient of a pulmonary infection associated with mycoplasma pneumonia (the micro-organisms were found in necropsy specimens of pulmonary tissue) does not seem to have been reported before in the literature.

Aspergillosis↗
PubMed1987

[Cerebral aspergillosis. Apropos of 4 cases].

Four patients with aspergillosis of the central nervous system collected in less than two years are reported. Three patients had hematologic malignancies (acute myelogenous leukemia, Hodgkin's disease) and were treated with corticosteroids and chemotherapy. One patient received antimicrobial agents fort a post operative meningitis (after acoustic neuroma surgery). Analysis of these cases and review of literature available us to point out the increased frequency of invasive and cerebral aspergillosis particularly in immunocompromised hosts treated by cytotoxic drugs or broad spectrum antibiotic therapy. Diagnosis is very difficult because: --there are non specific radiologic features for aspergillus granuloma, abscess, aneurysm or meningitis, --blood and cerebrospinal fluid cultures are invariably negative, --serologic tests have limited value in immunosuppressed patients (poor capacity to elaborate antibodies). Diagnosis can be made only by surgical biopsy who isolate fungal elements. However diagnosis in greatest cases is only made at autopsy. Treatment consist by antifungal drugs administered intravenously and surgery when it is possible. Prognosis of cerebral aspergillosis is very poor and mortality rate very high about 70%.

Adult↗
PubMed1986

Radiological aspects of aspergillosis in the paranasal sinuses.

A retrospective radiographic study was performed on 142 proven cases of Aspergillosis in the paranasal sinuses. In all but two cases the mycosis was unilateral and in all cases the maxillary sinus was infected. A common radiographic presentation was a homogeneous opacity of the infected maxillary sinus, while about 50% of the cases showed nonspecific infectious changes of other paranasal sinuses additionally. Earlier stages of the disease showed an intraluminal soft tissue mass, representing the mycelium conglomerate. Bone destruction due to Aspergillosis could not be proven. 58% of the cases presented with intraluminal structures of metallic density. Histochemical studies proved these to consist mainly of tertiary Calciumphosphate. These concrements are considered to be pathognomonic of Aspergillosis.

Adult↗
PubMed1979

[Orbital aspergillosis--a contribution to its diagnosis and treatment (author's transl)].

In connection with a case report, the mycological diagnosis and treatment of orbital aspergillosis are reviewed. In a 59-year-old male patient an exophthalmus on the right side could be diagnosed as aspergillosis spreading from the corresponding sinus maxillaris into retro- and peri-orbicular regions, after other causes had been excluded by differential diagnosis. In a biopsy specimen from the retrobulbar tumor, a fungal granuloma was found which, histologically and by isolation of the fungus, could be identified as an infection by A. fumigatus. Because of the good visus of the right eye, no exenteratio orbitae but an enoral revision of the sinus maxillaris, ethmoidal bone, and bottom of orbita was performed.--By infusions of amphotericin B and local washings with pimaricin (natamycin) in the sinus maxillaris and the region of the operation, a complete healing of the mycotic process was achieved.--Since 1 1/2 years, the patient has not had a relaps. This success of therapy was possible by exemplary cooperation of otorhinolaryngologists, ophthalmologists, pathologists and microbiologists.--In view of the prophylaxis of such infections, recent contributions to the epidemiology of aspergillosis are discussed.

Amphotericin B↗
PubMed1985

[Invasive pulmonary aspergillosis--a diagnostic and therapeutic problem in patients with severe aplastic anemia].

Three young patients with severe aplastic anemia undergoing intensive immunosuppressive therapy developed fever and pulmonary infiltrates during longlasting severe granulocytopenia, despite multiple broad spectrum antibiotic combinations and granulocyte transfusions. Invasive pulmonary aspergillosis was diagnosed only by thoracotomy. In conjunction with high dose amphotericin-B therapy complete resolution of aspergillosis was achieved in two cases, paralleled by slow recovery of bone marrow function, whereas in the third case only a partial remission was possible together with transient amelioration of granulopoiesis. We suggest early aggressive surgical methods to establish the diagnosis of aspergillosis in these severely menaced patients, so that antifungal therapy with high dose amphotericin-B can be initiated at an early stage.

Adolescent↗
PubMed1979

Aspergillosis and other systemic mycoses. The growing problem.

To measure the incidence in the United States of systemic mycoses necessitating hospitalization, we reviewed discharge records of 1,875 hospitals participating in the Professional Activity Study of the Commission on Professional and Hospital Activities. Projected incidence rates in 1976 ranged from 23.0 per million for histoplasmosis to 0.2 per million for blastomycosis. High prevalences of leukemia or lymphoma (5.9% to 10.2%) or of other malignancies (9.9% to 13.2%) were recorded in patients with aspergillosis, candidasis, or cryptococcosis. High prevalences of chronic obstructive lung disease (9.6% to 9.9%) were recorded in those with aspergillosis or histoplasmosis. Marked increases from 1970 to 1976 were found in the incidence of aspergillosis (158%), actinomycosis (92%), cryptococcosis (78%), and coccidioidomycosis (74%). Increasing numbers of persons with immunosuppressive conditions, migration of susceptible persons into hyperendemic areas, and aging of the population contributed to the increases.

Adolescent↗