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PubMed1984

Invasive aspergillosis in a "healthy" patient.

A case of invasive aspergillosis complicated by the formation of an aspergilloma is described. The patient, a 48-year-old man, was apparently healthy except for mild alcoholic steatosis of the liver. A review of the literature revealed that 5 of the 14 previously reported cases of invasive aspergillosis in seemingly immunocompetent hosts were associated with liver disease. Immunologic investigation in this case revealed transient cutaneous anergy during the acute illness and normal lymphocyte function. Assessment of polymorphonuclear leukocyte function, however, showed abnormalities of phagocytosis as well as impairment of intracellular bactericidal activity. These abnormalities may have contributed to a relative immunodeficiency. Impairment of immune function may play a role in the pathogenesis of invasive aspergillosis in some apparently healthy patients.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Aspergillosis of the cerebral ventricles in a heroin abuser. Case report and review of the literature.

Aspergillosis of the cerebral ventricles developed in a 36-year-old heroin abuser who died during the sixth week of illness. The diagnosis was not made during life. A review of our case and of four previous cases from the literature indicates that aspergillosis should be considered in parenteral drug abusers with the syndrome of chronic meningitis or ventriculitis. The diagnosis is difficult to establish, but serologic tests may be helpful. This form of CNS aspergillosis can be cured with antifungal drugs.

Adult↗
PubMed1984

[Generalized aspergillosis].

A rare case of the generalized aspergillosis in a man of 39 is described. Aspergillosis developed in the presence of portal liver cirrhosis and chronic alcoholism. The case was marked by aspergillosis endocarditis with spheroid fungi growths on the heart valves in the form of fungus ball, widespread embolism with fungus mycelium and thrombovasculitis with the development of infarcts in the inner organs and brain.

Adult↗
PubMed1982

[Bronchopulmonary aspergillosis (author's transl)].

Bronchopulmonary infections with Aspergillus give rise to three different pathological entities. Allergic bronchopulmonary aspergillosis, found in patients with an atopic predisposition, is marked by dyspnea of the asthmatic type associated with labile radiologically detectable infiltrates, blood hypereosinophilia, enhanced total IgE levels, specific IgG fractions, and positive immediate reactions to skin tests. The long-term risk is the development of proximal bronchiectasis. Dosage and duration of corticotherapy are function of eosinophilia and total IgE levels. Pathogenicity is similar to that of extrinsic allergic alveolitis, probably involving disturbances in immune complexes from a type I reaction. Intracavital pulmonary aspergillosis involves mycotic development within a cavity or a complicating parenchymatous lesion. Severe hemoptysis may occur. Medical treatment is ineffective, and radical surgery is necessary in patients able to support operative procedures, which vary as a function of the condition of the patient. Diffuse aspergillosis occurs in immunodeficient patients, usually during the acute phase of chemotherapy induction. Spread of the disease is either from the upper respiratory tract or through the blood as septicemia. A nosocomial origin is frequent. Diagnosis depends more on the presence of hyphae in tissue biopsy specimens than cultures or serological tests which are too unreliable. Treatment is with amphotericin B preferably associated with 5 fluorocytosin.

Adrenal Cortex Hormones↗
PubMed1982

Aspergillus antigen detection in bronchoalveolar lavage fluid from patients with invasive aspergillosis and aspergillomas.

Improved diagnostic techniques have been needed for pulmonary aspergillosis, a common opportunistic fungal infection with a high mortality rate. Radioimmunoassay was used in this study to detect Aspergillus antigen in bronchoalveolar lavage fluid. In four patients with invasive aspergillosis or aspergillomas, Aspergillus antigen was detected in bronchoalveolar lavage fluid. In two patients, results of fungal cultures were negative or delayed. The specificity of antigen detection in bronchoalveolar lavage fluid was 91 percent in 35 control patients with a variety of pulmonary disorders. The technique or radioimmunoassay detection of microbial antigen in bronchoalveolar lavage fluid appears promising for the diagnosis of aspergillosis.

Aged↗
PubMed1995

Allergic bronchopulmonary aspergillosis presenting with cough variant asthma and identifiable source of Aspergillus fumigatus.

BACKGROUND: A 76-year-old man developed allergic bronchopulmonary aspergillosis initially presenting with cough variant asthma. Symptoms worsened after exposure to ground mulch which was an identifiable source of Aspergillus fumigatus. Symptoms improved after corticosteroids and avoidance measures were instituted. OBJECTIVE: To report a case of allergic bronchopulmonary aspergillosis presenting as cough variant asthma with identifiable source of Aspergillus fumigatus. METHODS: Single case report. Serum precipitating antibodies against Aspergillus fumigatus were tested using gel diffusion techniques. Total IgE, specific IgE, and IgG indices were measured by ELISA. Cutaneous reactivity to Aspergillus fumigatus was also tested. RESULTS: Skin test and serum precipitating antibodies to Aspergillus fumigatus were positive. Precipitins were also detected between Aspergillus fumigatus and the mulch. Total serum IgE was 538 IU/mL (1290 ng/mL) which declined to 228 IU/mL (544 ng/mL) after corticosteroid therapy. IgE index = 1.10 and IgG index = 2.86. CONCLUSION: Allergic bronchopulmonary aspergillosis can present as cough variant asthma. Identification of exacerbating factors such as sources of Aspergillus fumigatus are important in management.

Aged↗
PubMed1995

[Invasive pulmonary aspergillosis in neutropenic patients. Analysis of a series of 36 cases: contribution of thoracic scanners and itraconazole].

In neutropenic patients, one way of improving invasive pulmonary aspergillosis (IPA) prognosis is an earlier initiation of the antifungal treatment. We report our experience with 36 cases of IPA in 35 patients with haematological malignancies. When aspergillosis was diagnosed, all but 2 patients were neutropenic (PMN < 500; median duration = 20 days). The most frequent clinical signs were cough (100%), chest pain (78%) and haemoptysis (58%). Before the diagnosis of IPA, Aspergillus antibody test was positive in 60% of cases. A thoracic CT-scan was performed in 23 patients and demonstrated highly suggestive images in 22 cases (96%) with presence of CT halo sign (n = 13) or CT air-crescent sign (n = 9). Moreover, Aspergillus antigen test was positive in 13 of 28 tested patients. IPA diagnosis was determined to be definite in 23 cases and probable or possible in 13 cases. Thirty-five patients were treated: in 3 cases with amphotericin B (2 failures) and in 32 cases with itraconazole (7 failures and 25 successes or improvements). In 7 cases (including 5 emergencies) surgical resection was successfully combined with the medical treatment. In neutropenic patients with fever, we consider that thoracic CT-scan and repeated biological tests (Aspergillus antibody and antigen tests) can be used to establish the diagnosis of aspergillosis. Early treatment with itraconazole and surgical resection appears to improve prognosis.

Adult↗
PubMedDate not supplied

[Bronchopulmonary aspergillosis].

Case histories of 510 patients operated on for chronic destructive pulmonary tuberculosis and mycetoma are analyzed, as are the findings of examinations of 56 patients with cavitary forms of lung involvement (mostly cavernous and fibrocavernous tuberculosis), whose resected lung and bronchial specimens were inoculated to detect the fungi. X-Ray and tomographic examinations were carried out according to the routine methods. Blood serum IgG antibodies to aspergillosis antigen were determined in the enzyme immunoassay. The pathologic material (sputum, bronchial lavage water) was studied in tissue cultures and the pathomorphologic findings analyzed. An x-ray symptom of the foamy nuclear (septal) structure of pulmonary shifts was revealed, that represents a sort of a pathologic tissue response in one of bronchopulmonary aspergillosis forms. This condition was confirmed by high (over 1:1600) values of enzyme immunoassay with aspergillosis antigen.

Adult↗
PubMed1995

[Aspergillosis of the larynx].

Aspergillosis of the larynx is extremely rare. Six cases of aspergillosis of the larynx were presented. Clinical characters of the patients were as follows: (1) their physical conditions were excellent: (2) Hoarsenes was the first symptom; (3) true vocal cord demonstrated white mass; (4) Biopsy of the lesion revealed suppurative, granulomatous and necrotic inflammation with hyphae and spore with in the tissue; (5) Culture of fungi displayed tobaco colour colonies of aspergillus. microscopic examination demonstrated spore and septate hyphae with coral-shape dichotomous banching and flask-shape vesicle with phialide and spore on top; (6) All patients were cured with Ketoconazol and Itraconazol without recurrence for long-term follow-up. Etiology, diagnosis and therapy of aspergillosis of the larynx were discussed.

Adult↗
PubMed1994

Probable disseminated cerebral aspergillosis: recovery with medical treatment.

Cerebral aspergillosis has a very poor prognosis. When this complication occurs in the immunocompromised host, evolution is virtually fatal in all cases despite surgical and medical treatment. We describe in this report the case of a child with acute lymphoblastic leukaemia who developed pulmonary aspergillosis, and subsequent cerebral dissemination during therapeutic induction. Due to multifocal cerebral lesions, surgery was impossible. The patient was administered long term treatment including amphotericin B, flucytosine and itraconazole for 9 months, during which time a neutropenic period occurred with reactivation of cerebral mycotic lesions, in spite of modification of antileukaemic therapy. Seven years later, he nevertheless remains in complete remission without any neurological sequelae. Thus cerebral aspergillosis requires early diagnosis and can be treated using a strong combination of antimycotic drugs (amphotericin B, flucytosine and itraconazole) on a long term basis, even when aspergillomas cannot be removed surgically. Antileukaemic therapy must be concomitantly adapted to avoid or limit neutropenia.

Amphotericin B↗
PubMed1995

MR of cerebral aspergillosis in patients who have had bone marrow transplantation.

PURPOSE: To assess the CT and MR appearance of cerebral aspergillosis in patients who have undergone bone marrow transplantation. METHODS: The imaging and clinical data of five patients with cerebral aspergillosis were reviewed retrospectively and compared with autopsy findings. RESULTS: Lesions are often located in the basal ganglia and demonstrate an intermediate signal intensity within surrounding high-signal areas on long-repetition-time MR scans. The lesions were multiple in four of the five patients and more numerous on MR images than on CT scans. The lesions (which demonstrate no parenchymal enhancement) are consistent with acute infarcts as confirmed at autopsy. In the large lesions, there is early intravascular and meningeal enhancement, as expected in acute infarcts involving an appreciable portion of the territory of a cerebral artery. CONCLUSION: The diagnosis of early cerebral infarction in a patient considered at risk for invasive aspergillosis, even without overt pulmonary disease, is an indication to institute aggressive antifungal therapy.

Adult↗
PubMed1994

[Two cases of invasive pulmonary aspergillosis in non-immunocompromised hosts].

Invasive pulmonary aspergillosis generally occurs in immunocompromised hosts such as patients with leukemia, and other malignancies, who are receiving anti-cancer chemotherapy. In this report, two non-immunocompromised patients who developed invasive pulmonary aspergillosis are presented. Case 1: A 63-year-old man complained of productive cough and fever. He received antibiotic therapy from his personal physician. This symptoms did not respond, however, and dyspnea developed. He was then transferred to our hospital, about one month after the onset. The chest X-ray showed a meniscus shadow suggesting an aspergilloma in the right upper lung field and an infiltrative shadow in the remaining right lung field. Case 2: A 78-year-old man was admitted because of dyspnea, productive cough and appetite loss over the previous three months. The chest X-ray showed a meniscus shadow in the left upper field, an infiltrative shadow in the left lower field and a right pleural effusion sign was also observed. Both cases were diagnosed as having aspergillosis, early in their illness, by the detection of aspergillus antigen in their sera and histopathological and cultural studies of specimens obtained by TBLB. Both improved with intravenous amphotericin B (30 mg/day) and intravenous ulinastatin (200000 IU/day) administration. On the examinations conducted during hospitalization, there was no evidence of any immunosuppressive diseases or immunoincompetent conditions such as leukemia, and other malignancies human immunodeficiency virus infection, diabetes or alcoholism.

Aged↗
PubMed1994

[Hypopituitarism caused by colonic carcinoma metastasis associated with hypophysial aspergillosis].

Pituitary metastases constitute 1% to 8.3% of all metastatic brain tumors. The most frequent localization is in the posterior lobe and diabetes insipidus may be the only symptom of dysfunction. Cerebral aspergillosis is an unusual disease and it has been described complicating an underlying malignancy or following intracraneal surgery. We describe a case of hypopituitarism and hyperprolactinemia in a patient with pituitary metastases of a colon carcinoma and aspergillosis. Two years before a colon adenocarcinoma (Class C1 of Duke) had been resected. There were no clinical signs of hypopituitarism or galactorrea. The laboratory findings showed deficiency of cortocotropin (ACTH), luteinizing hormone (LH), follicle stimulating hormone (FSH) and slight hyperprolactinemia (PRL). Cerebral magnetic resonance image (MRI) revealed an intra and suprasellar mass which extended to the hypothalamus. Chest X-ray film and computed tomographic scanning (TC) confirmed a macronodular mass at the apical segment of the inferior left lung lobule with mediastinal hypertrophic lymph nodes. A non functional pituitary tumor was diagnosed and transphenoidal surgery was carried out. At microscopic examination a malignant proliferation was found suggesting colonic differentiation. Fragments of tumoral pituitary tissue showed hyphae of aspergillus in the form of abscess. Aspergillosis complicating neoplastic disease is more often present in leukemia and lymphoma than in solid tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1994

[Contamination by aspergillosis: evaluation of preventive measures and monitoring of the environment].

Aspergillosis has become a major fungal infection in hospitals since the advent of immunosuppressive therapy in the last fifteen years. Aspergilli are saprophytic and ubiquitous fungi and are associated with pulmonary and disseminated infections in immunodepressed patients with a mortality rate of about 85%. Aspergillosis is an air-borne infection, thus intensive care units should be conceived so as to decrease the outer risk of contamination. In the first part of this chapter the conception of such a unit is presented, taking the bone marrow transplantation unit of St-Louis Hospital as an example. A prospective study of the quality of the environment is a complementary and necessary information. In the second part of this chapter, the methods of airborn control of Aspergillus sp. are investigated. According to the literature, commun concepts can be drawn to evaluate nosocomial risks of aspergillosis. Nevertheless in the absence of a defined and accepted methodology, it is not possible up to that date to propose norms and acceptable norms of levels of contamination adapted to the degree of immunodepression of patients.

Air Microbiology↗
PubMed1994

[Evaluation of (1-3)-beta-D-glucan in aspergillosis and cryptococcosis].

(1-3)-beta-D-Glucan (beta-glucan) is a major structural component of fungi. The G test is a direct method to detect beta-glucan using fractionated (1-3)-beta-D-glucan-sensitive component, factor G, eluted from the limulus lysate. Previously, we reported that the G test is a more sensitive method than the mannan detection assay for the serological diagnosis of Candida infection. In this study, we discuss beta-glucanemia in patients with pulmonary aspergillosis and cryptococcosis. The concentration of beta-glucan was less than 10 pg/ml in 9 of 10 cases of pulmonary cryptococcosis, except for one case receiving hemodialysis (16.5 pg/ml). beta-Glucan increased in 3 cases of invasive pulmonary aspergillosis (27-937 pg/ml). Galactomannan antigen was positive in all of those cases. In 8 cases of aspergilloma, which showed fungus ball on roentgenogram, the mean concentration of beta-glucan was 67.1 +/- 92.7 pg/ml. Two of 8 cases were positive for galactomannan antigen. One of three cases of PAIC (productive aspergilloma on the inner wall of a cavity) and one case of chronic necrotizing pulmonary aspergillosis showed slightly increased levels of beta-glucan and positive results of galactomannan antigen test.

Adult↗
PubMed1994

Aspergillus ribotoxins react with IgE and IgG antibodies of patients with allergic bronchopulmonary aspergillosis.

Asp f I has been identified as a major allergen of Aspergillus fumigatus and shows amino acid sequence homology with the mitogillin family of cytotoxins. In this study we compared the various cytotoxins from Aspergillus species for their reactivity with immunoglobulin E (IgE) and immunoglobulin G (IgG) antibodies in the serum samples of patients with allergic bronchopulmonary aspergillosis. Elevated levels of IgE and IgG antibodies to all A. fumigatus antigens and ribotoxins were demonstrated in a majority of ABPA patients as compared with allergic patients with asthma and normal subjects. In approximately 75% of patients with allergic aspergillosis, IgE antibody to ribotoxins showed marked elevation, whereas in the remaining patients it was below the baseline, although crude A. fumigatus antigen showed higher specific serum IgE. These results suggest that cytotoxins play a major role in the pathogenesis of allergic bronchopulmonary aspergillosis.

Antibodies↗
PubMed1976

Allergic bronchopulmonary aspergillosis: a study of 46 cases with special reference to laboratory aspects.

A study of 46 cases of allergic bronchopulmonary aspergillosis has been presented with special reference to laboratory aspects. Episodic airways obstruction and dual skin reaction to aspergillin were present in all the cases. Furthermore, there were pulmonary infiltrations in 91.1%, blood eosinophilia in 80.4%, precipitins in 91.3%, and sputum cultures repeatedly positive for A. fumigatus in 82.6% of the patients. It was observed that the multiplicity of precipitin bands corresponded to the higher recovery of A. fumigatus in culture. A. flavus and A. niger were recovered from 58.7 and 80.4% cases of allergic bronchopulmonary aspergillosis respectively but dual skin reactions to these species occurred only in 47.6 and 26.2% and precipitins in 21.7 and 4.3% of cases, respectively. The findings are compatible with the poor allergenic and antigenic properties attributed to these two species in comparison with A. fumigatus. It is suggested that allergic bronchopulmonary aspergillosis may not be too uncommon in India and it deserves greater attention in the differential diagnosis of chest diseases.

Adolescent↗
PubMed1993

[Aspergillosis of the sphenoid sinus. Apropos of 4 cases].

Aspergillosis of the sphenoid sinus is a rare entity. The authors report four cases of non invasive aspergillosis sinusitis, three isolated cases and one with nasal polyps. All cases were treated by functional endoscopic surgery. Good results were noted with a mean follow-up of 18 months. Frequency, clinical features, treatment, and etiopathogenesis of sphenoidal aspergillosis are discussed.

Aged↗