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PubMed2004

Observations of aspergillosis in the brains of turkey poults using different histopathological staining techniques.

Different staining methods were evaluated for studying aspergillosis of the central nervous system (CNS). The pathological changes and fungal elements in cerebrum and cerebellum of 17 turkey poults with aspergillosis were examined and described. Tissue sections were stained with hematoxylin-eosin (HE), Kluver-Barrera's and Grocott's methods, and periodic acid-Schiff (PAS). Focal granulomatous reactions with central necrosis were observed in the HE stained slides. Fungal hyphae were easily demonstrated using Grocott's method and PAS. These two methods, however, were not suitable for describing detailed histopathological changes. The Kluver-Barrera method was used to demonstrate the neural tissue reaction. Neurons were found to be sensitive to aspergillosis, in contrast to glial cells that showed fewer pathological changes. The fungal elements were clearly visible with the Kluver-Barrera method, resulting in better information about the interactions of neural tissue, the inflammatory response, and the fungus. The use of the Kluver-Barrera method for this purpose has not been documented previously.

Animals↗
PubMed2004

Successful treatment of brain aspergillosis with voriconazole.

Until recently, brain aspergillosis was almost always fatal, with a response rate to amphotericin B of < 10%. This study describes a retrospective analysis of eight consecutive cases of brain aspergillosis. All patients were immunosuppressed and five required mechanical ventilation. Antifungal treatment included amphotericin B (n = 7), itraconazole (n = 3), voriconazole (n = 2) and flucytosine (n = 1). Three (38%) patients survived following prolonged azole therapy after initial amphotericin B treatment, combined with a reduction in their immunosuppressive treatment. The prognosis of brain aspergillosis might be improved if immunosuppression could be reduced and prolonged oral azole therapy used.

Adult↗
PubMed2005

Conventional and diffusion-weighted MR imaging of cerebral aspergillosis.

Central nervous system aspergillosis has increased dramatically in recent years. Most of the cases are immunocompromised patients infected from a primary site, usually the lungs or paranasal sinuses, and the organism may spread to the central nervous system. Different neuroimaging patterns that have been reported vary depending on the immunological status of the patients and on the age of the lesions. Description of typical radiological patterns in cerebral aspergillosis patients may be helpful in establishing early diagnosis and treatment. In this case report, we present magnetic resonance images of cerebral aspergillosis and the contribution of diffusion-weighted magnetic resonance imaging to the diagnosis.

Adult↗
PubMed1985

Rapid immunoelectrophoretic assay for detection of serum antibodies to Aspergillus fumigatus catalase in patients with pulmonary aspergillosis.

A rapid immunoelectrophoretic assay was developed to detect antibodies to Aspergillus fumigatus catalase. The method's diagnostic sensitivity for pulmonary aspergillosis was 88% (72-97%, 95% confidence limits) in 33 patients presenting with either aspergilloma or Aspergillus lung infiltrate. The diagnostic specificity was 94% (90-97%) as judged from 191 patients with other infiltrative lung diseases, including infections and neoplasia. None of the 185 healthy subjects had catalase antibodies. The highest titres (ranging up to 256) were found in aspergillosis patients with cavitary lesions. Catalase antibody titres increased in two patients with concomitant development of lung cavities and mycetomas. In patients with resected or stable Aspergillus lung disorders catalase antibody titres declined by less than one dilution step per year.

Adolescent↗
PubMed1986

Chronic necrotizing pulmonary aspergillosis mimicking bronchocentric granulomatosis.

We present a case of slowly progressive Aspergillus infection occurring in a partially immunocompromised host. The histologic pattern mimicked bronchocentric granulomatosis as seen in allergic bronchopulmonary aspergillosis, but the clinical history, spread of disease in the face of steroid therapy, peculiar granulomatous response to the organisms, and large numbers of organisms present suggest that this was really a case of chronic necrotizing pulmonary aspergillosis. These entities must be distinguished because their therapy, prognosis, and clinical significance are totally different.

Aspergillosis↗
PubMed2003

[Aspergillosis in cystic fibrosis patients].

Allergic bronchopulmonary aspergillosis (ABPA) should be suspected in any CF patient whose pulmonary disease deteriorates precipitously, suddenly or unexpectedly, and has to be correlated to fungal hypersensitivity biological tests. The standard therapeutic approach is based upon systemic corticosteroids. Invasive pulmonary aspergillosis (IPA) may occur mainly but not exclusively in immunosuppressed patients undergoing lung transplantation. New antifungal compounds (Triazoles, Itraconazole, Voriconazole), Echinochandins (Caspofungin) are effective, synergistic, well tolerated, should their contraindications and side effects be carefully respected and monitored.

Aspergillosis↗
PubMed2002

Epidemiology of invasive aspergillosis in France: a six-year multicentric survey in the Greater Paris area.

Invasive aspergillosis is the most prevalent mould infection. An epidemiological surveillance network was set up in 18 teaching hospitals in Paris and the Greater Paris area. Prospective surveillance was conducted between 1994 and 1999. Between 1994 and 1997 cases were categorized as proven or probable aspergillosis and then the European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria were used. The authors analysed 621 cases (115 proven, 506 probable). No seasonal variation was found. Haematological disorders (73%) including stem-cell transplantation (36%), solid-organ transplantations (10%) and AIDS (9%) were the main underlying conditions. The crude mortality was 63%. Incidence of IA was 8% (CI(95): 6.5-9.5) in acute myelocytic leukaemia and 6.3% (CI(95): 4.3-8.3) in acute lymphocytic leukaemia. Incidence was 12.8% (CI(95): 10.8-14.8) following allogeneic stem-cell transplantation and 1.1% (CI(95): 0.7-1.5) following autologous stem-cell transplantation. In solid-organ recipients incidence ranged from 11% following heart-lung transplantation and small bowel to 0.4% following kidney transplantation. Incidence in HIV infected patients ranged from 0.02 to 0.13% per annum. This large series confirmed that patients with haematologic disorders and transplantations are the most at risk for IA.

Adolescent↗
PubMed1991

[The radiologic picture of bronchopulmonary aspergillosis].

The increasing incidence of conditions associated with immune suppression, either as part of the illness or as the result of treatment, makes it necessary to investigate the possibility of fungus infections whenever there are broncho-pulmonary changes. In this respect, aspergillus is a common infection which produces more or less typical radiological changes. It often requires a variety of radiological procedures, including the use of CT and nuclear medicine. The latter can be useful in the allergic form of aspergillosis used for ventilation scintigraphy. The possibility of aspergillosis must be brought to the attention of the clinicians by the radiologist, even in cases that are not entirely typical.

Adult↗
PubMed2005

The radiological spectrum of pulmonary aspergillosis.

Imaging findings in the pulmonary aspergilloses can answer important clinical questions. Steroid-responsive chronic asthma due to allergic bronchopulmonary aspergillosis can be differentiated from simple asthma by computed tomography (CT) evidence of extensive and severe central bronchiectasis, mucoid impaction, or small airways lesions. The simple aspergilloma can be differentiated from the complex aspergilloma by the absence of: constitutional symptoms, para-cystic lung opacities, cyst expansion, or progressive pleural thickening. The CT halo sign is a transient finding that can provide a probable diagnosis of early invasive pulmonary aspergillosis in patients who are at extraordinarily high risk of the infection. Patients with a halo sign at baseline are more likely to have a satisfactory treatment response than those without this indicator.

Aspergillosis↗
PubMed2001

Chronic forms of pulmonary aspergillosis.

Aspergillus is a genus of fungi commonly found in all environments. Remarkably, only a few species cause disease and equally remarkably, those same species cause multiple diseases. In the lung, exposure to the fungus, the immunological status of the individual and the condition of the lung determine the pattern of disease. In asthmatic patients and those with cystic fibrosis, allergic bronchopulmonary aspergillosis (ABPA) is a complication that reduces pulmonary function and, in asthmatics, is substantially improved by itraconazole therapy. Patients with pre-existing lung cavities develop aspergillomas (fungal masses inside the cavity). Aspergillomas carry a 40% 5 years survival, and it not clear whether antifungal therapy is helpful. Similar in presentation to aspergilloma is chronic necrotizing pulmonary aspergillosis (CNPA). Development of new or expansion of existing pulmonary cavities with surrounding paracavitary shadowing is the hallmark of CNPA These two entities are probably a continuum of the same pathological process. Patients with CNPA respond to systemic antifungal therapy, but this may need to be lifelong. Surgery is appropriate for isolated aspergillomas, but not pleural or multicavity lesions. Aspergillus empyema is a complication of aspergilloma and CNPA, or surgery for these diseases and is slow to respond to treatment.

Antifungal Agents↗
PubMed1995

Specific antibody detection in invasive aspergillosis by analytical isoelectrofocusing and immunoblotting methods.

Aspergillus fumigatus antigens have been tested to determine their potential as aids in the diagnosis of invasive aspergillosis (IA). Immunoglobulin G (IgG) antibodies to these antigens were detected by analytical isoelectrofocusing in conjunction with immunoblotting. A total of 12 antigenic fractions, including culture filtrates and surface and mycelial extracts of A. fumigatus, were investigated. Eleven were reactive with serum specimens from patients with aspergilloma, which served as positive controls for the evaluation of a specific IgG response. Eight of 12 antigens showed good responses with serum specimens from patients with allergic bronchopulmonary aspergillosis, which were used to assess the sensitivity of IgG detection. No measurable reactivity was detected in 18 negative control serum specimens, while 11 of 13 patients with proven, highly probable, or probable cases of IA had anti-Aspergillus IgG to multiple antigenic preparations. Patients with IA who were capable of mounting a substantial humoral response to Aspergillus antigens gave an antibody profile with five antigenic preparations which seemed to be characteristic of the disease. Data show that this method is highly sensitive and may allow the selection of fractions which are both highly antigenic and specific for the detection of antibodies to Aspergillus antigens. They also indicate that the use of a spectrum of antigenic molecules is advisable, given the variability observed in the immune responses of individual patients.

Antibodies, Fungal↗
PubMed1979

Allergic bronchopulmonary aspergillosis-like syndrome consequent to aspergilloma.

Two patients who represent the first well-documented cases of an allergic bronchopulmonary aspergillosis-like syndrome developing consequent to an aspergilloma are reported. These patients experienced both subjective and objective evidence of improvement after the initiation of corticosteroid therapy. Literature relevant to the combined occurrence of aspergilloma and allergic bronchopulmonary aspergillosis and their immunology is reviewed.

Adult↗
PubMed1993

Simultaneous legionellosis and invasive aspergillosis in an immunocompetent patient newly treated with corticosteroids.

Invasive pulmonary aspergillosis (IPA), although unusual, has been recognized in the immunocompetent host. Several cases of IPA with rapidly progressive respiratory failure have been reported in patients receiving short-term corticosteroid therapy for chronic obstructive pulmonary disease. Atypical pneumonia caused by dual infection with Legionella pneumophila and Mycoplasma pneumoniae has also been reported. We report an unusual case of simultaneous L pneumophila pneumonia and IPA in an asthma patient with suspected allergic bronchopulmonary aspergillosis newly treated with corticosteroids.

Adrenal Cortex Hormones↗
PubMed1989

Aspergillosis.

The wide spectrum of disease states caused by fungi of the genus Aspergillus is dependent in large measure on environmental conditions leading to exposure, and to local and systemic host defenses. Allergic aspergillosis occurs in individuals hypersensitive to the fungus and is treated by immunosuppression, whereas invasive aspergillosis predominates in the severely immunocompromised and is treated with antifungal therapy. Aspergillomas generally arise from saprophytic colonization of a pre-existing pulmonary cavity with Aspergillus, and may be complicated by life-threatening hemoptosis.

Antifungal Agents↗
PubMed1994

[Remission of invasive sinusal and pulmonary aspergillosis with liposomal amphotericin B in a patient with chronic lymphatic leukemia following failure with conventional amphotericin].

Invasive aspergillosis is a severe complication in the immunocompromised patient. Despite antifungal treatment the mortality rate is higher than 90% if the immunity deficiency is not corrected. The use and dosage of conventional amphotericin B (deoxycholate-suspended formulation) is limited by its toxicity, especially nephrotoxicity. To reduce these untoward effects, amphotericin B has been formulated in liposomes. Better tolerance and lower nephrotoxicity in the liposomal formulations allow higher doses to be given safely, even in the presence of renal failure. Liposomal encapsulated amphotericin B (LAmB) is a safe and effective alternative to conventional formulations for antifungal therapy. We present a case of a 60-year-old man affected by chronic lymphocytic leukaemia. In the course of his disease and after chemotherapy treatment, he presented an invasive aspergillosis of the lung and paransal sinuses. The rhino-sinusal lesion had progressed despite surgical debridement and treatment with amphotericin B in a dosage of 50 mg per day. Moreover, renal impairment caused by conventional amphotericin was detected. Then, LAmB was started at a dose of 150 mg per day. Treatment with LAmB has resulted in clinical recovery and radiologic ressolution.

Amphotericin B↗
PubMed1991

Cytologic diagnosis of aspergillosis in cardiac transplantation.

Fine-needle aspiration of the lung is now widely utilized to diagnose pulmonary neoplasms, but often serologic techniques or open-lung biopsy is relied on for the diagnosis of infectious pulmonary processes. We report a series of four patients in whom the fine-needle aspiration technique was used to make the rapid cytologic diagnosis of pulmonary aspergillosis. Culture confirmation was also obtained on the aspirated material. A discussion of the available techniques for the laboratory diagnosis of pulmonary aspergillosis is presented and the advantages of fine-needle aspiration cytology are stressed. Our favorable results support expanded use of fine-needle aspiration cytology in the evaluation of lung nodules appearing in immunosuppressed populations.

Adult↗
PubMed1999

Fatal invasive aspergillosis in an adolescent with cystic fibrosis.

We report on a 13-year-old girl with cystic fibrosis (CF) who developed refractory airflow obstruction despite high-dose steroids. She developed invasive aspergillosis and died despite oral and intravenous antifungal therapy. We speculate that the increasing use of immunosuppressive strategies and aggressive antipseudomonal therapy in CF may lead to an increase in aspergillus lung disease, including invasive aspergillosis in the future.

Adolescent↗
PubMed1978

Patho-radiologic correlation of invasive pulmonary aspergillosis in the compromised host.

The autopsy findings and antemortem radiographic abnormalities were correlated in 20 patients with invasive pulmonary aspergillosis to define typical radiographic patterns, their progression and anatomic basis. Sixteen (80%) patients had radiographic abnormalities due to aspergillosis. Fifty-nine percent of the specific radiographic abnormalities seen in these patients were caused by anatomic lesions of asperigillosis and 67% of such anatomic lesions were radiographically definable. The most common initial radiographic pattern was a patchy density (single or multifocal) or a well defined nodule. The densities remained stable in half the patients but progressed, over several weeks to either diffuse consolidation or cavitation in the others. Most anatomic lesions were categorized as either nodular ("target") lesions (1-3 cm in diameter) or hemorrhagic infarctions (5-10 cm in diameter), both due to vascular invasion causing thrombosis and ischemic necrosis. Unlike pulmonary candidiasis, which is usually radiographically undetectable, invasive pulmonary asperigillosis frequently caused radiographically visible lesions.

Adult↗