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PubMed2006

Allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis is an uncommon but serious respiratory condition characterized by chronic airway inflammation and airway damage resulting from persistent colonization by and sensitization to the fungus Aspergillus fumigatus. The immunopathogenesis of allergic bronchopulmonary aspergillosis involves several pathways. Aspergillus allergens stimulate an interleukin 5-mediated Th2 pathway responsible for the eosinophilic infiltrate, whereas aspergillus proteases promote epithelial activation and a potent chemokine response that induces neutrophilic airway inflammation. The resulting airway inflammation is intense, involves tissue damage and remodeling, and is linked with the severity of bronchiectasis. Treatment involves corticosteroids and antifungal therapy with oral azoles. Additional management seeks to monitor and control the other disease components of severe asthma, bronchiectasis, and disease exacerbations.

Animals↗
PubMed1997

[The typical radiological findings and course of invasive pulmonary aspergillosis in the immunosuppressed patient].

PURPOSE: This retrospective study was designed to show whether invasive pulmonary aspergillosis, which is often difficult to diagnose by bronchoscopy or serology, can be diagnosed at an early stage by typical radiological findings on conventional radiographs or by CT, specially high resolution CT (HR-CT). PATIENTS AND METHODS: In 19 Patients with 20 disease episodes, 20 thorax radiographs and eight spiral CT examinations were performed and in four cases HR-CT was also available. The earliest pathological findings and the course of the disease were analysed and the results of the various examinations were compared. RESULTS: 90% of chest examinations, including CT and HR-CT, showed the following lesions as part of the earliest changes: round or wedge-shaped opacities or the so-called "halo" sign. CT or HR-CT always demonstrated more lesions than plain chest radiographs; 75% of lesions appeared typical and thereby contributed to the diagnosis. CONCLUSION: The typical radiological findings of round or wedge-shaped opacities and the so-called "halo" sign are additional criteria for the diagnosis of invasive pulmonary aspergillosis. The superiority of CT or HR-CT in the demonstration of pathological changes suggests that these should be used early in the investigation of patients who are specially at risk.

Adult↗
PubMed1993

Primary cutaneous aspergillosis in a preterm infant.

A case of primary cutaneous aspergillosis in a very low birthweight infant that responded to medical therapy is reported. Knowledge of the potential pathogenic role of this organism in neonatal skin lesions is important because of resistance to standard empirical antibacterial therapy and the potential for dissemination and deep parenchymal invasion. Surgical excision may be necessary if cutaneous aspergillosis progresses despite systemic antifungal therapy.

Amphotericin B↗
PubMed1991

[Aspergillosis of the central nervous system in glioblastoma multiforme].

A 45 year-old male with a butterfly glioma received stereotactic biopsy for histologic confirmation of the clinical diagnosis. Microscopically, the results were controversial since some biopsy specimens showed distinct inflammatory changes, while others displayed typical features of a malignant glioma. The patient died four days after the stereotactic approach due to therapy-resistant intracranial pressure rise. In addition to a large butterfly glioblastoma originating from the frontal part of the corpus callosum, neuropathologic examination revealed a mycotic encephalitis with formation of numerous fungi-containing inflammatory foci in all parts of the brain and in the glioma. General autopsy disclosed pulmonary aspergillosis as the source of the inflammatory spread. A previous steroid medication over several weeks for treatment of increased intracranial pressure may be considered as an important factor in the origin of the pulmonary aspergillosis complicating the butterfly glioma.

Aspergillosis↗
PubMed1985

[Metal-dense structures in the paranasal sinuses--a reliable indication of aspergillosis?].

The significance of mycotic concretions of 'metal density' in the diagnosis of aspergillosis of the paranasal sinuses has been analysed in 47 patients with this diagnosis. The incidence, types, radiological appearances and chemical composition of these very dense calcifications are discussed. Demonstration of these concretions, if metal foreign bodies and displaced dental fillings are excluded, are evidence for a mycosis of the paranasal sinuses. Absence of these dense structures does not exclude aspergillosis and was present in our clinical material in only 50% of cases.

Adult↗
PubMed1976

Immunologically mediated lung diseases. Extrinsic allergic alveolitis and allergic bronchopulmonary aspergillosis.

Early recognition and treatment of immunologically mediated diseases of the lung are vital to prevent irreparable damage. Extrinsic allergic alveolitis and allergic bronchopulmonary aspergillosis are often confused but should not be difficult to distinguish. The former is nonatopic and is marked by chills, fever, chest pains, cough, dyspnea, and restrictive pulmonary function. The immunologic hallmark is the presence of precipitating antibody to the suspected antigen. Allergic bronchopulmonary aspergillosis is atopic and is marked by low-grade fever, obstructive pulmonary function, markedly elevated serum IgE levels, and positive immediate and late response on skin tests. Both diseases respond well to early corticosteroid therapy. Prophylactic measures are also important in controlling extrinsic allergic alveolitis.

Animals↗
PubMed1978

Specific double diffusion microtechnique for the diagnosis of aspergillosis and paracoccidioidomycosis using monospecific antisera.

Using experimental reference sera against species-specific antigens of Aspergillus fumigatus and Paracoccidioides brasiliensis in a microdouble diffusion technique, a simple and specific test for the immunodiagnosis of aspergillosis and paracoccidioidomycosis has been developed. Only sera that produced lines of identity with either one of the bands formed by the anti-C2 or the anti-E2 reference sera were considered positive for aspergillosis or paracoccidioidomycosis, respectively. The sensitivity of the diagnostic test was similar to those of the classical double diffusion and the immunoelectrophoresis test. No false positives were found in sera obtained from patients affected by other mycoses, nor from healthy controls. The amount of reagents for the specific test was ten fold less than that required by the classical double diffusion test.

Aspergillosis↗
PubMed2005

Aspergillosis in a North Island robin (Petroica longipes).

CASE HISTORY: A 3-year-old female North Island robin (Petroica longipes) was found dead on Tiritiri Matangi Island during the breeding season. CLINICAL FINDINGS: The bird was in poor condition, and there was a 13 x 8 mm granulomatous mass in the thoracic cavity causing displacement of the heart and left lung. Histologically, the mass was a large granuloma infiltrated with fungal hyphae, and the liver contained multifocal aggregates of inflammatory cells. DIAGNOSIS: Thoracic aspergillosis and multifocal hepatitis. CLINICAL RELEVANCE: Determining the causes of death in populations of wild birds is often hampered by a lack of recovery of carcasses, autolysis and poor clinical history. In this case, the life history of the bird was known and recovery of the body was relatively swift. This is the first published description of aspergillosis in a free-living North Island robin.

Animals↗
PubMed1989

Invasive aspergillosis in an alpaca (Lama pacos).

An invasive form of aspergillosis in an alpaca (Lama pacos) is described, with dissemination causing small abscesses and multifocal areas of necrosis in the lung, heart, spleen and kidneys. Histological sections showed hyphae morphologically compatible with an Aspergillus species. Direct immunofluorescent testing confirmed the diagnosis of aspergillosis.

Animals↗
PubMed1994

Western blot detection of IgG anti-Aspergillus fumigatus elastase in sera of patients with aspergillosis.

Anti-Aspergillus fumigatus alkaline protease IgG was investigated by Western blot. Specific IgG antibodies were detected in sera of two of nine patients with proven or highly probable invasive aspergillosis and in sera of one of eight patients with proven or highly probable allergic bronchopulmonary aspergillosis. No response was obtained in sera of 23 control patients. The specific but transient IgG response to this induced enzyme does not recommend its use as sole serodiagnostic aid.

Antibodies, Fungal↗
PubMedDate not supplied

Cure of chronic invasive sinus aspergillosis with oral saperconazole.

We report a case of chronic invasive aspergillosis of the maxillary sinus which continued to progress despite treatment with high doses of oral itraconzole. The patient was unable to tolerate treatment with intravenous amphotericin B and had limited response to two different lipid-complexed preparations of amphotericin B (AmBisome, Vestar Ltd; Amphocil, Liposome Technology Inc.). Treatment with oral saperconazole (Cilag Ltd) resulted in a dramatic clinical and radiological response but was associated with abnormalities of liver function at a daily dose of 200 mg 12 hourly. These biochemical abnormalities were not associated with clinical symptoms and resolved fully within 2 weeks of reducing the dose to 100 mg 12 hourly. Saperconazole may represent an effective treatment of invasive sinus aspergillosis in patients who are unable to tolerate, or fail treatment with itraconazole and amphotericin B.

Administration, Oral↗
PubMed2000

Intracavitary administration of amphotericin B in the treatment of cerebral aspergillosis in a non immune-compromised patient: case report and review of the literature.

A 24-year-old man presented with cerebral aspergillus fungal granuloma involving the left frontal region secondary to pulmonary aspergillosis. He was otherwise healthy with no evidence of immune-suppression. Because of poor penetration of amphotericin B into the brain and cerebrospinal fluid (CSF), this patient was treated by a combination of systemic and local therapy in addition to surgical excision resulting in a cure with follow up for more than three years. This form of treatment produced no untoward long-term side effects or neurological sequel. On review of the literature on aspergillosis of the central nervous system (CNS), we found that six patients, including the present case, have been reported who survived longer than 1 year; their treatment included local administration of antifungal agent in the abscess cavity or into cerebral ventricles in order to control this devastating, treatment-resistant pathological fungal infection.

Adult↗
PubMed2002

Superior vena cava syndrome after bone marrow transplantation caused by aspergillosis: a case report.

Aspergillosis is known for the variety of unusual presentations in immuno-suppressed patients. We report a patient in whom aspergillosis caused the superior vena cava (SVC) syndrome. A 37-year-old woman became febrile soon after bone marrow transplantation (BMT). Chest radiography demonstrated a 5-cm mass extending from the right lung apex to the right supraclavicular fossa beside her Hickman catheter. She then developed SVC syndrome, which progressed despite treatment. Despite recovery of the white blood cell count, the patient continued to deteriorate, became comatose, suffered a cardiac arrest and died 31 days after BMT. Autopsy revealed Aspergillus infection at the apex of the right lung associated with innominate artery thrombosis.

Adult↗
PubMed2005

Complete resolution of hepatic aspergillosis after non-myeloablative hematopoietic stem cell transplantation in a patient with acute myeloid leukemia.

Fungal infections due to Aspergillus are a frequent cause of transplant-related mortality. For this reason, leukemic patients with severe fungal infection are usually excluded from conventional allotransplantation. Recently, some authors suggested a role for non-myeloablative hematopoietic stem cell transplantation (HSCT) in this subset of patients. We used this therapeutic approach in a patient with high-risk acute myeloid leukemia in second complete remission (CR) with pre-existing hepatic aspergillosis refractory to conventional anti-fungal therapy. A complete regression of hepatic lesions was observed after 3 months from allogeneic stem cell transplantation. Our work confirms previous reports suggesting that non-myeloablative HSCT is effective in patients not eligible for conventional transplantation because of invasive aspergillosis.

Adult↗
PubMed2004

Treatment of murine systemic aspergillosis with polyene-intralipid admixtures.

The objective of this research was the evaluation of the activity of admixtures of amphotericin B (AMB)--intralipid (AMB-IL) and nystatin (Ny)--intralipid (Ny-IL) against experimental systemic aspergillosis in immunocompromised mice. ICR mice were transiently immunosuppressed by intraperitoneal (i.p.) administration of cyclophosphamide (CY). Three days post CY administration the mice were inoculated intravenously (i.v.) with Aspergillus fumigatus conidia. The animals were treated with various doses of AMB-IL or Ny-IL admixtures administered i.v. for 5 consecutive days, starting 2 h after infection. The mean survival rate (MSR) and mean survival time (MST) were evaluated during an observation period of 30 days in comparison to untreated infected mice and to animals treated with conventional formulations of these drugs. These experiments showed that AMB-IL increased significantly the MSR. Specifically, the MSR ranged in dependence of dose, between 48 and 65.7% vs. 0% of the untreated (P < 0.001, anova analysis) and 39.7% of AMB-treated animals (P < 0.01). The MSR of the Ny-IL-treated mice ranged between 16.2 and 40% in comparison to 0% of the untreated group (P < 0.001). Treatment with both admixtures prolonged the MST of the mice (AMB-IL: 17.3-23.07 days; Ny-IL: 8.61-16.8 days) in comparison to either untreated (6.13 days) or AMB treated animals (15.23 days). The data obtained in this study show that both AMB-IL and Ny-IL formulations, particularly AMB-IL at the highest dose, were effective in the treatment of experimental systemic aspergillosis.

Amphotericin B↗
PubMed2005

Aspergillosis in mammals and birds: impact on veterinary medicine.

Aspergillosis is relatively uncommon in mammals, but dogs, horses, cows and dolphins are susceptible. On the other hand, aspergillosis is a major cause of mortality in birds. This paper provides an overview of the manifestations of this disease in these animals. Treatment options are still lacking, but the increased incidence of the disease in humans has led to increased study, which may benefit both human and veterinary medicine.

Animals↗
PubMed2005

New findings and unique aspects in pediatric aspergillosis.

There is a paucity of specific data on pediatric invasive aspergillosis. While the underlying predisposing patient diseases and treatments differ in children and adults, it also appears that there is a heterogeneity of invasive aspergillosis disease that extends to children. These aspects extend in some reports to the Aspergillus spp. distribution as well as the fundamental pathophysiology of the disease in different age groups. For instance, the newer diagnostic tools hold great promise for adult patients but it appears that they have limited usefulness in children. Only through dedicated pediatric study will clinicians fully discover the nuances and unique findings in children with this deadly disease.

Adolescent↗
PubMed2005

Invasive aspergillosis in primary immunodeficiencies.

Primary immunodeficiencies are rare and usually first manifest during childhood. Invasive aspergillosis is the leading cause of mortality in chronic granulomatous disease (CGD), reflecting the key role of the phagocyte NADPH oxidase in host defense against opportunistic fungi. Despite interferon-gamma prophylaxis, invasive filamentous fungal infections are a persistent problem in CGD. Key principles of management of fungal infections involve early recognition and aggressive treatment and appropriate surgical debridement of localized disease. Because CGD is a disorder of phagocyte stem cells in which the gene defects are well defined, it is a model disease to evaluate immune reconstitution through stem cell transplantation and gene therapy. Patients with the hyper-IgE syndrome with recurrent infections (Job syndrome) are prone to colonization of lung cavities (pneumatoceles) by Aspergillus species leading to local invasion and rarely disseminated infection. Other primary phagocytic disorders, T-cell disorders, and mitochondrial disorders are uncommonly associated with invasive aspergillosis. Taken together, these rare primary immunodeficiencies highlight the complex coordination of both innate and acquired pathways mediating host defense against Aspergillus infection.

Animals↗