Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ASPERGILLOSIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 901 records · Page 50Linked to original sources
PubMed2005

Design issues in studies evaluating diagnostic tests for aspergillosis.

Although invasive aspergillosis is recognized as an increased concern for immunosuppressed patients, establishing an early diagnosis remains a challenge. Current methods for diagnosis, including sensitive radiography and invasive procedures to identify organisms in affected tissues, provide an early diagnosis for only a small proportion of patients infected with Aspergillus species. The availability of a standardized assay to detect circulating Aspergillus galactomannan, the BioRad Platelia Aspergillus galactomannan enzyme immunoassay, should be considered as a valuable tool. However, at present, clinical utility is hampered by controversies surrounding the performance of the test and an apparent lack of definitive data. These controversies emphasize the complexity inherent in analyzing diagnostic tests for aspergillosis. The widespread availability of a standardized assay may now allow us to address the multiple sources of variability and bias via large, cooperative studies.

Aspergillosis↗
PubMed2003

Invasive pulmonary aspergillosis soon after therapy with infliximab, a tumor necrosis factor-alpha-neutralizing antibody: a possible healthcare-associated case?

BACKGROUND: Infliximab is a chimeric monoclonal antibody against tumor necrosis factor (TNF)-alpha, used for the treatment of Crohn's disease and rheumatoid arthritis. Recently, an increased risk of infection due to Mycobacterium tuberculosis and rare cases of invasive fungal disease have been reported following infliximab therapy. CASE REPORT: A 73-year-old woman with chronic rheumatoid arthritis who had been treated with methotrexate, leflunomide, and prednisone was given the first of three doses of infliximab in June 2001. In July 2001, she presented with cough, and in August, she had a right upper lobe infiltrate that was treated with levofloxacin without improvement. In October, the patient had right upper and middle lobe infiltrates on a chest X-ray and computed tomography scan. At bronchoscopy, an endobronchial mass was biopsied, which demonstrated Aspergills fumigatus. Our patient had frequently accompanied her daughter on visits to another medical center following a stem cell transplant, where her daughter was instructed to wear a mask during all visits because of extensive building construction. We postulate that our patient may have acquired pulmonary aspergillosis during this period. Literature reviews on granulomatous diseases following infliximab therapy and hospital-acquired aspergillosis are presented. CONCLUSION: The temporal relationship between the administration of infliximab and A. fumigatus infection in this patient suggests a causal relationship and possible healthcare-associated acquisition. These data underscore the importance of both patient and family education on prevention strategies when potent immune-modulating medications such as infliximab have been prescribed.

Aged↗
PubMed2006

Pathogenesis of Aspergillus fumigatus and the kinetics of galactomannan in an in vitro model of early invasive pulmonary aspergillosis: implications for antifungal therapy.

BACKGROUND: Little is known about the pathogenesis of invasive pulmonary aspergillosis and the relationship between the kinetics of diagnostic markers and the outcome of antifungal therapy. METHODS: An in vitro model of the human alveolus, consisting of a bilayer of human alveolar epithelial and endothelial cells, was developed. An Aspergillus fumigatus strain expressing green fluorescent protein was used. Invasion of the cell bilayer was studied using confocal and electron microscopy. The kinetics of culture, polymerase chain reaction, and galactomannan were determined. Galactomannan was used to measure the antifungal effect of macrophages and amphotericin B. A mathematical model was developed, and results were bridged to humans. RESULTS: A. fumigatus penetrated the cellular bilayer 14-16 h after inoculation. Galactomannan levels were inextricably tied to fungal invasion and were a robust measure of the antifungal effect of macrophages and amphotericin B. Neither amphotericin nor macrophages alone was able to suppress the growth of A. fumigatus; rather, the combination was required. Monte Carlo simulations showed that human dosages of amphotericin B of at least 0.6 mg/kg were required to achieve adequate drug exposure. CONCLUSIONS: This model provides a strategy by which relationships among pathogenesis, immunological effectors, and antifungal drug therapy for invasive pulmonary aspergillosis may be further understood.

Amphotericin B↗
PubMed1998

Invasive pulmonary aspergillosis due to Aspergillus terreus: 12-year experience and review of the literature.

A 12-year retrospective analysis was done to identify and evaluate in detail cases of invasive pulmonary aspergillosis (IPA) caused by Aspergillus terreus. We identified 13 A. terreus infections among 133 total cases of confirmed invasive aspergillosis; 11 were IPA and 2 were primary peritoneal infections. Of the 11 patients with IPA, 7 developed neutropenia during hospitalization, and the remaining four were receiving immunosuppressive agents. Ten patients with IPA died; one liver transplantation patient without neutropenia survived after treatment with amphotericin B, itraconazole, and a pulmonary lobectomy. Six patients developed disseminated disease, with the heart the most common extrapulmonary site identified (four patients). These cases demonstrate that IPA caused by A. terreus rapidly progresses in immunocompromised patients receiving amphotericin B and illustrate the need for sensitive diagnostic tests and more effective antifungal agents.

Antifungal Agents↗
PubMed1996

Primary cutaneous aspergillosis: case report and review of the literature.

Primary cutaneous aspergillosis is an uncommon entity that may occur in immunosuppressed hosts, usually resulting from contact with contaminated medical devices used in patient care. The infection spreads locally with subsequent skin necrosis due to angioinvasion and thrombosis. We report primary cutaneous aspergillosis following contact with contaminated gauze, and we review the relevant literature.

Adult↗
PubMed2003

Effective protection of allogeneic stem cell recipients against Aspergillosis by HEPA air filtration during a period of construction--a prospective survey.

High incidence of aspergillosis on transplant units or hematological wards without HEPA air conditioning during periods of demolishing or construction has been reported by several investigators. Here we report monitoring of fungal air contamination during a period of construction on a stem cell transplantation ward using the gravity air-setting plate (GASP) method. Fungal air contamination in HEPA-conditioned patient rooms was constantly low, independent from construction activity. Outside of the patient rooms at the ward's corridor, the fungal load was significantly higher with some peak values. Outside the transplant unit measures of construction led to a significant increase of fungal spore concentration in air. Transplant activity was not reduced during construction and patients were nursed strictly under HEPA conditions. Patients were monitored prospectively for incidence of infections since 1990 and data of patients grafted during construction (n = 28) were compared to those grafted outside building activity (n = 652). An increase of aspergillosis during construction could be clearly excluded. It can be concluded: Nursing of patients undergoing stem cell transplantation in HEPA-conditioned rooms is an effective protection against acquisition of aspergillus-infection, even under environmental conditions with increased air contamination by conidia. The gravity air-setting plate (GASP) method is not expensive and easy to use and allows reliable and quantitative aerobiological spore monitoring.

Air↗
PubMed1993

An unusual form of pulmonary aspergillosis in two patients with the acquired immunodeficiency syndrome.

Two cases of an unusual pathologic form of pulmonary aspergillosis in patients with the acquired immunodeficiency virus are reported. Each was characterized by chronic cavitary disease with involvement of small bronchioles and extension into subtending alveoli. It is suggested that this variant would best be described as chronic cavitary and invasive bronchopulmonary aspergillosis. A prominent feature in each case was the presence of numerous cytomegalovirus inclusions adjacent to the cavities and affected airways. The significance of this association is not known.

AIDS-Related Opportunistic Infections↗
PubMed1990

Experimental murine invasive pulmonary aspergillosis.

A new model of invasive pulmonary aspergillosis (IPA) was developed in immunosuppressed mice. Intranasal route of inoculation was used to deliver predictable numbers of Aspergillus flavus conidia. The LD50 was determined to be 2.7 X 10(2) viable conidia, and a combination of quantitative culture and determination of chitin content was shown to best measure the progression of pulmonary disease. The evolution of IPA in these mice conformed with what has been reported in human cases of aspergillosis; both histopathology of the pulmonary lesions and dissemination pattern resembled their human counterparts. The authors hope to use this model to study virulence mechanisms of Aspergillus and novel therapeutic methods.

Administration, Intranasal↗
PubMedDate not supplied

Efficacy of fluconazole in experimental invasive aspergillosis.

The efficacy of fluconazole against Aspergillus fumigatus was evaluated in an immunosuppressed, temporarily leukopenic rabbit model of invasive aspergillosis. Fluconazole was given at a dosage of 60 mg/kg twice daily and was compared with amphotericin B given intravenously at a dosage of 1.5 mg/(kg.d). Fluconazole reduced the tissue burden of Aspergillus from that in untreated controls by 10- to 100-fold in liver, kidney, and lung. However, at these doses amphotericin B was more effective in sterilizing tissues and in reducing the tissue burden of Aspergillus in those organs. Both fluconazole and amphotericin B decreased or eliminated circulating Aspergillus antigen and improved survival over that of untreated controls. Thus fluconazole shows activity in this rabbit model of invasive aspergillosis and should be further evaluated for use in the treatment of this disease.

Amphotericin B↗
PubMed1992

Animal models: usefulness for studies of fungal pathogenesis and drug efficacy in aspergillosis.

This review describes our experience during the past 8 years with an immunocompromised rabbit model of invasive aspergillosis. We have used the model to evaluate the efficacy of a variety of antifungal therapies, including amphotericin B-deoxycholate, a liposomal amphotericin B preparation, some of the newer azoles (i.e., fluconazole, saperconazole, and the experimental compound SCH 39304), and combination therapy with amphotericin B-deoxycholate plus fluconazole. The model provides a rigorous test of efficacy when animals receive a lethal challenge; permits studies of the kinetics of aspergillar antigenemia in response to therapy with each antifungal agent or regimen; allows comparison of the relation of antigenemia to the extent of disease in target organs; and is useful in correlating the timing of antifungal therapy with the success of treatment. These observations in our animal model may provide some insight into the treatment of invasive aspergillosis in humans.

Animals↗
PubMed1994

Invasive aspergillosis in patients with AIDS.

The prolonged survival of profoundly immunocompromised patients with AIDS has contributed to the increasing recognition of aspergillus infections as an emerging problem. Nevertheless, many of these infections continue to be diagnosed only at autopsy. In this article we review details of 293 reported cases. Invasive aspergillosis occurs in advanced AIDS and most commonly affects the lungs, although brain involvement has also been frequently reported. The diagnosis is often difficult to make while the patient is alive, although examination of specimens obtained via bronchoalveolar lavage, percutaneous needle aspiration, or biopsy is often successful. Biopsy of the affected organ along with histologic examination and culture may be necessary for diagnosis. The dismal prognosis of invasive aspergillosis in patients with AIDS can be improved only with earlier diagnosis of disease and the availability of more-effective antifungal regimens.

AIDS-Related Opportunistic Infections↗
PubMed1995

Treatment of cerebral Aspergillosis with itraconazole: do high doses improve the prognosis?

We describe a 72-year-old woman with chronic asthma who presented with cerebral abscesses due to Aspergillus fumigatus after she received treatment with corticosteroids. Therapy with high-dose itraconazole (800 mg/d for 5 months, followed by 400 mg/d for an additional 4.5 months) resulted in complete resolution of all lesions. Serum concentrations of the drug ranged from 2 micrograms/mL to 30 micrograms/mL. Review of 20 cases of cerebral aspergillosis that were treated with itraconazole revealed that three of the four patients who received high doses (800 mg/d in the adults) of the drug responded favorably, while only two of the 16 patients who received a dose of 400 mg/d were cured. The use of high-dose itraconazole appears to be justified for high-risk patients with cerebral aspergillosis for whom conventional therapy has failed.

Aged↗
PubMed1996

Primary cutaneous aspergillosis in neonates: case report and review.

A premature neonate (gestational age, 26 weeks) with multiple prematurity-related problems developed primary cutaneous aspergillosis due to Aspergillus fumigatus on the 30th day of life. The infection developed in an area that had been macerated by adhesive tape. During the infection, renovation of the hospital was in progress near the neonatal intensive care unit. The infection was cured with a short course of therapy with amphotericin B. Five cases of primary cutaneous aspergillosis in neonates have been previously reported in the English-language literature. We review these cases and discuss the risk factors and favorable outcome of the disease when treatment with amphotericin B is instituted.

Amphotericin B↗
PubMedDate not supplied

Invasive aspergillosis.

Invasive fungal disease of humans caused by species of the genus Aspergillus Micheli ex Linnaeus has become a significant and prevalent problem in contemporary medicine, particularly with regard to the compromised host. This review addresses the current status of invasive aspergillosis, including microbiological, clinical, and pathologic aspects. Diagnostic and therapeutic considerations are discussed with a view toward early and aggressive intervention in order to prevent the high mortality rate associated with aspergillosis.

Antifungal Agents↗
PubMedDate not supplied

Current trends in immunodiagnosis of candidiasis and aspergillosis.

The methods and reagents currently used for the immunodiagnosis of aspergillosis and candidiasis are reviewed. Problems associated with these techniques and approaches to resolving these problems are discussed. Latex agglutination and precipitin tests are used for detection of antibody in immunocompetent hosts. However, these tests are apparently inadequate when applied to the diagnosis of systemic candidiasis in compromised hosts. Enzyme immunoassays ( EIAs ) and radioimmunoassays (RIAs) can be used to detect antibodies in immunocompetent and compromised patients, but their value is limited because antibodies to the Candida species are detectable in healthy as well as colonized and infected patients. EIAs and RIAs are, however, promising for detection of antigenemia in patients with aspergillosis or candidiasis, and gas-liquid chromatography has been developed for the quantitation of serum arabinitol and mannose in candidiasis. Antigens of the Aspergillus and Candida species may circulate in patients' sera in the form of immune complexes. These may readily be dissociated by a variety of methods to permit the detection of diagnostically important antigens. Studies are being carried out to increase the sensitivity and reliability of these tests through the use of monoclonal antibodies and purified, clinically relevant antigens.

Animals↗
PubMed1979

A solid-phase radioimmunoassay for the measurement of antibody to Aspergillus in invasive aspergillosis.

A solid-phase radioimmunoassay (SPRIA) to measure antibody responses to Aspergillus fumigatus and Aspergillus flavus antigens in invasive aspergillosis (IA) was developed and compared with immunodiffusion (ID) and counterimmunoelectrophoresis (CIE). SPRIA detected significant elevations in levels of aspergillus antibody in 15 (79)% of 19 patients with IA. Fewer patients with IA were positive by ID (give of 19) or CIE (four of 19). Only seven )8%) of 58 subjects with other fungal or bacterial infections were positive by SPRIA, as was one (5%) of 20 by ID and CIE. Weak cross-reactivity between aspergillus and candida antigens was demonstrated by SPRIA. IgG levels in patients with IA and control subjects were equivalent. Thus, an antibody response to Aspergillus can be detected in a greater percentage of patients with IA by SPRIA than by ID or CIE. Although a few patients without aspergillosis had elevated levels of aspergillus antibody, a rise in antibody level was specific for IA.

Adolescent↗
PubMed1983

Treatment of experimental murine aspergillosis with BAY n7133.

BAY n7133, a recently developed imidazole antifungal drug, was evaluated in experimental murine aspergillosis. BALB/c mice were challenged with conidia of Aspergillus fumigatus by either the intravenous or the intranasal route. One day after challenge, oral treatment with BAY n7133, ketoconazole, or a placebo control was begun BAY n7133 was well absorbed after oral administration and penetrated all tissues evaluated. There was some evidence for accelerated inactivation of the drug after prolonged therapy. BAY n7133 and ketoconazole both markedly inhibited the growth of mycelia of A fumigatus in vitro. However, only BAY n7133 prolonged the survival time of infected mice. Prolonged survival was associated with a significant reduction in counts of A fumigatus in the lungs. BAY n7133 appeared to be slightly less effective than amphotericin B. In studies with combined drugs, BAY n7133 appeared to add modestly to the benefit conferred by amphotericin B. BAY n7133 seems promising for the treatment of aspergillosis, a disease in which ketoconazole has not been particularly effective.

Amphotericin B↗
PubMed1989

Treatment of experimental invasive aspergillosis with novel amphotericin B/cholesterol-sulfate complexes.

An immunosuppressed rabbit model of invasive aspergillosis was used to evaluate a novel micellar preparation of cholesterol sulfate complexed to amphotericin B. The acute LD50 of amphotericin B-deoxycholate was 5.1 mg/kg versus 20 mg/kg for the amphotericin/cholesterol-sulfate complexes. Amphotericin B-deoxycholate given iv at a dose of 1.5 mg/kg was more effective in sterilizing liver and kidney than the amphotericin/cholesterol-sulfate complexes given iv at 1.5-4.5 mg/kg, but infection persisted in the lungs of all rabbits treated with those doses. Infection persisted even when the rabbits were given a lethal dose of amphotericin B-deoxycholate (4.5 mg/kg), but a dose of 15 mg/kg of the amphotericin/cholesterol-sulfate complexes sterilized tissues and was associated with no acute lethality. Equivalent doses of the amphotericin/cholesterol-sulfate complexes were less effective than amphotericin B-deoxycholate, but a fourfold decrease in acute lethality improved the therapeutic index of amphotericin B. The amphotericin/cholesterol-sulfate complexes appear to be an improved means of amphotericin B delivery and may improve therapy for invasive aspergillosis.

Amphotericin B↗