Capítulo 5 - Aspergilose: do diagnóstico ao tratamento

Abstract

Aspergillosis is a multifaceted disease whose clinical manifestations (allergic, saprophytic and invasive forms) are determined by the host immune response. Allergic bronchopulmonary aspergillosis is characterized by corticosteroid-dependent asthma, fever, hemoptysis and destruction of the airways, which can evolve to fibrosis with honeycombing. The treatment consists of the combined use of a corticosteroid and itraconazole. Invasive pulmonary aspergillosis, which has a worse prognosis, is diagnosed based on histopathological documentation and positive culture of a sterile specimen. The treatment response obtained with voriconazole is better, in terms of survival and safety, than that obtained with amphotericin B. In patients with chronic pulmonary disease who are mildly immunocompromised, chronic necrotizing pulmonary aspergillosis causes progressive destruction of the lung. Such patients are treated with oral itraconazole. Chronic cavitary pulmonary aspergillosis causes multiple cavities, with or without aspergilloma, accompanied by pulmonary and systemic symptoms. In patients with chronic pulmonary disease, the aspergilloma is characterized by chronic productive cough and hemoptysis, together with a cavity containing a rounded, sometimes mobile, mass separated from the cavity wall by airspace. Surgical resection is the definitive treatment for both types of aspergillosis. Triazole fungicides provide long-term treatment benefits with minimal risk.

Chronic Pulmonary Aspergillosis: An Update on Diagnosis and Treatment

“…Simple aspergilloma is caused by Aspergillus spp., most frequently A. fumigatus , although other species including A. flavus , A. niger and A. terreus can be responsible for the condition [7,23,32]. Colonisation occurs in either scarred lungs or in a pre-existing lung cavity that may have been caused by a previous infection, most commonly TB.…”

“…CCPA (formerly called complex aspergilloma) is the formation and expansion of multiple cavities or the extension of a pre-existing cavity; some contain fungal balls [3,7]. Pulmonary and systemic symptoms reflect a granulomatous reaction and tissue necrosis, which are destructive for the lung and lead to the formation of cavities through parenchymal necrosis (see the paragraph above: ‘The Role of CT Scan Imaging in CPA Diagnosis').…”

“…The condition is associated with high morbidity and mortality. It usually requires long-term antifungal treatment, which transforms disease prognosis in many cases [7,8]. This review will systematically explore the current classifications, diagnostic procedures, risk factors and treatment strategies for CPA.…”

Aspergilose pulmonar em paciente imunocompetente e previamente sadio

“…Alguns fatores estão implicados na gênese da APC: infecção micobacteriana prévia, enfisema, bolhas, sarcoidose, pneumoconiose, câncer de pulmão, cirurgia torácica, fibrose dos lobos superiores, infecção por Legionella, defeitos sutis na imunidade, corticosteróides, diabetes mellitus, desnutrição, AIDS, uso de álcool 1,2,8,9 . No presente caso, não encontramos nenhum desses fatores, o que nos conduziu ao relato do mesmo.…”

“…Dentre as complicações com risco de morte incluem-se: hemoptise, fibrose pulmonar e aspergilose invasiva 8 .…”