Aspergillus Tracheobronchitis

Abstract

Aspergillus tracheobronchitis (AT) is an infrequent but severe form of invasive pulmonary aspergillosis in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We reviewed 8 cases of AT diagnosed in our tertiary care center during an 18-year period, as well as 148 cases previously reported in the English literature from 1985 to July 2011. The demographic, clinical, imaging, bronchoscopic, and outcome characteristics of every eligible patient were excerpted, and predictors of inhospital mortality were identified by logistic regression. Solid organ transplantation (SOT) (44.2%), hematologic malignancy (21.2%), neutropenia (18.7%), and chronic obstructive pulmonary disease (15.4%) were the most common underlying conditions reported. Most cases occurred in patients receiving long-term corticosteroid treatment (71.8%) or chemotherapy (25.0%). Fever and respiratory complaints (cough, dyspnea, stridor, or wheezing) were the most frequent symptoms; one-third of patients developed acute respiratory distress at presentation, and 15.1% were asymptomatic at the time of diagnosis. Initial imaging studies were not informative in 47.4% of the cases. Aspergillus fumigatus was the predominant species (74.4%). The pseudomembranous form was the most commonly observed (31.9% of cases) and was more frequent in neutropenic patients (p = 0.007), whereas ulcerative AT (31.2%) was associated with SOT (p = 0.001). The most frequent antifungal monotherapy regimens were amphotericin B deoxycholate (23.1%) and itraconazole (18.6%), whereas combined therapy was administered in 35.9% of the cases. Overall inhospital mortality was 39.1%, with neutropenia (odds ratio [OR], 20.47; p < 0.001) and acute respiratory distress at presentation (OR, 9.54; p = 0.002) as independent prognostic factors. Our pooled analysis of the literature shows that AT remains a rare opportunistic infection with a nonspecific presentation and a variable course depending on the nature of the predisposing factor.

Invasive tracheobronchial aspergillosis progressing from bronchial to diffuse lung parenchymal lesions

“…Invasive tracheobronchial aspergillosis (ITBA) without parenchymal disease is relatively rare, seen in less than 10% of IPA cases [3]. Based on the bronchoscopic and/or pathologic features, ITBA is classified into three subtypes; Aspergillus tracheobronchitis, ulcerative Aspergillus tracheobronchitis, and pseudomembranous Aspergillus tracheobronchitis.…”

Traqueobronquite aguda causada por Aspergillus: relato de caso e achados de imagem

“…The latter is an uncommon manifestation of the disease predominantly limited to the airways, generally occurring in severely immunocompromised patients or in those affected by AIDS (1,2,4) . Other relevant risk factors described in the literature include lung transplant and corticotherapy (5) . The clinical presentation is variable and nonspecific, which masks and delays the diagnosis.…”

“…The clinical presentation is variable and nonspecific, which masks and delays the diagnosis. Cough, fever and dyspnea are the most frequent symptoms, and hemoptysis is reported in 11.5% to 26.3% of cases (5,6) .…”

“…At bronchoscopy, tracheobronchial aspergillosis may present either as a diffuse or focal ulcerative form, or even as elevated whitish plaques associated with inflammatory lesions and pseudomembranes (1,2) , historically classified into three presentation forms according to such findings, as follows: pseudomembranous, ulcerative, and obstructive (4,5) . However, currently some authors propose that such presentations might represent different stages of a single disease and not distinctive entities.…”

An update of clinical characteristics and imaging findings of pulmonary aspergillosis

“…Clinically, it includes acute tracheobronchitis, bronchiolitis, and bronchopneumonia. Bronchoscopic examination with microscopic sampling and culture of the biopsy specimens appears to have a high diagnostic yield for Aspergillus tracheobronchitis in immunocompromised patients [37] . Histopathologic demonstration of Aspergillus-like hyphae invading bronchial mucosa gives a definite diagnosis.…”