Aspergillus tracheobronchitis, bronchopleural fistula and empyema after lobectomy for aspergilloma

Rummens, Peter; Bruyneel, Marie; Lungarella, Michele; Ninane, Vincent

doi:10.1016/j.mmcr.2014.07.006

Cited by 8 publications

(5 citation statements)

References 18 publications

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“…While surgical resection is currently considered the gold standard of treatment for symptomatic aspergilloma, many patients have contraindications to surgery including poor respiratory reserve, multiple or bilateral aspergilloma, and patient preference. The morbidity associated with surgery is considerable and potential complications include hemorrhage, empyema, wound infection, tracheobronchitis, bronchopleural fistula formation, and seeding of Aspergillus infection [30][31][32]. Fortunately, as most patients with aspergilloma are asymptomatic, they may not need treatment and can be observed conservatively, but this remains an area of debate.…”

Section: Non-surgical Treatmentsmentioning

confidence: 99%

Non-surgical treatment options for pulmonary aspergilloma

Lang

Chauhan

et al. 2020

Respiratory Medicine

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Section: Non-surgical Treatmentsmentioning

confidence: 99%

Non-surgical treatment options for pulmonary aspergilloma

Lang

Chauhan

et al. 2020

Respiratory Medicine

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“…9 Of note, tracheal fistulae are an uncommon complication of Aspergillus tracheobronchitis (ATB). 10 The AM in our patient might have been caused by a tracheobronchial mediastinal fistula due to TBTB or PMATB, but we could not confirm the position of the fistula because of the existence of a pseudomembrane. Involvement of the full tracheobronchial layer in ATB that may lead to mediastinitis has been identified as a poor prognostic factor in previous study.…”

Section: Discussionmentioning

confidence: 64%

Acute mediastinitis associated with tracheobronchial tuberculosis and aspergillosis: a case report and literature review

et al. 2020

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Acute mediastinitis (AM) is a rare but life-threatening disease. Here, we report a case of AM secondary to endobronchial tuberculosis (EBTB) and pseudomembranous Aspergillus tracheobronchitis (PMATB) co-infection. EBTB was confirmed by tissue culture for Mycobacterium tuberculosis and GeneXpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) detection (simultaneous detection of M. tuberculosis and resistance to rifampin) using endobronchial biopsies; PMATB was confirmed by histopathology. Even with antibiotic treatment and systemic support treatment, the patient died of massive hemoptysis on day 10 after admission. When immunocompromised hosts have AM, especially with central airway involvement, EBTB and aspergillosis should be considered potential causes. Bronchoscopy is helpful for rapid diagnosis and administering precise treatment.

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“…Surgery is the gold standard treatment for simple symptomatic aspergilloma; however, the morbidity associated with the surgery is considerable [19][20][21]. Further, surgery may not be the best treatment option for patients with chronic cavitary or fibrosing pulmonary aspergillosis, who have an aspergilloma.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Intrabronchial Voriconazole Instillation for Inoperable Pulmonary Aspergilloma: A Pilot Randomized Controlled Trial

et al. 2022

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Background: Endobronchial administration of voriconazole is a potential therapeutic option for inoperable aspergilloma. Objective: This study aimed to assess the efficacy of endobronchial instillation of voriconazole for inoperable pulmonary aspergilloma. Method: Patients with mild to moderate hemoptysis, due to inoperable aspergilloma, were randomized to receive either medical therapy (MT) alone or bronchoscopic instillation of voriconazole with MT and followed up till 3 months. The primary objective of this study was to compare the percentage of patients achieving reduction in the severity of hemoptysis assessed on visual analogue scale (VAS) in intervention and control arm at 3 months. Results: This study included 60 patients (female = 47) with mean (SD) age of 40.6 (13.2) years who were randomized to receive either bronchoscopic instillation of voriconazole (n = 30) or MT alone (n = 30). At 3-month follow-up, the primary objective was achieved in 26/30 (86.7%) patients in intervention group as compared to 11/30 (36.7%) in the control group (p value <0.0001). The VAS score at 3 months was significantly lower in voriconazole group 13.9 (9.3) mm as compared to MT alone group 22.3 (11.5) mm, p value of 0.003. Bronchoscopic instillation of voriconazole was also associated with reduction in cough severity and size of the aspergilloma; however, there was no benefit of this therapy in terms of requirement of hospitalization and BAE. Conclusions: Our study shows that for nonoperable aspergilloma, bronchoscopic instillation of voriconazole is associated with reduction in the severity of hemoptysis. This therapy should be evaluated in large multi-center trials.

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Aspergillus tracheobronchitis, bronchopleural fistula and empyema after lobectomy for aspergilloma

Cited by 8 publications

References 18 publications

Non-surgical treatment options for pulmonary aspergilloma

Non-surgical treatment options for pulmonary aspergilloma

Acute mediastinitis associated with tracheobronchial tuberculosis and aspergillosis: a case report and literature review

Efficacy of Intrabronchial Voriconazole Instillation for Inoperable Pulmonary Aspergilloma: A Pilot Randomized Controlled Trial

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