Chronic Invasive Aspergillosis in Apparently Immunocompetent Hosts

Karim, Muhammad Osman; Alam, Mehboob; Shah, Asad Hussain; Ahmed, Rashida; Sheikh, Hizbullah

doi:10.1093/clind/24.4.723

Cited by 56 publications

(32 citation statements)

References 55 publications

(43 reference statements)

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“…Weshould have treated not only the infection of Aspergillus but also thrombus. Invasive aspergillosis in an immunocompromised host has been documented (5,6). However, there have been few reports of invasive aspergillosis in immunocompetent hosts (7,8).…”

Section: Discussionmentioning

confidence: 99%

Invasive Pulmonary Aspergillosis with Thrombosis in the Left Atrium.

et al. 2001

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Wereport a female patient with left atrial wall invasion from pulmonary aspergillosis. She had been treated for diabetes mellitus. Pulmonary aspergillosis extended to the left atrial wall via the left pulmonary vein and formed a polypoid lesion in the left atrium. The polypoid lesion was composed of thrombus, and the thrombus increased in size to become large, and it showed invagination into the mitral valve during diastole. Weconsidered that the thrombus was formed on the injured endocardium. Severe invasive aspergillosis thus could occur in a mild systemic immunocompromisedhost. (Internal Medicine 40: 250-254, 2001)

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Section: Discussionmentioning

confidence: 99%

Invasive Pulmonary Aspergillosis with Thrombosis in the Left Atrium.

et al. 2001

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“…The incidence of invasive aspergillosis varies between 1 and 19 % for patients who have undergone solid organ transplantation (Patel & Paya, 1997;Verweij & Denning, 1997), and patients with leukaemia, AIDS and granulomatous disease are also at risk (Brown et al, 1998;Denning, 1998;Kaizer et al, 1998). In contrast, the disease is rarely found in immunocompetent hosts (Karim et al, 1997). A. fumigatus is a common, widespread saprophytic fungus, and environmental surveys indicate that humans inhale several hundred A. fumigatus conidia per day (Hospenthal et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Oxidative and amphotericin B-mediated cell death in the opportunistic pathogen Aspergillus fumigatus is associated with an apoptotic-like phenotype

Mousavi

Robson

2004

Microbiology

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When protoplasts of the opportunistic fungal pathogen Aspergillus fumigatus were treated with low but toxic levels of hydrogen peroxide (0?1 mM) or amphotericin B (0?5 mg ml "1 ), loss of cell viability and death were associated with a number of phenotypic changes characteristic of apoptosis. The percentage of protoplasts staining positive with annexin V-FITC, an indicator of the externalization of phosphatidylserine and an early marker of apoptosis, rose to~55 % within 1 h. This was followed by a similar increase in apoptotic DNA fragmentation detected by the TUNEL assay, and led to a loss of cell permeability and death in~90 % of protoplasts, as indicated by the uptake of propidium iodide. The development of an apoptotic phenotype was blocked when protoplasts were pre-treated with the protein synthesis inhibitor cycloheximide, indicating active participation of the cell in the process. However, no significant activity against synthetic caspase substrates was detected, and the inclusion of the cell-permeant broad-spectrum caspase inhibitor Z-VAD-fmk did not block the development of the apoptotic-like phenotype. Higher concentrations of H 2 O 2 (1?8 mM) and amphotericin B (1 mg ml "1 ) caused protoplasts to die without inducing an apoptotic phenotype. As predicted, the fungistatic antifungal agent itraconazole, which inhibits growth without causing immediate cell death, did not induce an apoptotic-like phenotype. INTRODUCTIONThe incidence of life-threatening invasive aspergillosis in immunocompromised hosts has increased dramatically over the last two decades (Groll et al., 1996;Vogeser et al., 1997;Latgé, 1999;Denning et al., 2002). Aspergillus fumigatus is the most common aetiological agent of invasive aspergillosis, being responsible for approximately 90 % of human infections (Derouin, 1994). The incidence of invasive aspergillosis varies between 1 and 19 % for patients who have undergone solid organ transplantation (Patel & Paya, 1997;Verweij & Denning, 1997), and patients with leukaemia, AIDS and granulomatous disease are also at risk (Brown et al., 1998;Denning, 1998;Kaizer et al., 1998). In contrast, the disease is rarely found in immunocompetent hosts (Karim et al., 1997). A. fumigatus is a common, widespread saprophytic fungus, and environmental surveys indicate that humans inhale several hundred A. fumigatus conidia per day (Hospenthal et al., 1998). Ingestion and killing of spores by alveolar macrophages represent the first line of defence against infection, mainly by non-oxidative mechanisms, whilst neutrophils employ an oxidative respiratory burst to kill germinating conidia that have escaped macrophage engulfment (Schaffner et al., 1986;Levitz et al., 1986; Morgenstern et al., 1997;Roilides et al., 1998; Latgé, 2001). Invasive aspergillosis has a high mortality and morbidity rate, with only 34 % of patients showing a favourable response to antifungal therapy (Denning, 1996). The fungicidal agent amphotericin B is widely used to treat invasive aspergillosis, although it can have serious side-effect...

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“…3 However, several reports have described invasive aspergillosis in patients who had no obvious immunocompromise including patients who had disseminated aspergillosis, pulmonary aspergillosis, or invasive aspergillosis of the paranasal sinuses. [4][5][6][7][8][9][10][11] The spectrum of fungal diseases of the paranasal sinuses ranges from allergic sinusitis to acute invasive disease. Case reports and series have not always provided sufficient details necessary to distinguish various forms of fungal sinusitis.…”

Section: Introductionmentioning

confidence: 99%

“…18 Since then, this condition was reported mainly from the Sudan but also from other tropical areas, including the Indian subcontinent. 10,[19][20][21][22][23] Therapy for chronic invasive Aspergillus sinusitis includes surgical evacuation and antifungal chemotherapy. Nevertheless, outcome is poor and the disease frequently relapses.…”

Section: Introductionmentioning

confidence: 99%

Chronic invasive aspergillosis of the paranasal sinuses in immunocompetent hosts from Saudi Arabia.

Alrajhi¹,

Enani²,

Mahasin³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. In immunocompetent patients, paranasal invasive aspergillosis is rare and has a high recurrence rate. Twenty-three cases of paranasal invasive aspergillosis, involving 14 male and nine female immunocompetent patients were reviewed. All patients were cancer-free, HIV-negative, with normal WBC, and none of the patients had received immunosuppressive therapy or corticosteroids. Mean duration of symptoms before diagnosis was 18 months. Aspergillus flavus was the species most frequently isolated. Surgical debridement was performed in all patients followed by antifungal therapy in 18 patients. Mean follow-up duration was 30 months. Fourteen patients relapsed after a mean of 13 months and required an average of 4.3 admissions for repeat surgical evacuation. In a logistic regression model, relapse was not associated with age, duration of symptoms, clinical findings, extent of disease, or mode of therapy. However, patients who were relapse-free tended to have had complete surgical evacuation followed by antifungal therapy.

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Chronic Invasive Aspergillosis in Apparently Immunocompetent Hosts

Cited by 56 publications

References 55 publications

Invasive Pulmonary Aspergillosis with Thrombosis in the Left Atrium.

Invasive Pulmonary Aspergillosis with Thrombosis in the Left Atrium.

Oxidative and amphotericin B-mediated cell death in the opportunistic pathogen Aspergillus fumigatus is associated with an apoptotic-like phenotype

Chronic invasive aspergillosis of the paranasal sinuses in immunocompetent hosts from Saudi Arabia.

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