Chronic Pulmonary Aspergillosis: An Update on Diagnosis and Treatment

Abstract

Chronic pulmonary aspergillosis (CPA) affects individuals with non-systemic or mildly systemic immunodepression or altered pulmonary integrity due to underlying disease. It has been reported with a variety of clinical and radiological patterns. The condition should be distinguished from simple aspergilloma and allergic bronchopulmonary aspergillosis as well as invasive aspergillosis in severely immunocompromised patients. CPA generally requires long-term antifungal treatment and surgery may be considered. Life-threatening haemoptysis may be prevented by bronchial arteriography with embolisation. However, currently there are no documented treatment recommendations for CPA. This review provides an up-to-date practical overview of this condition, including a comprehensive update on diagnosis and management.

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

“…The distinctive hallmarks of CPA are new and/or expanding cavities of variable wall thickness in the setting of chronic lung disease with or without intracavitary fungal ball formation, often with pleural thickening and marked parenchymal destruction and/ or fibrosis. Aspergillus empyema may be seen [11]. Associated enlargement of bronchial or non-bronchial systemic arteries and, less frequently, pseudo-aneurysms may lead to sometimes fatal haemoptysis.…”

“…Radiological evolution, over time, is typically slower than that observed in SAIA and may take several years (figure 3) [10]. Over time, if untreated, these cavities enlarge and coalesce, and the fungal balls may appear or disappear [11]. The differential diagnosis includes active TB [26], NTM, histoplasmosis, actinomycosis, coccidioidomycosis and lung carcinoma, the last sometimes associated concurrently with chronic (or invasive) Aspergillus infection [73,74].…”

“…Advances in thoracic surgery, during this era, produced cures from aspergilloma in some patients with single lesions and recognition that outcomes were often poor in those with multicavity disease, termed complex aspergilloma [8,9]. Very few patients are described in the literature as being treated with amphotericin B [10], and early open trials of itraconazole, without standardised response criteria, showed partial clinical benefits without radiological change [11]. Subsequently criteria for the diagnosis and categorisation of patients were proposed in 2003 [10], and later refinements to the criteria and classification of the disease were proposed [12,13].…”

Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic Pulmonary Aspergillosis: A Case Presentation

“…In almost all cases, it develops as a result of an underlying pulmonary pathology, which may be responsible for the presence of a residual bronchopulmonary or, less frequently, pleural cavity [5].…”

“…infections has been proposed as the following three entities: (1) simple aspergilloma, (2) chronic cavitary pulmonary aspergillosis (CCPA), as symptomatic complex aspergilloma or slowly progressive chronic necrotising pulmonary aspergillosis (CNPA) (>3 months in duration), occurring in patients with a previous history of bronchopulmonary disease, with pre-existing cavitary and with/without intracavitary fungal balls and (3) sub-acute IPA (rapidly progressive CNPA of <3 months in duration) [5].…”