Chronic pulmonary aspergillosis

Schweer, K. E.; Bangard, C.; Hekmat, K.; Cornely, O. A.

doi:10.1111/myc.12152

Cited by 95 publications

(90 citation statements)

References 120 publications

(380 reference statements)

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“…hronic pulmonary aspergillosis (CPA) is a slowly progressive pulmonary infectious disease secondary to local invasion by a species of Aspergillus, usually Aspergillus fumigatus (1,2). Although the optimal therapeutic regimen and duration of treatment have not been established, long-term oral itraconazole is currently recommended as the primary treatment for CPA (3)(4)(5).…”

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confidence: 99%

Effect of Rifampin and Rifabutin on Serum Itraconazole Levels in Patients with Chronic Pulmonary Aspergillosis and Coexisting Nontuberculous Mycobacterial Infection

Moon

Park

Jeong

et al. 2015

Antimicrob Agents Chemother

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bWe investigated the effects of rifampin and rifabutin on serum itraconazole levels in patients with chronic pulmonary aspergillosis. Serum itraconazole concentrations were significantly lower in patients who received itraconazole with rifampin (median, 0.1 g/ml; P < 0.001) or rifabutin (median, 0.34 g/ml; P < 0.001) than those receiving itraconazole alone (median, 5.92 g/ml). Concomitant use of rifampin or rifabutin and itraconazole should be avoided in patients with chronic pulmonary aspergillosis and coexisting mycobacterial infections. Chronic pulmonary aspergillosis (CPA) is a slowly progressive pulmonary infectious disease secondary to local invasion by a species of Aspergillus, usually Aspergillus fumigatus (1, 2). Although the optimal therapeutic regimen and duration of treatment have not been established, long-term oral itraconazole is currently recommended as the primary treatment for CPA (3-5). CPA usually occurs in middle-aged and elderly patients, for whom the most common underlying disease is pulmonary tuberculosis (6, 7). In addition, there is increasing evidence that nontuberculous mycobacterial (NTM) lung disease is an important underlying condition associated with CPA (7-12), with some patients having CPA and coexisting NTM lung disease (12,13).Mycobacterium avium complex (MAC) is the most common etiology of NTM lung disease (14-16). Rifampin is recommended as part of a multidrug antibiotic regimen for the treatment of MAC lung disease (14-16). Rifampin is a potent inducer of hepatic cytochrome P450 enzymes, which in turn can accelerate the hepatic metabolism of antifungal agents. In this way, rifampin presents a practical challenge for choosing the appropriate antibiotics for treating CPA with coexisting NTM lung disease (17,18). Indeed, previous case reports have demonstrated that concurrent administration of rifampin with itraconazole can greatly reduce serum itraconazole concentrations (19)(20)(21)(22).Rifabutin has less severe drug-drug interactions than does rifampin and is used as a substitute for rifampin in the treatment of tuberculosis and NTM lung disease, especially for patients who are receiving medications that have unacceptable interactions with rifampin, such as antiretroviral agents (14, 23). Nevertheless, there are no published studies that evaluated the interaction between rifabutin and itraconazole. Thus, the objective of the present study was to investigate the effects of rifampin and rifabutin on serum itraconazole levels in patients with CPA and coexisting mycobacterial lung disease.This study was a single-institution retrospective review of 66 patients with CPA who were treated with oral itraconazole (Sporanox, Janssen Pharmaceutica) (200 mg twice daily) and for whom serum itraconazole concentrations were measured between January 2013 and June 2014. Peripheral venous sampling was performed prior to morning itraconazole administration to determine trough concentrations after at least 7 days of treatment.The serum concentrations of itraconazole and hydroxyl-itraconazole we...

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confidence: 99%

Effect of Rifampin and Rifabutin on Serum Itraconazole Levels in Patients with Chronic Pulmonary Aspergillosis and Coexisting Nontuberculous Mycobacterial Infection

Moon

Park

Jeong

et al. 2015

Antimicrob Agents Chemother

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“…Chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA) occur in immunocompetent hosts (3)(4)(5)(6)(7)(8)(9). CPA usually affects patients with underlying lung disease, such as mycobacterial infections, chronic obstructive pulmonary disease (COPD), ABPA, and emphysema (7,9,10).…”

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confidence: 99%

Prospective Evaluation of a New Aspergillus IgG Enzyme Immunoassay Kit for Diagnosis of Chronic and Allergic Pulmonary Aspergillosis

et al. 2016

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j Anti-Aspergillus IgG antibodies are important biomarkers for the diagnosis of chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA). We compared the performance of a new commercial enzyme immunoassay (EIA) (Bordier Affinity Products) with that of the Bio-Rad and Virion‫گ‬Serion EIAs. This assay is novel in its association of two recombinant antigens with somatic and metabolic antigens of Aspergillus fumigatus. In a prospective multicenter study, 436 serum samples from 147 patients diagnosed with CPA (136 samples/104 patients) or ABPA (94 samples/43 patients) and from 205 controls (206 samples) were tested. We obtained sensitivities of 97%, 91.7%, and 86.1%, and specificities of 90.3%, 91.3%, and 81.5% for the Bordier, Bio-Rad, and Virion‫گ‬Serion tests, respectively. The Bordier kit was more sensitive than the Bio-Rad kit (P < 0.01), which was itself more sensitive than the Virion‫گ‬Serion kit (P ‫؍‬ 0.04). The Bordier and Bio-Rad kits had similar specificity (P ‫؍‬ 0.8), both higher than that of the Virion‫گ‬Serion kit (P ‫؍‬ 0.02). The area under the receiver operating characteristic (ROC) curves confirmed the superiority of the Bordier kit over the Bio-Rad and the Virion‫گ‬Serion kits (0.977, 0.951, and 0.897, respectively; P < 0.01 for each comparison). In a subset analysis of 279 serum samples tested with the Bordier and Bio-Rad kits and an in-house immunoprecipitin assay (IPD), the Bordier kit had the highest sensitivity (97.7%), but the IPD tended to be more specific (71.2 and 84.7%, respectively; P ‫؍‬ 0.10). The use of recombinant, somatic, and metabolic antigens in a single EIA improved the balance of sensitivity and specificity, resulting in an assay highly suitable for use in the diagnosis of chronic and allergic aspergillosis.

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“…The term CPA refers to a group of specific entities which usually present with chronic cough, dyspnea and weight loss, and occasional acute symptoms such as haemoptysis 16. These symptoms are very difficult to distinguish from those of pulmonary infections with Mycobacterium tuberculosis and Klebsiella pneumoniae .…”

Section: Discussionmentioning

confidence: 99%

Haemoptysis in a female with diabetes mellitus: a unique presentation of chronic pulmonary aspergillosis, pulmonary tuberculosis, and Klebsiella peumoniae co‐infection

Ekwueme

Otu

Chinenye

et al. 2016

Clinical Case Reports

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Key Clinical MessageWhile chronic pulmonary aspergillosis (CPA), pulmonary tuberculosis (PTB), and Klebsiella pneumoniae pneumonia co‐infection is rare, we present a 50‐year‐old woman with uncontrolled diabetes who presented with these three diseases. There is considerable overlap in symptoms of PTB and CPA. Treatment with antifungals, anti‐tuberculosis therapy, and antibiotics is beneficial.

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Chronic pulmonary aspergillosis

Cited by 95 publications

References 120 publications

Effect of Rifampin and Rifabutin on Serum Itraconazole Levels in Patients with Chronic Pulmonary Aspergillosis and Coexisting Nontuberculous Mycobacterial Infection

Effect of Rifampin and Rifabutin on Serum Itraconazole Levels in Patients with Chronic Pulmonary Aspergillosis and Coexisting Nontuberculous Mycobacterial Infection

Prospective Evaluation of a New Aspergillus IgG Enzyme Immunoassay Kit for Diagnosis of Chronic and Allergic Pulmonary Aspergillosis

Haemoptysis in a female with diabetes mellitus: a unique presentation of chronic pulmonary aspergillosis, pulmonary tuberculosis, and Klebsiella peumoniae co‐infection

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