Complications of chronic necrotizing pulmonary aspergillosis: review of published case reports

Abstract

Chronic necrotizing pulmonary aspergillosis (CNPA), a form of chronic pulmonary aspergillosis (CPA), affects immunocompetent or mildly immunocompromised persons with underlying pulmonary disease. These conditions are associated with high morbidity and mortality and often require long-term antifungal treatment. The long-term prognosis for patients with CNPA and the potential complications of CNPA have not been well documented. The aim of this study was to review published papers that report cases of CNPA complications and to highlight risk factors for development of CNPA. The complications in conjunction associated with CNPA are as follows: pseudomembranous necrotizing tracheobronchial aspergillosis, ankylosing spondylarthritis, pulmonary silicosis, acute respiratory distress syndrome, pulmonary Mycobacterium avium complex (MAC) disease, superinfection with Mycobacterium tuberculosis, and and pneumothorax. The diagnosis of CNPA is still a challenge. Culture and histologic examinations of bronchoscopically identified tracheobronchial mucus plugs and necrotic material should be performed in all immunocompromised individuals, even when the radiographic findings are unchanged. Early detection of intraluminal growth of Aspergillus and prompt antifungal therapy may facilitate the management of these patients and prevent development of complications.

Allergic Bronchopulmonary Aspergillosis in a Patient With Poorly Controlled Bronchial Asthma

“…CNPA represents a subacute process typically discerned in patients displaying degrees of immunosuppression, commonly linked to underlying lung disorders, alcoholism, or extended corticosteroid usage. Given its relative rarity, CNPA frequently evades timely recognition, progressing over weeks or months, and inducing a gradual cavitary pulmonary infiltrate [ 7 ].…”

Silicosis: Diagnosis and Medicolegal Implications

“…It is thought that this largely arises as a result of alveolar macrophage functional impairment by inhaled silica particles. Less commonly, chronic necrotizing pulmonary aspergillosis may develop . Thus, lung tissue or abscess aspirate cultures and/or special stains such as acid‐fast (AFB) or silver (GMS) may be of utility in decedents with a history of respiratory dysfunction and silica exposure.…”

Pathological Diagnosis of Pulmonary Aspergillosis

“…13 19 TBA is a rare condition that is mostly encountered in lung transplant patients, and some clinicians subdivide this disease into three different entities; (1) an obstructive, (2) a pseudomembranous, and (3) an ulcerative form. 19 20 Although histopathological examination of biopsy specimens remain the gold standard for diagnosing IPA, the poor clinical condition of this group of patients often limits the access to such samples due to the risk of complications from the invasive procedures. 21 22 This is one of the reasons why the EORTC/MSG (European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group) guidelines divide the diagnosis of IPA into three categories; proven, probable, and possible, based on the level of diagnostic evidence of infection, with histopathology being a key element for establishing a proven diagnosis.…”

“…13,19 TBA is a rare condition that is mostly encountered in lung transplant patients, and some clinicians subdivide this disease into three different entities; (1) an obstructive, (2) a pseudomembranous, and (3) an ulcerative form. 19,20 Although histopathological examination of biopsy specimens remain the gold standard for diagnosing IPA, the poor clinical condition of this group of patients often limits the access to such samples due to the risk of complications from the invasive procedures.…”