Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenic patients

Reichenberger, Frank; Habicht, James; Gratwohl, Aloïs; Tamm, Michael

doi:10.1183/09031936.02.00256102

Cited by 126 publications

(145 citation statements)

References 140 publications

(188 reference statements)

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“…The infectious agent of A fumigatus is its airborne conidium, which may develop 45° dichotomous branching of hyphae 2-5 µm in diameter that are able to invade tissue [1] . Invasive pulmonary aspergillosis (IPA) is a rapidly progressing, often fatal disease that commonly affects immunocompromised patients and is characterized by necrotic tissue containing abundant hyphae.…”

Section: Introductionmentioning

confidence: 99%

NAC is associated with additional alleviation of lung injury induced by invasive pulmonary aspergillosis in a neutropenic model

Jian

et al. 2009

Acta Pharmacol Sin

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Aim: Neutropenic individuals are at high risk for invasive pulmonary aspergillosis (IPA), a life-threatening infection. To evaluate the therapeutic potential of antioxidants, IPA was induced in neutropenic mice and the effect of N-acetyl-l-cysteine (NAC) on oxidative stress levels and lung injury was analyzed. Methods: Mice were pretreated with three daily intraperitoneal injections of 150 mg/kg cyclophosphamide, followed by intratracheal inoculation with 4.5×10 6 conidia of Aspergillus fumigatus. The infected mice were then randomly assigned to an amphotericin B (AMB) group, an AMB plus NAC group, or an untreated control (C) group. In each group, the duration of treatment was 24, 48, or 72 h, and activities such as appearance, feeding, and dermal temperature were observed throughout the experiment. Sera and lung tissues were collected and analyzed by quantitative enzyme-linked immunosorbent assay (ELISA) for total protein, superoxide dismutase (SOD), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), and interleukin-10 (IL-10) levels. The wet/dry weight ratio of the lung was also calculated and lung sections were stained with hematoxylin-eosin for pathological examination and with methenamine silver stain for fungus detection. Results: Compared with the mice untreated with NAC, mice in the AMB plus NAC group had increased SOD and reduced MDA levels both systemically and locally at 24, 48, and 72 h after inoculation with conidia. NAC treatment also decreased the pulmonary protein content at 48 and 72 h and the lung wet/dry weight ratio at 24 and 48 h. Additionally, NAC enhanced pulmonary production of TNF-α and IL-10 at 24 h and 48 h. Conclusion: In combination with antifungal therapy, NAC treatment can alleviate oxidative stress and lung injury associated with IPA in neutropenic mice.

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Section: Introductionmentioning

confidence: 99%

NAC is associated with additional alleviation of lung injury induced by invasive pulmonary aspergillosis in a neutropenic model

Jian

et al. 2009

Acta Pharmacol Sin

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“…She was discharged from hospital and advised to continue with psychiatric therapy. The reason for the occurrence of this rare disease in our patient must have been an incredibly low food intake that in turn caused extensive weight loss and immune system breakdown [11,12]. Even though a precise cause-and-effect relationship between anorexia nervosa, immunodeficiency and pulmonary aspergillosis has not yet been clarified, we presume that the long-term malnutrition of our patient led to the failure of the host defense mechanisms.…”

Section: Discussionmentioning

confidence: 94%

“…According to some authors, these disorders are not associated with increased risk of infection [13]. On the other hand, a number of cases with decline of innate and cell-mediated immunity have been described in patients with anorexia [11,12]. The normal function of the immune system, especially the innate ones, as well as the normal function of Th1 cells, is essential to defend from aspergillus infection.…”

Section: Discussionmentioning

confidence: 99%

Necrotizing pulmonary aspergillosis caused by anorexic syndrome — a case report

et al. 2011

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AbstractThe patient presented is a 44-year-old female treated for cavitary changes in the lung apexes. Due to suspected tuberculosis, treatment began with anti-tuberculosis (AT) drugs, despite negative sputum smears for acid-fast bacilli. During hospitalization, the patient was febrile (up to 38°C), hypotensive, extremely cachectic (32 kg), had a dry cough, increased nitrogen products, hypokalemia and anemia. Because of poor response to the applied AT therapy, bronchoscopic tests were repeated and spores of aspergillus fungus were discovered in the pathohistological findings of transbronchial lung biopsy. The appropriate treatment with amphotericin B and voriconazole was initiated. A psychiatric opinion was requested because we suspected that the patient suffered from the anorexic syndrome (anorexia nervosa). This diagnosis was confirmed by a psychiatrist; her psychiatric treatment began simultaneously with the treatment in our facility. Anorexia was the cause of the cachexia, immunodeficiency and invasive pulmonary aspergillosis. The disorder was not recognized before the manifestation of the somatic disorder. There is little data in the available literature on the association between these two diseases.

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“…The culture of Aspergillus from a site that is normally sterile in tandem with histological evidence of tissue invasion by fungal hyphae is regarded as the "gold standard" (9). However, acquisition of tissue specimens from critically ill patients without clinical suspicion is not always possible.…”

Section: Discussionmentioning

confidence: 99%

Airway centered invasive pulmonary aspergillosis in an immunocompetent patient: case report and literature review

Kim¹,

Lee²,

Kim³

et al. 2016

J. Thorac. Dis.

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Invasive pulmonary aspergillosis is a major problem that occurs in severely immunocompromised patients. Airway centered invasive pulmonary aspergillosis is rare in patients with normal immunity or those without critical illness. Computed tomography (CT) is a very useful diagnostic modality, yielding characteristic imaging findings for early diagnosis of this infection in immunocompromised and immunocompetent patients. We describe the case of an immunocompetent patient with airway centered invasive aspergillosis, who was successfully treated with voriconazole.

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Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenic patients

Cited by 126 publications

References 140 publications

NAC is associated with additional alleviation of lung injury induced by invasive pulmonary aspergillosis in a neutropenic model

NAC is associated with additional alleviation of lung injury induced by invasive pulmonary aspergillosis in a neutropenic model

Necrotizing pulmonary aspergillosis caused by anorexic syndrome — a case report

Airway centered invasive pulmonary aspergillosis in an immunocompetent patient: case report and literature review

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