Fungal Tracheobronchitis Report of 9 Cases and Review of the Literature

Clarke, Ann E.; Skelton, Jane; Fraser, Richard S.

doi:10.1097/00005792-199101000-00001

Cited by 80 publications

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“…3 The first clinical symptoms were cough, dyspnea and wheezing and the CT scan at that time failed to demonstrate any obvious abnormalities in the lung. Her neutrophil counts remained normal, but dyspnea rapidly progressed and was followed by respiratory failure.…”

Section: Discussionmentioning

confidence: 98%

“…Underlying airway disease, prolonged use of endotracheal tubes and decreased mucociliary production are reported to be the risk factors in non-BMT patients, 3 but this has not been confirmed in BMT recipients. We suspect that prolonged administration of corticosteroids and steroid-pulse therapy might have been associated with the development of Aspergillus tracheobronchitis in this patient.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, there have been only four case reports published concerning this type of Aspergillus infection after bone marrow transplan- tation. [2][3][4][5] Here we report a patient with Aspergillus tracheobronchitis who deteriorated rapidly despite intensive antifungal therapy. This report exemplifies the difficulties in early diagnosis and instigation of appropriate treatment for patients with Aspergillus tracheobronchitis after stem cell transplantation.…”

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Aspergillus tracheobronchitis after allogeneic bone marrow transplantation

Machida

Kami

Kanda

et al. 1999

Bone Marrow Transplant

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Summary:We describe a patient who developed Aspergillus tracheobronchitis after BMT. She complained of progressive dyspnea on day +165 and her respiratory function deteriorated rapidly. Although neither early chest Xrays nor CT scans were negative, bronchoscopy revealed formation of a pseudomembrane around the bronchial walls. Based upon pathological and microbiological examinations, she was diagnosed as having invasive Aspergillus tracheobronchitis. Retrospectively analyzed, the Aspergillus circulating antigen detection tests became positive before clinical symptoms developed, and may be beneficial for early diagnosis of Aspergillus tracheobronchitis. This form of aspergillosis should be regarded as one of the serious complications after BMT. Keywords: bone marrow transplantation; aspergillus; tracheobronchitis; steroid; pseudomembrane Aspergillus infection is a potentially fatal complication in bone marrow transplant recipients. Despite the improvement in prophylaxis and treatment, it is still associated with a high morbidity and mortality. 1 Invasive pulmonary aspergillosis (IPA), the most common form of Aspergillus infection in bone marrow transplant recipients, usually affects the lung parenchyma and occasionally disseminates to a variety of organs. A small number of patients, however, develop invasive tracheobronchitis as a local manifestation. Clinical characteristics of this disease are quite different from those of IPA. To improve the prognosis of Aspergillus infection, early diagnosis and prompt initiation of intensive antifungal treatment are requisites, but both the optimal diagnostic methods and treatments remain to be established. Because of its low incidence, we have little information on this type of Aspergillus infection. To our knowledge, there have been only four case reports published concerning this type of Aspergillus infection after bone marrow transplan- tation. 2-5 Here we report a patient with Aspergillus tracheobronchitis who deteriorated rapidly despite intensive antifungal therapy. This report exemplifies the difficulties in early diagnosis and instigation of appropriate treatment for patients with Aspergillus tracheobronchitis after stem cell transplantation.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 90%

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Aspergillus tracheobronchitis after allogeneic bone marrow transplantation

Machida

Kami

Kanda

et al. 1999

Bone Marrow Transplant

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“…Besides the angioinvasive form of pulmonary aspergillosis, 2 invasive airway disease has been described in several forms: Aspergillus tracheobronchitis, 3 pseudomembranous tracheobronchitis 3,4 and ulcerative tracheobronchitis. 5 Small airway Aspergillus infections have also been described.…”

Section: Discussionmentioning

confidence: 99%

Invasive airway aspergillosis with new airflow obstruction mimicking post-BMT bronchiolitis obliterans

Nusair¹,

Amir²,

Or³

et al. 2002

Bone Marrow Transplant

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Summary:A 52-year-old male with severe gastrointestinal graft-versus-host disease (GVHD), developed dyspnea and irreversible airflow obstruction, 11 weeks post-allogeneic bone marrow stem cell transplantation. Based on the clinical picture and presence of 'mosaic attenuation' pattern on chest high-resolution computerized tomography (HRCT), he was presumed to have bone marrow transplantation-related bronchiolitis obliterans. Postmortem examination revealed invasive airway aspergillosis with no evidence of bronchiolitis obliterans.Bone Marrow Transplantation (2002) 29, 711-713. DOI: 10.1038/sj/bmt/1703553 Keywords: airway obstruction; aspergillus; bronchiolitis obliterans; bone marrow transplantation; graft-versushost disease Allogeneic bone marrow transplantation (BMT) has been consistently associated with a high incidence of pulmonary complications, such as opportunistic infections, toxic effects of chemoradiotherapy, and inflammatory lesions associated with graft-versus-host disease (GVHD). About 15% of patients after allogeneic BMT develop post-BMT bronchiolitis obliterans. 1 We present a patient in whom invasive airway aspergillosis was manifested by severe irreversible obstructive airway disease, mimicking post-BMT bronchiolitis obliterans. Case reportA 52-year-old male with chronic myelogenous leukemia underwent allogeneic peripheral blood stem cell transplantation from his major histocompatibility complex (MHC) identical sister, during second chronic phase after a lymphoblastic crisis. Routine pulmonary evaluation prior to transplantation included normal high resolution com- puterized tomography (HRCT) of the chest, with normal spirometry and lung volumes and a mildly decreased carbon monoxide transfer factor (TL CO ) (70%).Conditioning prior to allogeneic BMT consisted of oral busulfan 4 mg/kg p.o. in divided doses daily for 3 days (total dose 12 mg/kg), with intrathecal methotrexate (12.5 mg) and Ara-C (50 mg), followed by infusion of allogeneic peripheral blood stem cells (14 ϫ 10 8 cells/kg) on day 0.At week +8 after transplantation, the patient's condition deteriorated with development of paroxysmal abdominal pain and diarrhea, marked hypoalbuminemia and elevated liver enzymes. Endoscopic biopsies obtained from the stomach and the duodenum revealed epithelial atrophy with necrosis and mucosal ulceration of the intestinal mucosa, accompanied by few apoptotic epithelial cells. Based on clinical and histologic findings, a diagnosis of chronic GVHD was made and the patient received a course of methylprednisolone, followed by prednisone at a dose of 50 mg daily. As there was unsatisfactory improvement in his symptoms, cyclosporin A was added to his immunosuppressive regimen, followed by thalidomide (200 mg/kg). The patient developed fever, and sputum culture yielded Klebsiella pneumonia, which was treated by ticracillinsulbactam. At this stage, prophylactic treatment against cytomegalovirus with ganciclovir three times weekly and intravenous immunoglobulin were added, as well as amphotericin B at a low dai...

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“…In some patients, Aspergillus infection is limited to the tracheal or bronchial mucosa: distinct clinical entities are saprophytic tracheobronchial aspergillosis (including mucoid bronchial impaction and obstructing bronchial aspergillosis); allergic aspergillosis (including allergic bronchopulmonary aspergillosis and bronchocentric granulomatosis); and invasive tracheobronchial aspergillosis (including Aspergillus (tracheo)bronchitis, ulcerative Aspergillus bronchitis and pseudomembranous Aspergillus tracheobronchitis) [4,5]. Bronchial stump aspergillosis (BSA), i.e.…”

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confidence: 99%

Three cases of bronchial stump aspergillosis: unusual clinical presentations and beneficial effect of oral itraconazole

Noppen¹,

Claes²,

Maillet³

et al. 1995

Eur Respir J

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We present three more patients, in whom BSA occurred very late (4.5, 6 and 7 yrs) after pulmonary resection. Other unusual features were: complete absence of symptoms in one patient, and simultaneous occurrence of aspergilloma in another. Removal of the endobronchial suture probably constitutes the key therapy for BSA. In all three of our patients oral itraconazole resulted in clinical, histological and microbiological improvement.In conclusion, BSA should be considered in the differential diagnosis of haemoptysis occurring up to 7 yrs after lung surgery, although an asymptomatic presentation is possible. Furthermore, BSA can be associated with other clinical presentations of Aspergillus infection, e.g. aspergilloma. Finally, long-term oral itraconazole therapy may represent a valid alternative when removal of the suture is not feasible.

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Fungal Tracheobronchitis Report of 9 Cases and Review of the Literature

Cited by 80 publications

References 0 publications

Aspergillus tracheobronchitis after allogeneic bone marrow transplantation

Aspergillus tracheobronchitis after allogeneic bone marrow transplantation

Invasive airway aspergillosis with new airflow obstruction mimicking post-BMT bronchiolitis obliterans

Three cases of bronchial stump aspergillosis: unusual clinical presentations and beneficial effect of oral itraconazole

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