Intrabronchial Voriconazole is a Safe and Effective Measure for Hemoptysis Control in Pulmonary Aspergilloma

Tiwari, Pawan; Madan, Karan; Hadda, Vijay; Poulose, Rosemary; Bhalla, Ashu Seith; Khandelwal, Rohit; Khilnani, Gopi C; Guleria, Randeep

doi:10.1097/lbr.0000000000000321

Cited by 12 publications

(14 citation statements)

References 19 publications

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“…9,12 Very few studies have evaluated the effect of multiple instillations of antifungal agents for hemoptysis control in patient with aspergilloma. 12,15 One patient in our study had recurrence of hemoptysis requiring BAE for hemoptysis control. The recurrence rates of hemoptysis after various procedures have been reported from 24 to 30 % at 12 months.…”

Section: Resultsmentioning

confidence: 87%

“…All patients had mild increase in cough immediately after the procedure which did not require any interventions or treatment. Transient post-procedure cough was reported by 46.3% of patients in case series reported by Mohan et al 15 All case reports and case series reported till date have found endobronchial antifungal instillation as a safe procedure. 9,15,17 This study has several limitations.…”

Section: Resultsmentioning

confidence: 98%

“…14 One of the largest case series of intracavitary Voriconazole instillation for hemoptysis control in patients with pulmonary aspergilloma has been reported recently by Mohan A et al in 2017. 15 In their retrospective case series of 82 patients with pulmonary aspergilloma, they used four sessions of intrabronchial Voriconazole (400 mg dissolved in 20 ml of 0.9% normal saline) at weekly intervals. The most common underlying etiology for pulmonary aspergilloma was post tubercular sequelae (95.1%) in their study.…”

Section: Resultsmentioning

confidence: 99%

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Bronchoscopic Voriconazole Instillation in Pulmonary Aspergilloma: A Single Center Experience

Shrestha

Dhungana

2019

Nep. Med. J.

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Introduction: Saprophytic growth of Aspergillus species in preexisting lung cavities commonly presents with hemoptysis. Surgical resection is the preferred treatment for hemoptysis control in pulmonary aspergilloma. In patients, who are not candidates for surgical resection bronchoscopic Voriconazole instillation, is an effective option.Materials and Methods: In this retrospective study, data of patients presenting with active hemoptysis, radiological evidence of aspergilloma and those undergoing bronchoscopic Voriconazole instillation at National Academy of Medical Sciences from January 2018 to December 2018 were retrieved. Clinical details including the severity of hemoptysis, number, size and location of aspergilloma, number of Voriconazole instillation sessions and symptom control were assessed. Follow up CT scan after four to six sessions were also evaluated to compare the size of aspergilloma.Results: A total of 11 patients presented with aspergilloma and hemoptysis. Of these, five (45.4%) patients underwent at least four sessions of bronchoscopic Voriconazole instillation. Two patients required six sessions whereas one required nine sessions for hemoptysis control. The procedure was successful in all patients; however, one had a recurrence after 3 months and required bronchial artery embolisation. In four patients there was a reduction in the size of aspergilloma on follow up CT scan. The procedure was well tolerated by all the patients, except for a mild increase in cough in the immediate post-procedure period.Conclusions: Intrabronchial Voriconazole instillation is a safe and effective option for hemoptysis control in patients with pulmonary aspergilloma. However, the optimal dose, frequency, and duration of Voriconazole instillation need to be further evaluated.

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Section: Resultsmentioning

confidence: 87%

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

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Bronchoscopic Voriconazole Instillation in Pulmonary Aspergilloma: A Single Center Experience

Shrestha

Dhungana

2019

Nep. Med. J.

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“…For treatment of refractory abscesses, cavities (eg in the lung) or severe haemoptysis from pulmonary aspergilloma in which surgical intervention is not feasible, a drainage (in particular for fungal empyema) as well as a local drug instillation may be considered 321,322 . Here, antifungal preparations (commonly containing AmB preparation or azoles, eg voriconazole) have been used (CIII) 323‐325 . No change to previous AGIHO recommendations.…”

Section: Resultsmentioning

confidence: 99%

Treatment of invasive fungal diseases in cancer patients—Revised 2019 Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Ruhnke

Cornely

Schmidt‐Hieber

et al. 2020

Mycoses

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Summary Background Invasive fungal diseases remain a major cause of morbidity and mortality in cancer patients undergoing intensive cytotoxic therapy. The choice of the most appropriate antifungal treatment (AFT) depends on the fungal species suspected or identified, the patient's risk factors (eg length and depth of granulocytopenia) and the expected side effects. Objectives Since the last edition of recommendations for ‘Treatment of invasive fungal infections in cancer patients’ of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) in 2013, treatment strategies were gradually moving away from solely empirical therapy of presumed or possible invasive fungal diseases (IFDs) towards pre‐emptive therapy of probable IFD. Methods The guideline was prepared by German clinical experts for infections in cancer patients in a stepwise consensus process. MEDLINE was systematically searched for English‐language publications from January 1975 up to September 2019 using the key terms such as ‘invasive fungal infection’ and/or ‘invasive fungal disease’ and at least one of the following: antifungal agents, cancer, haematological malignancy, antifungal therapy, neutropenia, granulocytopenia, mycoses, aspergillosis, candidosis and mucormycosis. Results AFT of IFDs in cancer patients may include not only antifungal agents but also non‐pharmacologic treatment. In addition, the armamentarium of antifungals for treatment of IFDs has been broadened (eg licensing of isavuconazole). Additional antifungals are currently under investigation or in clinical trials. Conclusions Here, updated recommendations for the treatment of proven or probable IFDs are given. All recommendations including the levels of evidence are summarised in tables to give the reader rapid access to key information.

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“…Anti-fungal medication (voriconazole, itraconazole) also was a safe and effective modality and should be considered if surgery contraindicated [27][28][29]. In the case of both medical and surgical treatment were ineffective or contraindicated in massive hemoptysis due to aspergilloma, intervention treatment was an alternative therapy with the success rate was 40.0% [30].…”

Section: Discussionmentioning

confidence: 99%

Hemoptysis from Complex Pulmonary Aspergilloma Treated by Cavernostomy and Thoracoplasty

Giang¹,

Dũng²,

Hien³

et al. 2019

Preprint

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Background In high-risk patients with complex pulmonary aspergilloma but unable for lung resection, cavernostomy and thoracoplasty could be performed. This study aimed to evaluate this surgery compared two material used (table tennis ball and tissue expander) as a filler. Methods: The prospective study evaluated 63 in high-risk patients who had hemoptysis due to complex pulmonary aspergilloma that submitted to cavernostomy and thoracoplasty surgery from November 2011 to September 2018. Patients were allocated to the table tennis ball group (46 patients) and tissue expander group (17 patients). We evaluated at the time of before operation, six months and 24 months after operation. Results The most common comorbidity diseases were tuberculosis in two groups. Upper lobe occupied almost location. Hemoptysis symptoms plunged from time to time. Statistically significant Karnofsky score was observed in both groups. BMI showed slightly increasing but not statistically significant. Postoperative pulmonary functions (FVC and FEV1) have remained in both groups at all time points. The remarkable results were no death in the postoperative period, and long-term complication of surgery was low. There was no statistical significance between two groups in operative time, blood loss during operation, ICU length-stay time. Four patients died because of co-morbidity in 24 months follow-up. Conclusion: Cavernostomy and thoracoplasty was safe and effective surgery for the treatment of high-risk patients with complex pulmonary aspergilloma. There was no mortality related to surgery. The postoperative complications and long-term complication were low. The was no inferiority when compared table tennis ball group and tissue expander group. Keyword: Complex Pulmonary Aspergilloma (CPA), Hemoptysis, Cavernostomy, Thoracoplasty, Table Tennis Balls, Tissue expander,

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Intrabronchial Voriconazole is a Safe and Effective Measure for Hemoptysis Control in Pulmonary Aspergilloma

Abstract: Intrabronchial voriconazole instillation seems to be a safe and effective modality for hemoptysis control in pulmonary aspergilloma.

Cited by 12 publications

References 19 publications

Bronchoscopic Voriconazole Instillation in Pulmonary Aspergilloma: A Single Center Experience

Bronchoscopic Voriconazole Instillation in Pulmonary Aspergilloma: A Single Center Experience

Treatment of invasive fungal diseases in cancer patients—Revised 2019 Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Hemoptysis from Complex Pulmonary Aspergilloma Treated by Cavernostomy and Thoracoplasty

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