Invasive Aspergillosis

Prystowsky, Stephen D.; Vogelstein, Bert; Ettinger, David S.; Merz, William G.; Kaizer, Herbert; Sulica, Virginia I.; Zinkham, William H.

doi:10.1056/nejm197609162951206

Cited by 96 publications

(35 citation statements)

References 27 publications

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“…Less commonly, IPA may start in locations other than the lungs, such as sinuses, the gastrointestinal tract or the skin (via intravenous catheters, prolonged skin contact with adhesive tapes or burns) [53][54][55][56].…”

Section: Clinical Presentationmentioning

confidence: 99%

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

562

576

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Aspergillus is a mould which may lead to a variety of infectious, allergic diseases depending on the host's immune status or pulmonary structure. Invasive pulmonary aspergillosis occurs primarily in patients with severe immunodeficiency. The significance of this infection has dramatically increased with growing numbers of patients with impaired immune state associated with the management of malignancy, organ transplantation, autoimmune and inflammatory conditions; critically ill patients and those with chronic obstructive pulmonary disease appear to be at an increased risk. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has resulted in lower mortality rates associated with this infection. Chronic necrotising aspergillosis is a locally invasive disease described in patients with chronic lung disease or mild immunodeficiency. Aspergilloma is usually found in patients with previously formed cavities in the lung, whereas allergic bronchopulmonary aspergillosis, a hypersensitivity reaction to Aspergillus antigens, is generally seen in patients with atopy, asthma or cystic fibrosis. This review provides an update on the evolving epidemiology and risk factors of the major manifestations of Aspergillus lung disease and the clinical manifestations that should prompt the clinician to consider these conditions. Current approaches for the diagnosis and management of these syndromes are discussed.

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Section: Clinical Presentationmentioning

confidence: 99%

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

562

576

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“…[8][9][10][11][12] Aspergillus sp are common respiratory pathogens with a 10% incidence of dissemination to the brain, 13 most of which occur during the first 3 months after transplantation, 5,14 An acute brain infarction or bleeding may be the earliest clue to the presence of a brain abscess caused by Aspergillus sp because of the organism's propensity to invade both large and small cerebral vessels, producing thrombosis and consequently hemorrhagic or ischemic infarcts. 1,8,15,16 Associated fungal meningitis is rare and, therefore, cerebrospinal fluid smears and cultures for organisms are usually negative.…”

Section: Fungal Brain Abscessesmentioning

confidence: 99%

Brain Abscess in Solid Organ Transplant Recipients Receiving Cyclosporine-Based Immunosuppression

Selby

Ramirez²,

Singh³

et al. 1997

Arch Surg

125

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Objective-To determine the incidence, clinical presentation, and outcome and confounding factors associated with the development of a brain abscess in solid organ transplant recipients.Design-A 14-year retrospective survey.Setting-A single, multiorgan, academic transplantation center.Patients-A total of 2380 liver transplant recipients, 1650 kidney transplant recipients, and 598 heart, heart-lung, or lung transplant recipients of all ages (pediatric and adult) were included. All patients were given cyclosporine-based immunosuppression during this period.Main Outcome Measure-A brain abscess was determined to be present if there was histological and/or microbiological confirmation of a brain lesion seen by a computed tomographic scan. A brain abscess was considered suspicious if radiographic findings were seen in the clinical setting of neurologic symptoms and fever without histological or microbiological confirmation.Results-A brain abscess developed in a total of 28 patients (0.61%) of the total study population. The frequency of brain abscess according to organ type was as follows: 0.63%, liver; 0.36%, kidney; and 1.17%, heart and heart-lung. The overall mortality was 86%. Complicating factors associated with fungal (Candida and Aspergillus sp) abscess formation included major subsequent operations, retransplantations, antirejection therapy, associated bacteremia or viremia, and multiorgan failure. The lung was the primary site of dissemination in 18 patients. Low-dose prophylactic amphotericin was ineffective in preventing a fungal brain abscess in 10 high-risk patients. Because of the ineffective therapy and the deadly nature of established fungal abscesses, full-dose antifungal therapy and reduced immunosuppression were warranted on identification of a high-risk clinical setting. Nonfungal abscesses (Nocardia and Toxoplasma sp) occurred in healthy graft recipients long after transplantation. The existing medical therapy is usually effective in these patients, provided that rapid tissue diagnosis is established. Conclusion-The epidemiological features of brain abscess formation after solid organ transplantation suggest 2 populations of patients exist that differ in timing, clinical setting, and response to therapy. For the chronically immunosuppressed outpatient, an established abscess should be empirically treated with sulfonamides until tissue diagnosis is confirmed. On the other hand, the acutely immunosuppressed posttransplant recipient, with defined risk factors, should receive full-dose therapy with amphotericin B and concomitantly lowered immunosuppression.

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“…The spores penetrate via the pulmonary tract (Prytowski et al 1976;Krick & Remington, 1976) from different reservoirs amongst which ventilation and air-conditioning systems seem to play an important role (Krick & Remington, 1976;Sayer, Shean & Ghosseliri, 1969;Burton et al 1972;Mahoney et al 1979). However, this means of entry is not the only one, and more rarely contaminations can arise from the digestive tract, the skin and the nasopharynx (Prytowski et al 1976;Krik & Remington, 1976).…”

Section: Introductionmentioning

confidence: 99%

Invasive nosocomial pulmonary aspergillosis: risk factors and hospital building works

Perraud

Piens²,

Nicoloyannis

et al. 1987

Epidemiol. Infect.

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SUMMARYA retrospective epidemiological study of 22 observations of invasive pulmonary aspergillosis, of which 18 were fatal, occurring over a period of 30 months, implicated certain building sites within the hospital. The building works were responsible for the diffusion into the atmosphere of fungal spores from normally closed reservoirs, notably false ceilings, fibrous thermal and/or acoustic insulation materials and roller-blind casings. The results of our study permit us to suggest that protective measures should be set up or that immunodepressed patients are evacuated when such works are to be carried out in an in-patient establishment.

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Invasive Aspergillosis

Cited by 96 publications

References 27 publications

Pulmonary aspergillosis: a clinical review

Pulmonary aspergillosis: a clinical review

Brain Abscess in Solid Organ Transplant Recipients Receiving Cyclosporine-Based Immunosuppression

Invasive nosocomial pulmonary aspergillosis: risk factors and hospital building works

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