Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

Abstract

Aspergillus spp. cultured in specimens from the airways of chronic obstructive pulmonary disease (COPD) patients are frequently considered as a contaminant. However, growing evidence suggests that severe COPD patients are at higher risk of developing invasive pulmonary aspergillosis (IPA), although IPA incidence in this population is poorly documented. Some data report that COPD is the underlying disease in 1% of patients with IPA.Definitive diagnosis of IPA in COPD patients is often difficult as tissue samples are rarely obtained before death. Diagnosis is therefore usually based on a combination of clinical features, radiological findings (mostly thoracic computed tomography scans), microbiological results and, sometimes, serological information.Of 56 patients with IPA reported in the literature, 43 (77%) were receiving corticosteroids on admission to hospital. Breathlessness was always a feature of disease and excess wheezing was present in 79% of patients. Fever (.38uC) was present in only 38.5%. Chest pain and haemoptysis were uncommon. Six out of 33 (18%) patients had tracheobronchitis observed during bronchoscopy. The median delay between symptoms and diagnosis was 8.5 days. The mortality rate was high: 53 out of 56 (95%) patients died despite invasive ventilation and antifungal treatment in 43 (77%) of them.In chronic obstructive pulmonary disease patients, invasive pulmonary aspergillosis currently carries a very poor prognosis. Outcome could perhaps be improved by more rapid diagnosis and prompt therapy with voriconazole.

Evaluation of Risk Factors for Invasive Pulmonary Aspergillosis and Detection of Diagnostic Values of Galactomannan and PCR Methods in Bronchoalveolar Lavage Samples From Non-Neutropenic Intensive Care Unit Patients

“…Ayrıca daha önce yapılan klinik çalışmalar dikkate alınarak, geniş spektrumlu antibiyotik tedavisine yanıt alınamayan, diğer etiyolojik nedenlerle açıkla-namayan pnömoni ve kötüleşen PA akciğer grafi si bulguları da klinik/radyolojik kriterler olarak kabul edildi 4,5,17 . Öncelikle serum GM pozitifl iği ve BAL örneklerindeki kültür pozitifl iği mikolojik kriterler olarak belirlendi.…”

“…Ancak immün baskılanması olmayan yoğun bakım (YB) hastalarında da invazif pulmoner aspergilloz (İPA) artan sıklıkta bildirilmekte olup insidansı %0.33-19 arasında değişkenlik göstermek-tedir 4 . Nötropenik olmayan YB hastalarında kronik obstrüktif akciğer hastalığının (KOAH) varlığı, steroid kullanımı, çoklu organ yetmezliği, yoğun bakım ve hastane yatış süresin-deki uzama İPA gelişimini kolaylaştırmaktadır [5][6][7] . Özgül olmayan klinik ve radyolojik bulgular ve kolonizasyon-enfeksiyon ayrımının güçlükle yapılabildiği pozitif kültür sonuçları erken tanı konulmasını zorlaştırmaktadır [8][9][10] .…”

Pulmonary solid tumor with coexisting pulmonary aspergillosis: case reports and literature review

“…In fact, normal air contains a concentration range of 1-100 spores/m 3 , which are easily inhaled, can reach the lower respiratory tract and penetrate deeply into the alveoli (11,12). Resultant disease depends on the host's immune state, ranging from commensalism or symbiosis to a pathogenic phase that causes common clinical syndromes or fatal infections (14).…”

Bacterial Lung Disease and COPD

“…in a cohort of severe COPD patients requiring hospitalisation for an acute exacerbation was 16.6% upon admission, and 14.1% at a one-year follow-up [54]. A significant number of cases of fatal invasive pulmonary aspergillosis have been reported in COPD patients [66] and patients with severe COPD who are receiving corticosteroid therapy are now regarded as an important risk group for pulmonary aspergillosis [67].…”