Invasive pulmonary aspergillosis in patients with COPD: a report of five cases and systematic review of the literature

Samarakoon, Priyan C; Soubani, AO

doi:10.1177/1479972307085637

Cited by 96 publications

(86 citation statements)

References 70 publications

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“…59 (91%) patients died; the main cause of death was progressive respiratory failure. 31 (48%) patients were reported to have received mechanical ventilation, and 13 (20%) patients had evidence of disseminated IPA [40]. Potential explanations of the high mortality of IPA in these patients, also reported in other studies [41][42][43], are the delayed diagnosis secondary to low index of suspicion of this infection in this patient population, older age, poor pulmonary reserve and multiple comorbid illnesses.…”

Section: Risk Factorsmentioning

confidence: 65%

“…In a review of 65 cases of IPA in patients with COPD who did not have the traditional risk factors for IPA [40], 75% were on corticosteroid therapy for a median 2.6 yrs prior to the diagnosis of IPA. The dose was increased in 34% of cases following hospitalisation (usually for the treatment of acute exacerbation of COPD) and prior to the diagnosis of IPA.…”

Section: Risk Factorsmentioning

confidence: 99%

“…The isolation of Aspergillus spp. from a lower respiratory tract specimen should not be routinely dismissed as colonisation [40,41].…”

Section: Risk Factorsmentioning

confidence: 99%

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Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

583

596

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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: Risk Factorsmentioning

confidence: 65%

Section: Risk Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

583

596

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“…Over recent years, IPA has been increasingly reported in nonneutropenic patients, including those with underlying diseases of the lung (e.g., steroid-treated chronic obstructive pulmonary disease [COPD], asthma, lung cancer, or autoimmune diseases with pulmonary involvement) (4-7). Early recognition and appropriate treatment of IPA in patients with COPD is crucial, as mortality rates greater than 90% have been reported (8), and early initiation of systemic antifungal therapy may lead to improved survival rates of up to 80% (9,10). Diagnosis of IPA in patients with underlying respiratory diseases is difficult, however, as clinical presentation is typically characterized by nonspecific symptoms such as dyspnea, cough, or hemoptysis, and early radiological signs are also unspecific.…”

mentioning

confidence: 99%

“…Diagnosis of IPA in patients with underlying respiratory diseases is difficult, however, as clinical presentation is typically characterized by nonspecific symptoms such as dyspnea, cough, or hemoptysis, and early radiological signs are also unspecific. Typical radiological signs for IPA (e.g., halo or air-crescent sign) are particularly rare in early stages of the disease in nonneutropenic patients (8,11). Mycological culture-the previous gold standard for IPA diagnosis-is limited by low sensitivity and long turnaround time (10).…”

mentioning

confidence: 99%

Novel Tests for Diagnosis of Invasive Aspergillosis in Patients with Underlying Respiratory Diseases

Prattes

Flick²,

Prüller

et al. 2014

Am J Respir Crit Care Med

117

114

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Rationale: Invasive pulmonary aspergillosis has been increasingly reported in nonneutropenic patients, including those with underlying respiratory diseases.Objectives: We compared the diagnostic performances of galactomannan, 1,3-b-D-glucan, and Aspergillus-specific lateralflow device tests with that of conventional culture by using bronchoalveolar lavage fluid samples from patients with underlying respiratory diseases.Methods: We analyzed 268 bronchoalveolar lavage samples from 221 patients with underlying respiratory diseases (and without hematologic malignancy or previous solid organ transplantation) that were collected for routine microbiological workup between February 2012 and May 2014 at the University Hospital of Graz, Austria. Invasive pulmonary aspergillosis was defined according to European Organization of Research and Treatment of Cancer/ Mycoses Study Group criteria modified for patients with respiratory diseases.Measurements and Main Results: Thirty-one patients (14%) had probable or proven, 25 possible, and the remaining 165 patients no invasive pulmonary aspergillosis. Probable/proven aspergillosis was associated with a significantly higher (P = 0.034) 30-day mortality rate of 32%. Sensitivities, specificities, and diagnostic odd ratios differed markedly between galactomannan (cut-off 0. Conclusions: Probable or proven invasive pulmonary aspergillosis was diagnosed in 14% of our study population and associated with significantly higher 30-day mortality rates. Although the performance of b-D-glucan was limited by low specificity and that of mycological culture by low sensitivity, the Aspergillus lateral-flow device seems to be a promising alternative to galactomannan testing, which remains the diagnostic gold standard for aspergillosis. Clinical trial registered with www.clinicaltrials.gov (NCT 02058316).

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