Isolated invasive Aspergillus tracheobronchitis: a clinical study of 19 cases

Abstract

Isolated invasive Aspergillus tracheobronchitis (iIATB) is an uncommon clinical form of invasive Aspergillosis in which Aspergillus infection is limited entirely or predominantly to the tracheobronchial tree. In the present study, we retrospectively analyzed the medical records of 19 patients who had histological documented iIATB in the Department of Respiratory Medicine of Changhai Hospital between October 2000 and February 2008. Malignancy was the most common underlying disease, which existed in 14 patients (73.7%) in our series. Most patients had impaired airway structures or defence functions, whereas the systemic immune status was relatively normal. Only three patients (15.8%) had neutropenia. The clinical manifestations and chest radiograph were nonspecific. We classified iIATB into four different forms according to the bronchoscopic features of intraluminal lesions: superficial infiltration type (Type I, n = 4), full-layer involvement type (Type II, n = 2), occlusion type (Type III, n = 6) and mixed type (Type IV, n = 7). Type IV was the largest group in our study, followed by Type III. All patients with iIATB of Type IV had definite airway occlusion. Fourteen patients (73.7%) had a good response to antifungal treatments and five (26.3%) died as a result of the progression of Aspergillosis, all of whom had full-layer invasion of the involved bronchi. In conclusion, we found that iIATB could occur in moderately or non-immunocompromised patients with impaired airway structures or defence functions and may be an early period of invasive pulmonary Aspergillosis. Most of the iIATB patients had a favourable prognosis with early diagnosis and effective antifungal treatment. The morphological features of intraluminal lesions might be of prognostic value.

Invasive tracheobronchial aspergillosis progressing from bronchial to diffuse lung parenchymal lesions

“…proposed a novel classification of isolated ITBA (iITBA) based on bronchoscopic findings [2]. Namely, iITBA is classified into four categories: type I, superficial infiltration; type II, full‐layer involvement; type III, occlusive (air way occlusion ≥50%); and type IV, mixed.…”

“…However, invasive tracheobronchial aspergillosis (ITBA), in which the infection is entirely limited or predominantly confined to tracheobronchial lesions, is a relatively rare form of IPA [1]. In some cases, isolated ITBA progressed to IPA with diffused lung parenchyma lesions [2]. We present a case of Aspergillus infection that progressed from minute bronchial lesions to diffuse lung parenchymal lesions over a short time.…”

Invasive Tracheobronchial Aspergillosis in a Patient with Systemic Lupus Erythematosus-dermatomyositis Overlap Syndrome

“…To the best of our knowledge, only seven cases, including the present case, have been reported without any evidence of a severe immunosuppressive status (Table), such as solid organ and/or hematological malignancy, post-transplant, AIDS, insulin-dependent diabetes mellitus and steroids and/or immunosuppressive therapy (5,14,(16)(17)(18)(19)(20)(21). Four of the seven reported patients with ITBA were immunocompetent (5, 16, 19), and the others had either SLE/DM, tracheal and bronchial structural abnormalities such as tuberculosis (20) or COPD (21).…”

Aspergilosis traqueobronquial necrotizante en paciente crítico

“…Estas distintas variantes son probablemente distintos estadios en el desarrollo de la enfermedad 13 .…”

“…La mayor parte de los casos de aspergilosis traqueobronquial invasora reportados en la literatura se han observado en pacientes severamente inmunocomprometidos 13 , tanto trasplantados de órgano sólido 1,14,15 como de médula ósea 2,3 , además de pacientes con VIH 5,16 , neutropenia o tumores hematológicos 17,18 . Sin embargo, también se han descrito en pacientes menos inmunocomprometidos como pacientes con lupus eritematoso sistémico sin tratamiento inmunomodulador, diabéticos, enfermedad pulmonar obstructiva crónica, cirrosis hepática avanzada, usuarios tratamiento corticoidal o inclusive en ausencia de una inmunodeficiencia predisponente aparente [19][20][21][22][23][24] .…”