Many faces of pulmonary aspergillosis

Sharma, O. K.; Chwogule, R

doi:10.1183/09031936.98.12030705

Cited by 56 publications

(45 citation statements)

References 82 publications

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“…The infectious agent is the conidium of 1-3 mm in diameter, which can be carried by air. After germination, aspergillus grows with 45u dichotomous branching of hyphae of 2-5 mm diameter, which are able to invade tissue [3].…”

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confidence: 99%

Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenic patients

et al. 2001

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Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenic patients. F. Reichenberger, J.M. Habicht, A. Gratwohl, M. Tamm. #ERS Journals Ltd 2002. ABSTRACT: Invasive pulmonary aspergillosis is a major cause of morbidity and mortality in neutropenic patients.Microbiological and serological tests are of limited value. The diagnosis should be considered in neutropenic patients with fever not responding to antibiotics, and typical findings on thoracic computed tomography scan. Whenever possible, diagnosis should be confirmed by tissue examination. Newer techniques, such as polymerase chain reaction may change the current diagnostic approach.Therapeutic strategies consist of prophylaxis in risk groups and the early application of antifungal agents in suspected or probable disease. Amphotericin B as desoxycholate or lipid formulation is the current standard medication in invasive infection, although it has major side effects. Its role is challenged by the new azole derivates, such as itraconazole and voriconazole, and the new echinocandins. Additional therapies with cytokines, such as granulocyte macrophage colony stimulating factor and interferon-c, and with granulocyte transfusions are under evaluation. In selected cases lung resection is of proven diagnostic and therapeutic value.This paper analyses the current understanding of the pathogenesis and epidemiology of invasive aspergillosis and reviews the actual diagnostic and therapeutic strategies for invasive pulmonary aspergillosis in neutropenic patients.

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confidence: 99%

Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenic patients

et al. 2001

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“…invades blood vessels, resulting in thrombosis and subsequent hemorrhagic pulmonary infarction. (1,14,15) When the anatomopathological findings are correlated with the tomographic findings, foci/areas of infarction can present as nodules or as consolidation in the shape of a wedge, with a pleural base. (2,16) Either finding can be accompanied by the halo sign,…”

Section: Discussionmentioning

confidence: 99%

“…(1,2) The frequency of IPA ranges between 5% and 15% in patients submitted to BMT, and it is approximately 70% after 34 days of neutropenia in individuals with any kind of hematologic malignancy. (2)(3)(4)(5) In addition to being commonly found in such patients, IPA presents mortality rates as high as 94% according to certain studies.…”

Section: Introductionmentioning

confidence: 99%

Surto de aspergilose pulmonar invasiva em enfermaria de transplante de medula óssea: achados tomográficos

et al. 2009

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Objective: To evaluate the main aspects on CT scans of six patients hospitalized in a bone marrow transplant ward, diagnosed with invasive pulmonary aspergillosis (IPA), during an in-hospital outbreak of the disease. Methods: We reviewed 10 chest CT scans of six neutropenic or immunocompromised patients hospitalized in the hematology and bone marrow transplant ward of the Hospital São Paulo, in the city of São Paulo, Brazil, who were diagnosed with IPA between April of 2007 and October of 2007. The diagnosis of IPA was confirmed by anatomopathological findings (in 2 cases), culture (in 3 cases) or appropriate treatment response (in 1 case). Results: We evaluated the CT scans of three male and three female patients, ranging from 22 to 58 years of age. The most common tomographic findings were nodules (5/6 cases) and areas of consolidation (2/6 cases). The nodules were more often multiple (3/5 cases), with irregular contours (4/5 cases) and accompanied by the halo sign (3/5 cases). One case presented multiple, centrally distributed areas of consolidation, and another presented an isolated, peripheral area of consolidation. Areas of ground-glass attenuation and septal thickening were found in three and two patients, respectively. Bilateral pleural effusion occurred in three cases. Conclusions: Consolidation, nodules, septal thickening, pleural effusion and ground-glass opacities were the principal tomographic findings in the six patients hospitalized in the abovementioned ward during the IPA outbreak. The nodules were often (in 67% of the cases) accompanied by the halo sign, a classically described finding in patients with IPA.Keywords: Aspergillosis; Lung diseases, fungal; Neutropenia; Bone marrow transplantation; Tomography, X-Ray computed. ResumoObjetivo: Avaliar os principais aspectos encontrados na TC de seis pacientes internados em uma enfermaria de transplante de medula óssea, diagnosticados com aspergilose pulmonar invasiva (API) durante um surto intra-hospitalar da doença. Métodos: Foram revisadas 10 TC de tórax de seis pacientes internados na enfermaria de hematologia e transplante de medula óssea do Hospital São Paulo em São Paulo (SP) entre abril de 2007 e outubro de 2007, neutropênicos ou imunossuprimidos, que evoluíram com API. O diagnóstico de API foi comprovado por exames anatomopatológicos (2 casos), cultura (3 casos) ou por resposta terapêutica adequada (1 caso). Resultados: Foram avaliadas imagens tomográficas de três homens e três mulheres com idades variando de 22 a 58 anos. Nódulos (5/6 casos) e áreas de consolidação (2/6 casos) foram os achados tomográficos mais comuns. Os nódulos eram mais frequentemente múltiplos (3/5 casos), de contornos irregulares (3/5 casos) e com sinal do halo (3/5 casos). Foram encontradas consolidações múltiplas e de distribuição central em um caso e consolidação isolada e periférica em outro. Áreas de atenuação em vidro fosco e espessamento septal foram achados, respectivamente, em três e dois pacientes. Derrame pleural bilateral ocorreu em três casos. Concl...

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“…Inflammatory markers (C-reactive protein and leukocytes count) were within normal range. The number of neutrophils was normal 3,2 G/L (normal [2][3][4][5][6]8). The detection of lymphocyte subpopulations was not available in our laboratory at that time.…”

Section: Case Reportmentioning

confidence: 99%

“…Extensive pulmonary cavities may occur inside the lungs, most often bilaterally. The indolent form of the disease is often fatal if not treated in its early phases, but subacute and chronic invasive aspergillosis may have a more optimistic prognoses [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Necrotizing pulmonary aspergillosis caused by anorexic syndrome — a case report

et al. 2011

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AbstractThe patient presented is a 44-year-old female treated for cavitary changes in the lung apexes. Due to suspected tuberculosis, treatment began with anti-tuberculosis (AT) drugs, despite negative sputum smears for acid-fast bacilli. During hospitalization, the patient was febrile (up to 38°C), hypotensive, extremely cachectic (32 kg), had a dry cough, increased nitrogen products, hypokalemia and anemia. Because of poor response to the applied AT therapy, bronchoscopic tests were repeated and spores of aspergillus fungus were discovered in the pathohistological findings of transbronchial lung biopsy. The appropriate treatment with amphotericin B and voriconazole was initiated. A psychiatric opinion was requested because we suspected that the patient suffered from the anorexic syndrome (anorexia nervosa). This diagnosis was confirmed by a psychiatrist; her psychiatric treatment began simultaneously with the treatment in our facility. Anorexia was the cause of the cachexia, immunodeficiency and invasive pulmonary aspergillosis. The disorder was not recognized before the manifestation of the somatic disorder. There is little data in the available literature on the association between these two diseases.

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Many faces of pulmonary aspergillosis

Cited by 56 publications

References 82 publications

Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenic patients

Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenic patients

Surto de aspergilose pulmonar invasiva em enfermaria de transplante de medula óssea: achados tomográficos

Necrotizing pulmonary aspergillosis caused by anorexic syndrome — a case report

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