Pathogenesis and clinical features of chronic pulmonary aspergillosis – Is it possible to distinguish CNPA and CCPA clinically?

Izumikawa, Koichi; Tashiro, Takayoshi; Tashiro, Masato; Takazono, Takahiro; Kosai, Kosuke; Morinaga, Yoshitomo; Kurihara, Shintaro; Nakamura, Shigeki; Imamura, Yoshifumi; Miyazaki, Taiga; Tsukamoto, Misuzu; Kakeya, Hiroshi; Hayashi, Tomayoshi; Yanagihara, Katsunori; Nagayasu, Takeshi; Kohno, Shigeru

doi:10.1016/j.jiac.2013.10.016

Cited by 30 publications

(23 citation statements)

References 9 publications

(10 reference statements)

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“…Being unable to distinguish CCPA from CNPA based on clinical and radiological settings, these authors have proposed the term "chronic progressive pulmonary aspergillosis" for a broad clinical syndrome including both CCPA and CNPA. Our study in a large series of CPA patients was consistent with the findings of IZUMIKAWA et al [10]. Furthermore, the two classical subtypes of CCPA and CNPA did not emerge as two separate clusters.…”

Section: −2supporting

confidence: 93%

“…All three definitions include the notion of baseline imaging before more invasive investigations are considered, and histological data are rarely available. Recently, IZUMIKAWA et al [10] retrospectively studied 27 cases of CPA, and divided them into four groups according to the presence of histological lung invasion, in order to determine whether clinical or radiological parameters could discern between CCPA and CNPA. Being unable to distinguish CCPA from CNPA based on clinical and radiological settings, these authors have proposed the term "chronic progressive pulmonary aspergillosis" for a broad clinical syndrome including both CCPA and CNPA.…”

Section: −2mentioning

confidence: 99%

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Phenotyping chronic pulmonary aspergillosis by cluster analysis

et al. 2015

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Section: −2supporting

confidence: 93%

Section: −2mentioning

confidence: 99%

Phenotyping chronic pulmonary aspergillosis by cluster analysis

et al. 2015

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“…patients were divided into one of two groups, the Aspergillus disease or Aspergillus colonization group, based on clinical, radiological, mycological, and serological criteria (Table 1). These criteria are a combination of those used in each of the participating centers (12)(13)(14) and those described in the literature (1,2,15 (ii) Aspergillus Western blot IgG kit. Each serum was tested using the Asp-WB IgG kit (LDBio Diagnostics, Lyon, France) according to the manufacturer's instructions.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the Aspergillus Western Blot IgG Kit for Diagnosis of Chronic Aspergillosis

Oliva

Flori

Hennequin³

et al. 2015

J Clin Microbiol

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“…Very few patients are described in the literature as being treated with amphotericin B [10], and early open trials of itraconazole, without standardised response criteria, showed partial clinical benefits without radiological change [11]. Subsequently criteria for the diagnosis and categorisation of patients were proposed in 2003 [10], and later refinements to the criteria and classification of the disease were proposed [12,13]. Several prospective treatment studies were undertaken [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Denning¹,

Cadranel²,

et al. 2015

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Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ∼240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferably via video-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with single Aspergillus nodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up. @ERSpublications ERS and ESCMID guideline for the management of chronic pulmonary aspergillosis released

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Pathogenesis and clinical features of chronic pulmonary aspergillosis – Is it possible to distinguish CNPA and CCPA clinically?

Cited by 30 publications

References 9 publications

Phenotyping chronic pulmonary aspergillosis by cluster analysis

Phenotyping chronic pulmonary aspergillosis by cluster analysis

Evaluation of the Aspergillus Western Blot IgG Kit for Diagnosis of Chronic Aspergillosis

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

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