Phenotyping chronic pulmonary aspergillosis by cluster analysis

Godet, C.; Laurent, François; Béraud, Guillaume; Toper, C.; Camara, B.; Philippe, B.; Germaud, P.; Cottin, Vincent; Khalil, Antoine; Blouin, P.; Pouriel, Mathilde; Roblot, F.; Bergeron, Anne; Cadranel, J.

doi:10.1183/13993003.00869-2015

Cited by 10 publications

(12 citation statements)

References 10 publications

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“…Patients can present with a variety of respiratory and constitutional symptoms. The commonest symptoms are shortness of breath, chronic cough, sputum production, chest discomfort, weight loss and fatigue [ 10 – 12 ]. Fatigue can be substantial in CPA and a direct cause for poor quality of life, thought to be driven by uncontrolled chronic inflammation and the overlay of poor physiological baseline from impaired lung function.…”

Section: Diagnosismentioning

confidence: 99%

The Management of Chronic Pulmonary Aspergillosis: The UK National Aspergillosis Centre Approach

Maghrabi

Denning

2017

Curr Fungal Infect Rep

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Purpose of ReviewChronic pulmonary aspergillosis (CPA) is a serious long-term fungal disease of the lung with a worldwide prevalence. Treatment of CPA is not straightforward given the often-multiple associated co-morbidities, complex clinical picture, drug interactions, toxicities and intolerances.Recent FindingsFirst line treatment is oral itraconazole or voriconazole. In the event of intolerance or toxicity, patients may be swapped from itraconazole to voriconazole or vice versa. In the event of resistance or further intolerance, third line treatment with posaconazole could be initiated. In those with pan-azole resistance, short-term courses of intravenous liposomal amphotericin B or micafungin are fourth line therapy, keeping in mind the nephrotoxic effects of amphotericin B.SummaryThe available evidence for current treatments in CPA is limited and based mostly on retrospective cohort studies. There is a real need to raise awareness of this devastating disease to enable early treatment as well as prospective drug trials and studies to identify potential patient factors that correlate with progression, severity and overall outcomes in order to target future therapies.

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Section: Diagnosismentioning

confidence: 99%

The Management of Chronic Pulmonary Aspergillosis: The UK National Aspergillosis Centre Approach

Maghrabi

Denning

2017

Curr Fungal Infect Rep

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“…However these disease descriptions have been challenged, on the grounds that the subtype classification is over simplistic, difficult to apply clinically and of only academic interest [ 41 , 42 , 43 ]. It can be argued that the continuum of radiological and clinical features demonstrated within this population, combined with largely shared management principles, place the individual disease subtypes on a flexible, and potentially changeable, spectrum.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…It can be argued that the continuum of radiological and clinical features demonstrated within this population, combined with largely shared management principles, place the individual disease subtypes on a flexible, and potentially changeable, spectrum. Recent analysis using a subject centred, multivariate clustering approach, of a large series of patients with CPA, excluding those with single aspergilloma, demonstrated a high degree of homology with only one phenotype identified on cluster analysis [ 43 ]. Neither CCPA or CNPA were identified as individual clusters, confirming the findings of Izumikawa et al who highlighted the potential difficulty of identifying these subtypes based on clinical and radiological findings alone [ 44 , 45 ].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Chronic Pulmonary Aspergillosis—Where Are We? and Where Are We Going?

Hayes

Frazer

2016

JoF

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Chronic pulmonary aspergillosis (CPA) is estimated to affect 3 million people worldwide making it an under recognised, but significant health problem across the globe, conferring significant morbidity and mortality. With variable disease forms, high levels of associated respiratory co-morbidity, limited therapeutic options and prolonged treatment strategies, CPA is a challenging disease for both patients and healthcare professionals. CPA can mimic smear-negative tuberculosis (TB), pulmonary histoplasmosis or coccidioidomycosis. Cultures for Aspergillus are usually negative, however, the detection of Aspergillus IgG is a simple and sensitive test widely used in diagnosis. When a fungal ball/aspergilloma is visible radiologically, the diagnosis has been made late. Sometimes weight loss and fatigue are predominant symptoms; pyrexia is rare. Despite the efforts of the mycology community, and significant strides being taken in optimising the care of these patients, much remains to be learnt about this patient population, the disease itself and the best use of available therapies, with the development of new therapies being a key priority. Here, current knowledge and practices are reviewed, and areas of research priority highlighted.

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“…Les présentations habituelles de l’aspergillose pulmonaire sont l’aspergillose bronchopulmonaire allergique (ABPA), l’aspergillome, l’aspergillose nécrosante chronique et l’aspergillose invasive [ 4 ]. L’aspergillome se développe sous forme de colonisation par un conglomérat de filaments, de mucus et de débris cellulaires au niveau: Des voies aériennes (généralement pathologiques) ou des cavités pulmonaires pré existantes [ 1 ].…”

Section: Discussionunclassified

L’arbre qui cachait la forêt: aspergillose sur carcinome bronchique (à propos de deux cas)

et al. 2017

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L’aspergillome endobronchique et pulmonaire intracavitaire peut mimer à une néoplasie bronchique cliniquement et radiologiquement, ainsi une recherche systématique d'une association est impérative. Une association confirmée change complètement le pronostic ainsi que la conduite thérapeutique. Nous présenterons les observations de deux patients présentant deux formes différentes d'aspergillome pulmonaire mais renfermant en leur sein un carcinome bronchique.

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Phenotyping chronic pulmonary aspergillosis by cluster analysis

Cited by 10 publications

References 10 publications

The Management of Chronic Pulmonary Aspergillosis: The UK National Aspergillosis Centre Approach

The Management of Chronic Pulmonary Aspergillosis: The UK National Aspergillosis Centre Approach

Chronic Pulmonary Aspergillosis—Where Are We? and Where Are We Going?

L’arbre qui cachait la forêt: aspergillose sur carcinome bronchique (à propos de deux cas)

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