Pulmonary aspergillosis: a clinical review

Abstract

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.

The basophil surface marker CD203c identifies Aspergillus species sensitization in patients with cystic fibrosis

“…16,31 For this reason, identifying individuals with Af sensitization with or without ABPA is important to ensure appropriate and timely therapeutic intervention to minimize pulmonary impact. 30 In this study we focused on the basophil activation marker CD203c as an indicator of Af sensitization and assessed its effect on important clinical measures of CF disease.…”

Aspergilosis invasiva pulmonar: reporte de un caso

“…Las manifestaciones clínicas pulmonares de la infección por este agente, no difieren de las que se presentan con A. fumigatus (7,10). Dichas manifestaciones se han agrupado en cuatro sín-dromes clínicos: aspergilosis pulmonar invasiva, aspergilosis necrótica crónica, también llamada aspergilosis semiinvasiva, aspergiloma y aspergilosis broncopulmonar alérgica (11).…”

“…En este caso, la paciente presentaba síntomas de aspergilosis invasiva, como neutropenia prolongada, tos persistente, lesiones nodulares en los exámenes radiológicos, antígeno galactomanano positivo en suero y, en la biopsia, invasión por debajo de la membrana basal en el árbol bronquial (10,11,13). Además, en la fibrobroncoscopia se observaron masas endobronquiales, que pueden presentarse en el aspergiloma endobronquial, el cual es más común en pacientes inmunocompetentes con lesiones pulmonares preexistentes y que, en cambio, es infrecuente en aquellos con aspergilosis pulmonar invasiva.…”

“…El riesgo es directamente proporcional a la duración y el grado de la neutropenia. En pacientes con leucemia, el riesgo se incrementa en 1 % al día durante las primeras tres semanas y en 4 % al día durante los días siguientes (10,14). La prevalencia de aspergilosis pulmonar invasiva en pacientes con anemia aplásica se encuentra entre 25 y 55 % (9,14).…”

An update of clinical characteristics and imaging findings of pulmonary aspergillosis

“…Aspergillus infection may disseminate haematogenously to brain resulting in seizures, meningitis, epidural abscesses, ring-enhancing lesions, cerebral infarctions, and intracranial haemorrhage [25] . Involvement of other organs such as pleura, skin, oesophagus, liver, heart and kidneys are also reported [32] .…”