Pulmonary aspergillosis: diagnosis and treatment

Abstract

Aspergillusspecies are the most frequent cause of fungal infections of the lungs with a broad spectrum of clinical presentations including invasive pulmonary aspergillosis (IPA) and chronic pulmonary aspergillosis (CPA). IPA affects immunocompromised populations, which are increasing in number and diversity with the advent of novel anti-cancer therapies. Moreover, IPA has emerged as a complication of severe influenza and coronavirus disease 2019 in apparently immunocompetent hosts. CPA mainly affects patients with pre-existing lung lesions and is recognised increasingly frequently among patients with long-term survival following cure of tuberculosis or lung cancer. The diagnosis of pulmonary aspergillosis is complex as it relies on the presence of clinical, radiological and microbiological criteria, which differ according to the type of pulmonary aspergillosis (IPA or CPA) and the type of patient population. The management of pulmonary aspergillosis is complicated by the limited number of treatment options, drug interactions, adverse events and the emergence of antifungal resistance.

Massive hemoptysis in pregnancy due to invasive pulmonary aspergillosis with pulmonary tuberculosis co‐infection

“…9,11,12 Addressing the challenge of selecting antifungal and concomitant anti-TB therapy during pregnancy is complex. Voriconazole, the first choice for IPA, [11][12][13] poses fetal teratogenicity risks (category D), compounded by rifampicin coadministration, reducing voriconazole serum concentration through CYP450 induction. 14,15 The absence of therapeutic drug monitoring complicates treatment efficacy and safety.…”

“…In our case, surgical intervention serves dual purposes: providing definitive treatment for recurrent hemoptysis and eliminating the cavity that poses future recurrence risks of aspergillosis, especially as the patient requires lifelong immunosuppressive therapy. 9,11,12 Addressing the challenge of selecting antifungal and concomitant anti-TB therapy during pregnancy is complex. Voriconazole, the first choice for IPA, [11][12][13] poses fetal teratogenicity risks (category D), compounded by rifampicin coadministration, reducing voriconazole serum concentration through CYP450 induction.…”

“…Surgical resection, which is timely decided, aligns with guidelines for recurrent hemoptysis due to invasive pulmonary aspergillosis and supports better obstetric outcomes and fetal growth. In our case, surgical intervention serves dual purposes: providing definitive treatment for recurrent hemoptysis and eliminating the cavity that poses future recurrence risks of aspergillosis, especially as the patient requires lifelong immunosuppressive therapy 9,11,12 …”

Navigating the challenges of invasive pulmonary aspergillosis in lung cancer treatment: a propensity score study

“…Medical charts, chest radiologic examinations, and laboratory results were reviewed to diagnose IPA for every patient in the cohort. Patients with airway symptoms and suggestive lung lesions of IPA such as macronodule, cavitary lesion, or consolidation with halo sign 19 are candidates for GM tests in our hospital. We usually performed BAL to diagnose IPA.…”

Respiratory infections

“…Bronchiectasis, severe COPD and steroid treatment are particular risk factors that clinicians should consider when there is suspicion of such infections. In this ERR series, you can expect to read more about these two types of fungal respiratory infections in depth [ 5 , 6 ].…”