"Semi-invasive" pulmonary aspergillosis: a new look at the spectrum of aspergillus infections of the lung.

Abstract

A chronic cavitary form of pulmonary aspergillosis may occur with mild immunosuppression or underlying lung disease. In this "semi-invasive" type, the fungus is intermediate between a simple saprophyte and an invasive pathogen. Aspergillus may produce extensive lung destruction despite the lack of vascular invasion. The absence of a previous cavity distinguishes such cases from secondary noninvasive mycetomas. Radiographic features include a chronic infiltrate, progressive cavitation, and subsequent mycetoma formation. Biopsy may be helpful; however, marked squamous metaplasia can produce false-positive Class V cytological findings even though malignancy is excluded. This variety of aspergillosis supports the concept that the traditional allergic, saprophytic, and invasive forms may represent a spectrum of disease dependent on host immune status and lung architecture.

Intravenous micafungin versus voriconazole for chronic pulmonary aspergillosis: A multicenter trial in Japan

“…Severity was defined as mild, moderate and severe. The factors that were used for determining severity were (1) serum albumin value (less than 2.5 g/dl), (2) SpO 2 less than 90% or PaO 2 less than 60 Torr, (3) impaired oral administration of drugs, (4) expansion of newer infiltration shadow on chest X-ray film that was more than half of the lung field, (5) the existence of severe complications such as malignancies, cerebral vascular disorders, hepatic diseases, kidney diseases or heart failure, and (6) administration of corticosteroids. Mild severity was defined as the patient possessing none of the above factors.…”

“…1,2 Several names of these chronic forms of disease have been proposed: semi-invasive aspergillosis 3 , chronic necrotizing pulmonary aspergillosis (CNPA) 4 , simple or complex aspergilloma, and chronic cavitary and fibrosing pulmonary aspergillosis (CCPA and CFPA). 5 As Hope et al 6 indicated apparently distinct entities do not exist for this syndrome and these forms usually overlap.…”

Nontuberculous mycobacterial disease and Aspergillus-related lung disease in bronchiectasis

“…post-transplantation, isolation of A. fumigatus from a respiratory specimen is considered to have a high positive predictive value of invasive aspergillosis [5]. In immune-competent patients with CNPA, however, reliable diagnostic criteria are not available and histopathological confirmation cannot always be obtained [6,8]. positive results of Aspergillus precipitins.…”

“…There may be a clinical and radiological overlap between these groups as more than one Aspergillus-related lung disease can coexist [7]. Invasive aspergillosis has been further categorised as angio-invasive and acute or chronic airway invasive aspergillosis (chronic necrotising pulmonary aspergillosis (CNPA) or semi-invasive aspergillosis) [7,8]. The former is an aggressive form of aspergillosis seen in severe immunosuppression, whereas the latter is an indolent form of invasive aspergillosis, which has been associated with NTM infection [9].…”

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

“…Chronic pulmonary aspergillosis (CPA) was originally established in the early 1980s by Binder as chronic necrotizing pulmonary aspergillosis (CNPA) [1] and semi-invasive aspergillosis (SIA) by Gefter [2]. CNPA/SIA is characterized by a slow progressive cavitating process in the lungs due to Aspergillus spp.…”