Stereotactic body radiotherapy for recurrent hemoptysis due to chronic pulmonary aspergillosis: a case report and systematic review of the literature

Koch, AK; Schanne, Daniel H.; Günther, Gunar; Aebersold, Daniel M.; Eliçin, Olgun

doi:10.1007/s00066-022-02013-1

Cited by 5 publications

(4 citation statements)

References 37 publications

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“…109 A CT angiogram is almost always needed to delineate the source of the bleeding. 110 Mild and moderate hemoptysis can usually be controlled with the use of antifibrinolytic agents like tranexamic acid. Even though it is unlicensed for this purpose and the evidence is limited, it has been found to be associated with a reduction in the duration and volume of bleeding, length of hospital admission, and short-term mortality rates.…”

Section: Second-line Intravenous Therapymentioning

confidence: 99%

“…118,119 More case reports have been described recently but further studies are still needed to understand the full scope and use of this modality in practice. 110,120 Poor Prognostic Features and Outcome Factors affecting prognosis and outcome may be related to the patient, the extent of disease, and the treatment. Very few good-quality clinical trials have been conducted, although risk factors are drawn from numerous retrospective observational studies.…”

Section: Second-line Intravenous Therapymentioning

confidence: 99%

“…118 119 More case reports have been described recently but further studies are still needed to understand the full scope and use of this modality in practice. 110 120…”

Section: Long-term Azole Therapymentioning

confidence: 99%

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Chronic Pulmonary Aspergillosis: Clinical Presentation and Management

Evans,

Lawal,

Kosmidis

et al. 2023

Semin Respir Crit Care Med

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Chronic pulmonary aspergillosis (CPA) refers to a number of clinical syndromes resulting from the presence and local proliferation of Aspergillus organisms in the lungs of patients with chronic lung disease. CPA is more common than was realized two decades ago. Recognition remains poor, despite recent studies from many countries highlighting the high prevalence in at-risk populations. In low- and middle-income countries, CPA may be misdiagnosed and treated as tuberculosis (TB). In addition, CPA may develop following successful TB treatment. The coronavirus disease pandemic has resulted in significant disruption to provision of TB care, likely leading to more extensive lung damage, which could increase the risk for CPA.Although CPA refers to various syndromes, the classic presentation is that of chronic cavitary pulmonary aspergillosis, which manifests as one or more progressive cavities with or without a fungal ball, accompanied by systemic and respiratory symptoms for at least 3 months. Diagnosis relies on Aspergillus immunoglobulin G in serum, as sputum culture lacks sensitivity. Differential diagnosis includes mycobacterial infection, bacterial lung abscess or necrotizing pneumonia, lung cancer, and endemic fungi.The aim of antifungal treatment in CPA is to improve symptoms and quality of life, and to halt progression, and possibly reverse radiological changes. Current recommendations suggest treatment for 6 months, although in practice many patients remain on long-term treatment. Improvement may manifest as weight gain and improvement of symptoms such as productive cough, hemoptysis, and fatigue. Surgical management should be considered in cases of diagnostic uncertainty, in significant hemoptysis, and when there is concern for lack of response to therapy. Itraconazole and voriconazole are the first-line azoles, with more experience now accumulating with posaconazole and isavuconazole. Side effects are frequent and careful monitoring including therapeutic drug monitoring is essential. Intravenous antifungals such as echinocandins and amphotericin B are used in cases of azole intolerance or resistance, which often develop on treatment. Relapse is seen after completion of antifungal therapy in around 20% of cases, mostly in bilateral, high-burden disease.Several research priorities have been identified, including characterization of immune defects and genetic variants linked to CPA, pathogenetic mechanisms of Aspergillus adaptation in the lung environment, the contribution of non-fumigatus Aspergillus species, and the role of new antifungal agents, immunotherapy, and combination therapy.

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Section: Second-line Intravenous Therapymentioning

confidence: 99%

Section: Second-line Intravenous Therapymentioning

confidence: 99%

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Chronic Pulmonary Aspergillosis: Clinical Presentation and Management

Evans,

Lawal,

Kosmidis

et al. 2023

Semin Respir Crit Care Med

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“…The spores can propagate by transfer in air, colonizing the pulmonary airways and changing the status of the infection from asymptomatic to invasive. The disease's clinical manifestations will depend on the host's immune response [32,33]. The A. fumigatus complex, followed by others such as A. flavus, may cause allergic bronchopulmonary aspergillosis (ABPA) or asthma with fungal sensitization (SAFS), whereas CPA affects susceptible people with lung diseases [31].…”

Section: Fungal Pulmonary Diseasesmentioning

confidence: 99%

Could the Lung Be a Gateway for Amphotericin B to Attack the Army of Fungi?

Patricio

Pereira²,

Sarcinelli

et al. 2022

Pharmaceutics

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Fungal diseases are a significant cause of morbidity and mortality worldwide, primarily affecting immunocompromised patients. Aspergillus, Pneumocystis, and Cryptococcus are opportunistic fungi and may cause severe lung disease. They can develop mechanisms to evade the host immune system and colonize or cause lung disease. Current fungal infection treatments constitute a few classes of antifungal drugs with significant fungi resistance development. Amphotericin B (AmB) has a broad-spectrum antifungal effect with a low incidence of resistance. However, AmB is a highly lipophilic antifungal with low solubility and permeability and is unstable in light, heat, and oxygen. Due to the difficulty of achieving adequate concentrations of AmB in the lung by intravenous administration and seeking to minimize adverse effects, nebulized AmB has been used. The pulmonary pathway has advantages such as its rapid onset of action, low metabolic activity at the site of action, ability to avoid first-pass hepatic metabolism, lower risk of adverse effects, and thin thickness of the alveolar epithelium. This paper presented different strategies for pulmonary AmB delivery, detailing the potential of nanoformulation and hoping to foster research in the field. Our finds indicate that despite an optimistic scenario for the pulmonary formulation of AmB based on the encouraging results discussed here, there is still no product registration on the FDA nor any clinical trial undergoing ClinicalTrial.gov.

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