The Clinical Spectrum of Pulmonary Aspergillosis

Soubani, Ayman O.; Chandrasekar, Pranatharthi H.

doi:10.1378/chest.121.6.1988

Cited by 503 publications

(465 citation statements)

References 137 publications

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“…In view of this, the present authors did not attempt to review CT scans for evidence of ABPA but relied on combined clinical and serological criteria as recommended for patients with CF [21]. Depending on severity of ABPA the serum IgE and IgG antibodies to A. fumigatus may be low or high [17]. Furthermore, patients with mild ABPA may have abnormal serological markers without suggestive CT features [23].…”

Section: Discussionmentioning

confidence: 99%

“…High-resolution computed tomography (HRCT) scans were examined for evidence of aspergilloma, consisting of an upper lobe, mobile intra-cavitary mass with an air crescent in the periphery [17]. Since the radiological features of ABPA, including central bronchiectasis and pulmonary infiltrates, are difficult to differentiate in patients with bronchiectasis and NTM infection, clinical and serological criteria, including episodic bronchial obstruction (asthma), peripheral blood eosinophilia and positive Aspergillus serology, were used to diagnose ABPA [18].…”

Section: Methodsmentioning

confidence: 99%

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Nontuberculous mycobacterial disease and Aspergillus-related lung disease in bronchiectasis

Kunst

Wickremasinghe²,

Wells³

et al. 2006

European Respiratory Journal

123

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The aim of the present study was to determine whether patients with bronchiectasis and nontuberculous mycobacteria (NTM) have a higher prevalence of Aspergillus-related lung disease.A series of 30 consecutive patients with bronchiectasis and NTM (cases) were compared with 61 patients with bronchiectasis and no evidence of NTM (controls). Aspergillus serology and computerised tomography of the thorax were used to identify Aspergillus-related lung diseases, including aspergilloma, allergic bronchopulmonary aspergillosis and chronic necrotising pulmonary aspergillosis.The rate of positive Aspergillus serology was higher in cases with NTM disease compared with controls (10 out of 30 versus six out of 61). The radiological features of Aspergillus-related lung disease were also more common among patients with NTM disease than controls (six out of 30 versus none out of 61). This association between NTM disease and Aspergillus-related lung disease remained significant after adjustment for confounding effects of age and lung function (adjusted odds ratio 5.1, 95% confidence interval 1.5-17.0).Patients with bronchiectasis and nontuberculous mycobacterial disease have a higher prevalence of coexisting Aspergillus-related lung disease than patients with bronchiectasis and without nontuberculous mycobacteria. Identification of Aspergillus-related lung disease is important as prognosis amongst undetected cases is invariably poor.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Nontuberculous mycobacterial disease and Aspergillus-related lung disease in bronchiectasis

Kunst

Wickremasinghe²,

Wells³

et al. 2006

European Respiratory Journal

123

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“…Although the yield of SLB is much better than other procedures, it is not invariably diagnostic, and some diagnoses, such as aspergillosis, may be missed even with this procedure [11,12].…”

Section: Introductionmentioning

confidence: 99%

Surgical lung biopsy in patients with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: Improved Outcome with specific diagnosis

et al. 2005

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Using a retrospective review of medical records, we sought the findings of surgical lung biopsy (SLB) in patients with hematological malignancy or hematopoietic stem cell transplantation (HSCT) and unexplained pulmonary infiltrates and to determine the impact of this procedure on management and outcome of these patients. Sixty-two patients who underwent SLB were evaluated; 31 patients had underlying hematological malignancy and 31 patients were HSCT recipients; 58% of whom underwent allogeneic HSCT. Thirty-three patients (53%) had focal infiltrates on chest CT scan while 29 (47%) had diffuse infiltrates. Thirteen patients were mechanically ventilated prior to SLB, and 27 (43%) were neutropenic. There were 66 diagnoses in the 62 patients, 44 (67%) were specific and 22 (33%) were nonspecific. The most common specific diagnoses were infection (29%), malignancy (27%), and inflammatory conditions (11%). Aspergillosis was the most common diagnosis of all biopsies (21%). SLB led to a change in therapy in 40% of patients and was associated with complications in 7 patients (11%). Specific diagnosis was more likely to lead to a change in therapy (48% vs. 27%, P = 0.06) and was associated with a lower mortality when compared to a nonspecific finding (30% vs. 59%, P = 0.02). Nonspecific diagnosis, on the other hand, was seen more in patients on mechanical ventilation prior to SLB compared to those off mechanical ventilation (69% vs. 27%, P = 0.02). SLB provides a specific diagnosis in the majority of patients with hematologic malignancy or HSCT recipients and unexplained pulmonary infiltrates. Specific diagnosis is more likely to lead to a change in therapy and is associated with a better outcome. Am. J. Hematol. 78:94-99, 2005. ª 2005 Wiley-Liss, Inc.

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“…Bronchial artery embolization, procedure also used in the illustrative case, although temporarily effective, has been used to occlude the vessel that supplies the bleeding site in patients experiencing hemoptysis. Additional treatments for hemoptysis have included radiotherapy 7,18,20,23 .…”

Section: Discussionmentioning

confidence: 99%

“…These entities include chronic necrotizing aspergillosis (semi-invasive), allergic bronchopulmonary aspergillosis, intracavitary colonization (fungus ball), bronchocentric granulomatosis or hypersensitivity pneumonitis. The distinction among subacute, acute angioinvasive pulmonary aspergillosis, chronic necrotizing aspergillosis and fungus ball has not been rigorously defined and an overlap in clinical and radiological features among these different entities probably exist 3,10,16,20 . As Aspergillus is a phagocyte opportunistic fungus, aspergillosis is unusual in patients with AIDS, except in late stages of the viral disease 14 .…”

Section: Introductionmentioning

confidence: 99%

Fungus ball in HIV-infected patients

Guazzelli

Unis

Xavier

et al. 2009

Rev. Inst. Med. trop. S. Paulo

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SUMMARYAspergillus is a phagocyte opportunistic fungus that causes aspergillosis, an unusual disease in patients with AIDS. Six cases of fungal ball in patients with AIDS are reported here. In this group, all patients had hemoptysis and tuberculosis as the underlying lung disease. The diagnosis of pulmonary fungus ball was based on the clinical and radiographic feature, combined with serological and mycological evidence of Aspergillus fumigatus.

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The Clinical Spectrum of Pulmonary Aspergillosis

Cited by 503 publications

References 137 publications

Nontuberculous mycobacterial disease and Aspergillus-related lung disease in bronchiectasis

Nontuberculous mycobacterial disease and Aspergillus-related lung disease in bronchiectasis

Surgical lung biopsy in patients with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: Improved Outcome with specific diagnosis

Fungus ball in HIV-infected patients

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