Treatment of Pulmonary Aspergilloma With Amphotericin B

Abstract

treatment of bronchopulmonary aspergillosis have been reported following the administration of nystatin by aerosol1 as well as oral intake of large doses of potassium iodide.2 Parenteral injection of stilbamidine 3 and, more recently, amphotericin B 4,5 have also been considered to be successful in isolated cases. However, clinical effectiveness against deep-seated fungous diseases has been accompanied by a variety of disturbing side effects and evidence of toxicity during intravenous infusion of the drug 6,7 Fatal reactions due to renal or hepatic failure and drug hypersensitivity have also been recorded in the human.8-10 Furthermore, systemic drug therapy appears to have particularly limited value in the treatment of freelying Aspergillus fungus ball. There is only one preliminary report 11 of endobronchial use of amphotericin B in the English literature.In this report, amphotericin B was instilled intrabronchially by tracheal puncture in one patient with pulmonary aspergilloma. The instillation of the drug was associated with ex¬ pectoration of many fragments of fungus ball. Subsequently, the fungus ball disappeared al¬ most completely on the chest roentgenograms. There were no signs of side-effects or evidence of renal or hepatic toxicity during the treat¬ ment period. Report of a CaseA 68-year-old woman was transferred from an¬ other hospital to the Juntendo University Hospital on March 14, 1963, for evaluation of a pulmonary lesion which suggested aspergilloma. The patient produced a cup of mucoid sputum daily. She also gave a history of repeated episodes of spitting blood during the pre¬ ceding 13 months, and was admitted to a tuberculosis institution where she received streptomycin, aminosalicylic acid (Para-Aminosalicylic Acid), and isoniazid in varying combinations almost continuously. Sputum cultures did not reveal tubercle bacilli or fungi. Chest roentgenograms taken at that time showed lesions identical with those observed in roent¬ genograms taken on admission to the University Hospital ten months later.Physical examination was essentially noncontributory. Laboratory studies were within normal limits.Her temperature ranged from 98 to 101 F (36.7 to 38.3 C) during the first few weeks of hospitalization. Again tubercle bacilli were not found in the sputum, but culture for fungi revealed a small number of A fumigatus. A chest roentgenogram taken on March 16, 1963, revealed a contracted upper lobe of the right lung containing a hazy circular density. Tomograms of this area taken on March 24, 1963, showed a solid ovoid mass surrounded by a typical air crescent (Fig 1). A bronchogram of this area taken April 8, 1963, showed the solid density surrounded by contrast medium. Shortly after admission several sputum cul¬ tures became negative for Aspergillus, but were con sistently positive for KIcbsiella pneumoniae. It was decided that this was an aspergilloma of the upper lobe of the right lung, and that there was also a chronic KIcbsiella infection.On April 16, 1963, amphotericin B, totaling 200 mg, was i...

Non-surgical treatment options for pulmonary aspergilloma

“…A review performed by Benhamed and Woelffle found adjuvant amphotericin B did not affect morbidity or survival in post-surgical patients [36]. Furthermore, the potential complications associated with amphotericin B, particularly nephrotoxicity, makes this option unfavorable [37]. Within recent years, aerosolized amphotericin B administration through a nebulizer has shown promise at treating pulmonary aspergillosis and may be effective as a prophylaxis for invasive pulmonary aspergillosis in high-risk patients [38][39][40][41][42].…”

Aspergilloma: comparison of treatment methods and prognoses

“…Direct intracavitary administration of antifungal agents should be reserved for inoperable subjects. [11][12][13][14][15] However, the efficacy of intracavitary instillation of antifungals may depend upon the number and width of the drainage bronchi as well as on the mechanism of acceleration of fungus ball degradation. 16 Percutaneous intracavitary instillation of amphotericin B was performed in our case 4, but this therapy did not lead to a collapse of the fungus ball.…”

Pulmonary Aspergillosis

“…Arterial embolization 99,100 or cavernoscopic evacuation of aspergilloma 97,101 may offer an alternative method of palliation in patients at high risk for resection. Medical treatment with intravenous amphotericin B or 5-flucytosine (5-FC) is ineffective, 94,102-104 but local endobronchial or intracavitary installation of amphotericin B, [103][104][105] sodium iodide, 85,106 natamycin, 102,107 miconazole, 108 ketoconazole 102 and 5-FC 109,110 have been tried with encouraging results, although prolonged installation and recurrence even with successful lysis of the aspergilloma are common.…”