What happens to patients with pulmonary aspergilloma? Analysis of 23 cases.

Rafferty, P.; Biggs, Beverley‐Ann; Crompton, G.K.; Grant, Ianwb

doi:10.1136/thx.38.8.579

Cited by 131 publications

(72 citation statements)

References 9 publications

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“…Corticosteroid therapy and CPA Inhaled or systemic treatment with corticosteroids is one of the major risk factors for CPA, posing significant progression or dissemination risk [115]. Without adequate antifungal therapy, corticosteroid therapy accelerates disease progression.…”

Section: Follow-upmentioning

confidence: 99%

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Denning¹,

Cadranel²,

et al. 2015

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Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ∼240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferably via video-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with single Aspergillus nodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up. @ERSpublications ERS and ESCMID guideline for the management of chronic pulmonary aspergillosis released

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Section: Follow-upmentioning

confidence: 99%

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Denning¹,

Cadranel²,

et al. 2015

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“…In the context of massive haemoptysis, the risk-benefit assessment favours a surgical approach, with an observed 5-year survival of 84% of subjects receiving lung resection, compared with 41% for those who do not, [10,26] with some authors observing the development of invasive aspergillosis in 20% of nonsurgically treated cases. [4] In the absence of massive haemoptysis, the indication for prophylactic surgical resection is less clear, with most authors suggesting observation of asymptomatic patients, and surgery only if symptoms develop. [27] All our patients required surgical resection for symptomatic disease, yet the factors responsible for delays and lack of operations appeared complicated and multifactorial.…”

Section: Discussionmentioning

confidence: 99%

“…In the majority of cases, the lesion remains stable; however, in ~10% of cases, it may decrease in size or resolve spontaneously without treatment. [3,4] An aspergilloma may be asymptomatic for years, although some patients experience minor haemoptysis. Severe haemoptysis may occur, with associated mortality rates between 2 and 14%.…”

mentioning

confidence: 99%

Outcomes of resectable pulmonary aspergilloma and the performance gap in a high tuberculosis prevalence setting: A retrospective study

et al. 2017

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Background. Pulmonary aspergillomas develop in patients with underlying structural lung diseases. The mainstay of therapy is surgery. Objectives. To assess treatment and clinical outcomes following diagnosis of potentially resectable pulmonary aspergilloma at the Tygerberg Hospital (TBH) between January 2013 and December 2015.Methods. This was a retrospective analysis conducted at TBH. Patients were followed up between 6 and 29 months following diagnosis to analyse outcomes. Results. Fifty-nine patients presented for surgery. The mean (SD) age was 44.5 (8.8) years. Thirty-six (61.0%) were male and 13 (22.0%) were HIV-positive. A previous history of pulmonary TB was identified in 83.1% of the patients. One or both upper lobes were involved in 58 patients (98.3%) and haemoptysis was the most frequent symptom, occurring in 56 patients (94.9%). Nine patients (15.3%) were considered unfit for surgery. As of June 2016, 23 (46.0%) of the remaining 50 patients had undergone surgery and 3 (6.0%) had died before surgery was performed. The median time from multidisciplinary discussion to surgery was 190 days (interquartile range 134 -351). Twenty patients (87.0%) underwent lobectomy and 3 (13.0%) had pneumonectomy. There was no postoperative mortality. One patient developed bleeding, persistent air leak and aspiration pneumonia postoperatively. Three patients were hospitalised for >7 days postoperatively. Following surgery, only two patients reported ongoing respiratory symptoms by day 90. Conclusion. Less than half of the patients accepted for lung resection at TBH underwent surgery. Waiting times were long (>1 year in 25%) and were associated with mortality. Barriers to prompt surgery are complex, but should be addressed urgently.

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“…Corticosteroids are the mainstay of treatment for BCG, and there is little evidence that fungicidal therapy is effective (22). On the other hand, allergic bronchopulmonary aspergillosis (23) and aspergilloma (24,25) can progress to invasive aspergillosis. In fact, we previously reported a case of intrabronchial pseudallescheriasis (26), which progressed to lobar pneumonia despite oral itraconazole therapy (27).…”

Section: Discussionmentioning

confidence: 99%