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Haro-Reyes T, Díaz-Peralta L, Galván-Hernández A, Rodríguez-López A, Rodríguez-Fragoso L, Ortega-Blake I. Polyene Antibiotics Physical Chemistry and Their Effect on Lipid Membranes; Impacting Biological Processes and Medical Applications. MEMBRANES 2022; 12:membranes12070681. [PMID: 35877884 PMCID: PMC9316096 DOI: 10.3390/membranes12070681] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 01/27/2023]
Abstract
This review examined a collection of studies regarding the molecular properties of some polyene antibiotic molecules as well as their properties in solution and in particular environmental conditions. We also looked into the proposed mechanism of action of polyenes, where membrane properties play a crucial role. Given the interest in polyene antibiotics as therapeutic agents, we looked into alternative ways of reducing their collateral toxicity, including semi-synthesis of derivatives and new formulations. We follow with studies on the role of membrane structure and, finally, recent developments regarding the most important clinical applications of these compounds.
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Affiliation(s)
- Tammy Haro-Reyes
- Instituto de Ciencias Físicas, Universidad Nacional Autónoma de México, Av. Universidad s/n, Col. Chamilpa, Cuernavaca 62210, Morelos, Mexico; (T.H.-R.); (L.D.-P.); (A.G.-H.)
| | - Lucero Díaz-Peralta
- Instituto de Ciencias Físicas, Universidad Nacional Autónoma de México, Av. Universidad s/n, Col. Chamilpa, Cuernavaca 62210, Morelos, Mexico; (T.H.-R.); (L.D.-P.); (A.G.-H.)
| | - Arturo Galván-Hernández
- Instituto de Ciencias Físicas, Universidad Nacional Autónoma de México, Av. Universidad s/n, Col. Chamilpa, Cuernavaca 62210, Morelos, Mexico; (T.H.-R.); (L.D.-P.); (A.G.-H.)
| | - Anahi Rodríguez-López
- Facultad de Farmacia, Universidad Autónoma del Estado de Morelos, Cuernavaca 62210, Morelos, Mexico; (A.R.-L.); (L.R.-F.)
| | - Lourdes Rodríguez-Fragoso
- Facultad de Farmacia, Universidad Autónoma del Estado de Morelos, Cuernavaca 62210, Morelos, Mexico; (A.R.-L.); (L.R.-F.)
| | - Iván Ortega-Blake
- Instituto de Ciencias Físicas, Universidad Nacional Autónoma de México, Av. Universidad s/n, Col. Chamilpa, Cuernavaca 62210, Morelos, Mexico; (T.H.-R.); (L.D.-P.); (A.G.-H.)
- Correspondence: ; Tel.: +52-77-7329-1762
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Courtwright AM, Longworth S, Chojnowski D, Lee I, Hunt S. Treatment of a Pulmonary Aspergilloma in a Lung Transplant Recipient Using Catheter-directed Intracavitary Instillation of Liposomal Amphotericin B. Transplant Direct 2022; 8:e1270. [PMID: 34966841 PMCID: PMC8710325 DOI: 10.1097/txd.0000000000001270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/25/2021] [Accepted: 11/04/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Andrew M. Courtwright
- Advanced Lung Disease and Lung Transplantation, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Sarah Longworth
- Division of Infectious Disease, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Donna Chojnowski
- Advanced Lung Disease and Lung Transplantation, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ingi Lee
- Division of Infectious Disease, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Stephen Hunt
- Department of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia PA
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3
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Petreanu C, Croitoru A, Gibu A, Zariosu A, Bacalbasa N, Balescu I, Diaconu C, Stiru O, Dimitriu M, Cretoiu D, Savu C. Monaldi cavernostomy for lung aspergillosis: A case report. Exp Ther Med 2021; 22:957. [PMID: 34335899 PMCID: PMC8290423 DOI: 10.3892/etm.2021.10389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/22/2021] [Indexed: 12/02/2022] Open
Abstract
Pulmonary aspergillosis in patients with respiratory failure can severely affect the pulmonary functional status and may aggravate it through pulmonary suppuration, by recruitment of new parenchyma and hemoptysis, which can sometimes be massive, with lethal risk by flooding the bronchus. The treatment consists of a combination of medical therapy, surgery and interventional radiology. In small lesions, less than 2-3 cm, medical therapy methods may be sufficient; however, in invasive forms (larger than 3 cm) surgical resection is necessary. Surgical resection is the ideal treatment; nevertheless, when lung function does not allow it, action must be taken to eliminate the favorable conditions of the infection. In such cases, whenever the lung cavity is peripheral, a cavernostomy may be performed. Four cases of lung cavernous lesions colonized with aspergillus, in which the need for a therapeutic gesture was imposed by repeated small to medium hemoptysis and by the progression of respiratory failure, were evaluated, one of which is presented in the current study. Cavernostomy closure can be realized either surgically with muscle flap or spontaneously by scarring, after closure of the bronchial fistulas by epithelization and granulation. There were no recurrences of hemoptysis or suppurative phenomena. There was one death, a patient with severe respiratory failure caused by superinfection with nonspecific germs. However, in the case presented in this study, the patient recovered following cavernostomy, which seems to be an effective and safe method for cases in which lung resection is not feasible.
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Affiliation(s)
- Cornel Petreanu
- Department of Thoracic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Thoracic Surgery, 'Marius Nasta' National Institute of Pneumology, 050159 Bucharest, Romania
| | - Alina Croitoru
- Department of Thoracic Surgery, 'Marius Nasta' National Institute of Pneumology, 050159 Bucharest, Romania.,Department of Pneumology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alexandru Gibu
- Department of Thoracic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alexandru Zariosu
- Department of Thoracic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'I. Cantacuzino' Clinical Hospital, 030167 Bucharest, Romania
| | - Irina Balescu
- Department of Visceral Surgery, 'Ponderas' Academic Hospital, 021188 Bucharest, Romania
| | - Camelia Diaconu
- Department of Internal Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Ovidiu Stiru
- Department of Cardiovascular Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Cardiovascular Surgery, 'Prof. Dr. C. C. Iliescu' Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Mihai Dimitriu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Emergency Clinical Hospital, 021659 Bucharest, Romania
| | - Dragos Cretoiu
- Department of Cell and Molecular Biology and Histology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cornel Savu
- Department of Thoracic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Thoracic Surgery, 'Marius Nasta' National Institute of Pneumology, 050159 Bucharest, Romania
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4
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A Collaborative Tale of Diagnosing and Treating Chronic Pulmonary Aspergillosis, from the Perspectives of Clinical Microbiologists, Surgical Pathologists, and Infectious Disease Clinicians. J Fungi (Basel) 2020; 6:jof6030106. [PMID: 32664547 PMCID: PMC7558816 DOI: 10.3390/jof6030106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic pulmonary aspergillosis (CPA) refers to a spectrum of Aspergillus-mediated disease that is associated with high morbidity and mortality, with its true prevalence vastly underestimated. The diagnosis of CPA includes characteristic radiographical findings in conjunction with persistent and systemic symptoms present for at least three months, and evidence of Aspergillus infection. Traditionally, Aspergillus infection has been confirmed through histopathology and microbiological studies, including fungal culture and serology, but these methodologies have limitations that are discussed in this review. The treatment of CPA requires an individualized approach and consideration of both medical and surgical options. Most Aspergillus species are considered susceptible to mold-active triazoles, echinocandins, and amphotericin B; however, antifungal resistance is emerging and well documented, demonstrating the need for novel therapies and antifungal susceptibility testing that correlates with clinical response. Here, we describe the clinical presentation, diagnosis, and treatment of CPA, with an emphasis on the strengths and pitfalls of diagnostic and treatment approaches, as well as future directions, including whole genome sequencing and metagenomic sequencing. The advancement of molecular technology enables rapid and precise species level identification, and the determination of molecular mechanisms of resistance, bridging the clinical infectious disease, anatomical pathology, microbiology, and molecular biology disciplines.
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5
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Lang M, Lang AL, Chauhan N, Gill A. Non-surgical treatment options for pulmonary aspergilloma. Respir Med 2020; 164:105903. [DOI: 10.1016/j.rmed.2020.105903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/17/2020] [Indexed: 01/11/2023]
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Hakim A, Bazan IS, Sanogo ML, Manning EP, Pollak JS, Chupp GL. Pulmonary artery pseudoaneurysm causing massive hemoptysis in hyperimmunoglobulin E syndrome: a case report. BMC Pulm Med 2019; 19:34. [PMID: 30736787 PMCID: PMC6368789 DOI: 10.1186/s12890-019-0797-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/29/2019] [Indexed: 11/22/2022] Open
Abstract
Background Hyperimmunoglobulin E syndrome (HIES) is a rare primary immunodeficiency disorder defined by high serum immunoglobulin E titers that is associated with recurrent respiratory infections, formation of pneumoatoceles, recurrent skin abscesses, and characteristic dental and skeletal abnormalities. Case presentation We report a case of a 56-year-old male with a history of HIES, cavitary mycetomas, and allergic bronchopulmonary aspergillosis who presented with recurrent massive hemoptysis. Bronchial artery angiography and bronchoscopy failed to identify active hemorrhage, and two embolizations of the bronchial artery did not resolve the bleeding. Subsequently, selective pulmonary artery angiography was conducted that demonstrated a subsegmental pulmonary artery branch pseudoaneurysm with extravasation into an adjacent lung cavity. This was treated successfully with transcatheter embolization. Conclusions To our knowledge, this is the first case reported of pulmonary artery pseudoaneurysm in HIES in the medical literature. Pulmonary artery pseudoaneurysm should be considered in the differential diagnosis in patients with HIES and massive hemoptysis.
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Affiliation(s)
- Aaron Hakim
- Yale University School of Medicine, New Haven, CT, USA
| | - Isabel S Bazan
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Mamadou L Sanogo
- Section of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Edward P Manning
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jeffrey S Pollak
- Section of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Geoffrey L Chupp
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
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7
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Affiliation(s)
- Debabrata Bandyopadhyay
- Division of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Marc A. Judson
- Division of Pulmonary and Critical Care Medicine, MC-91, Albany Medical College, Albany, NY, USA
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8
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Denning DW, Cadranel J, Beigelman-Aubry C, Ader F, Chakrabarti A, Blot S, Ullmann AJ, Dimopoulos G, Lange C. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J 2016; 47:45-68. [PMID: 26699723 DOI: 10.1183/13993003.00583-2015] [Citation(s) in RCA: 512] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
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.
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Affiliation(s)
- David W Denning
- The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester and the Manchester Academic Health Science Centre, Manchester, UK
| | - Jacques Cadranel
- Service de Pneumologie, AP-HP, Hôpital Tenon and Sorbonne Université, UPMC Univ Paris 06, Paris, France
| | | | - Florence Ader
- Dept of Infectious Diseases, Hospices Civils de Lyon, Lyon, France Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, Lyon, France
| | - Arunaloke Chakrabarti
- Center of Advanced Research in Medical Mycology, Dept of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Stijn Blot
- Dept of Internal Medicine, Ghent University, Ghent, Belgium Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
| | - Andrew J Ullmann
- Dept of Internal Medicine II, Division of Infectious Diseases, University Hospital Würzburg, Julius-Maximilians-University, Würzburg, Germany
| | - George Dimopoulos
- Dept of Critical and Respiratory Care, University Hospital Attikon, Medical School, University of Athens, Athens, Greece
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9
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Takeda T, Itano H, Kakehashi R, Fukita S, Saitoh M, Takeda S. Direct transbronchial administration of liposomal amphotericin B into a pulmonary aspergilloma. Respir Med Case Rep 2014; 11:7-11. [PMID: 26029520 PMCID: PMC3969609 DOI: 10.1016/j.rmcr.2013.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/25/2013] [Accepted: 12/27/2013] [Indexed: 11/28/2022] Open
Abstract
Pulmonary aspergillomas usually occur in pre-existing lung cavities exhibiting local immunodeficiency. As pulmonary aspergillomas only partially touch the walls of the cavities containing them, they rarely come into contact with the bloodstream, which makes it difficult for antifungal agents to reach them. Although surgical treatment is the optimal strategy for curing the condition, most patients also have pulmonary complications such as tuberculosis and pulmonary fibrosis, which makes this strategy difficult. A 72-year-old male patient complained of recurrent hemoptysis and dyspnea, and a chest X-ray and CT scan demonstrated the existence of a fungus ball in a pulmonary cavity exhibiting fibrosis. Although an examination of the patient's sputum was inconclusive, his increased 1-3-beta-D-glucan level and Aspergillus galactomannan antigen index were suggestive of pulmonary aspergilloma. Since the systemic administration of voriconazole for two months followed by itraconazole for one month was ineffective and surgical treatment was not possible due to the patient's poor respiratory function, liposomal amphotericin B was transbronchially administered directly into the aspergilloma. The patient underwent fiberoptic bronchoscopy, and a yellow fungus ball was observed in the cavity connecting to the right B(2)bi-beta, a biopsy sample of which was found to contain Aspergillus fumigatus. Nine transbronchial administrations of liposomal amphotericin B were conducted using a transbronchial aspiration cytology needle, which resulted in the aspergilloma disappearing by seven and a half months after the first treatment. This strategy could be suitable for aspergilloma patients with complications because it is safe and rarely causes further complications.
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Affiliation(s)
- Takayuki Takeda
- Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center, 86, Kasuganomori, Ogura-cho, Uji City, Kyoto 611-0042, Japan
| | - Hideki Itano
- Division of Thoracic Surgery, Department of General Surgery, Uji Tokushukai Medical Center, 86, Kasuganomori, Ogura-cho, Uji City, Kyoto 611-0042, Japan
| | - Ryouhei Kakehashi
- Department of Pharmacology, Uji Tokushukai Medical Center, 86, Kasuganomori, Ogura-cho, Uji City, Kyoto 611-0042, Japan
| | - Shinichi Fukita
- Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center, 86, Kasuganomori, Ogura-cho, Uji City, Kyoto 611-0042, Japan
| | - Masahiko Saitoh
- Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center, 86, Kasuganomori, Ogura-cho, Uji City, Kyoto 611-0042, Japan
| | - Sorou Takeda
- Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center, 86, Kasuganomori, Ogura-cho, Uji City, Kyoto 611-0042, Japan
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Kravitz JN, Berry MW, Schabel SI, Judson MA. A Modern Series of Percutaneous Intracavitary Instillation of Amphotericin B for the Treatment of Severe Hemoptysis From Pulmonary Aspergilloma. Chest 2013; 143:1414-1421. [DOI: 10.1378/chest.12-1784] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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11
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Merritt RE, Shrager JB. Indications for surgery in patients with localized pulmonary infection. Thorac Surg Clin 2013; 22:325-32. [PMID: 22789596 DOI: 10.1016/j.thorsurg.2012.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nowadays, antibiotic and antifungal therapy is effective in treating some of the infections that can involve the lung parenchyma in a localized manner, such as bacterial abscess and infection with nonresistant tuberculosis strains. However, other localized pulmonary infections, for example aspergilloma and mucormycosis, are highly resistant to nonsurgical therapy, and in these diseases there are no generally successful options that do not include surgical resection. This article reviews the indications for surgical intervention in the treatment of common infections involving the lung, and also focuses on the general approaches to their management.
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Affiliation(s)
- Robert E Merritt
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
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12
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Pulmonary Aspergillosis: Therapeutic Management and Prognostic Factors from 16 Years of Monocenter Experience. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 755:225-36. [DOI: 10.1007/978-94-007-4546-9_29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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13
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Stather DR, Tremblay A, MacEachern P, Chee A, Dumoulin E, Tourin O, Gelfand GA, Mody CH. Bronchoscopic Removal of a Large Intracavitary Pulmonary Aspergilloma. Chest 2013; 143:238-241. [DOI: 10.1378/chest.12-0400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Limper AH, Knox KS, Sarosi GA, Ampel NM, Bennett JE, Catanzaro A, Davies SF, Dismukes WE, Hage CA, Marr KA, Mody CH, Perfect JR, Stevens DA. An official American Thoracic Society statement: Treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med 2011; 183:96-128. [PMID: 21193785 DOI: 10.1164/rccm.2008-740st] [Citation(s) in RCA: 358] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
With increasing numbers of immune-compromised patients with malignancy, hematologic disease, and HIV, as well as those receiving immunosupressive drug regimens for the management of organ transplantation or autoimmune inflammatory conditions, the incidence of fungal infections has dramatically increased over recent years. Definitive diagnosis of pulmonary fungal infections has also been substantially assisted by the development of newer diagnostic methods and techniques, including the use of antigen detection, polymerase chain reaction, serologies, computed tomography and positron emission tomography scans, bronchoscopy, mediastinoscopy, and video-assisted thorascopic biopsy. At the same time, the introduction of new treatment modalities has significantly broadened options available to physicians who treat these conditions. While traditionally antifungal therapy was limited to the use of amphotericin B, flucytosine, and a handful of clinically available azole agents, current pharmacologic treatment options include potent new azole compounds with extended antifungal activity, lipid forms of amphotericin B, and newer antifungal drugs, including the echinocandins. In view of the changing treatment of pulmonary fungal infections, the American Thoracic Society convened a working group of experts in fungal infections to develop a concise clinical statement of current therapeutic options for those fungal infections of particular relevance to pulmonary and critical care practice. This document focuses on three primary areas of concern: the endemic mycoses, including histoplasmosis, sporotrichosis, blastomycosis, and coccidioidomycosis; fungal infections of special concern for immune-compromised and critically ill patients, including cryptococcosis, aspergillosis, candidiasis, and Pneumocystis pneumonia; and rare and emerging fungal infections.
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15
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Marshall H, Jones S, Williams A. Chronic pulmonary aspergillosis - longterm follow-up over 20 years, a case report. J Radiol Case Rep 2010; 4:23-30. [PMID: 22470708 DOI: 10.3941/jrcr.v4i2.350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We describe a case of chronic pulmonary aspergillosis complicated with a slowly growing aspergilloma followed for two decades without specific intervention. It developed with no background of local or systemic immune dysfunction in a middle aged female. The case illustrates many features of this disease as well as uniquely documenting the natural radiological evolution from a small non-specific cystic lesion to a massive aspergilloma. The aspergilloma subsequently autolysed and the patient's condition changed to an allergic phenotype with development of widespread bronchiectasis and pulmonary fibrosis. We briefly discuss the range of disease aspergillus can cause in humans, its differential diagnosis and treatments.
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Affiliation(s)
- Henry Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
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16
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Pulmonary aspergilloma: Analysis of prognosis in relation to symptoms and treatment. J Thorac Cardiovasc Surg 2009; 138:820-5. [DOI: 10.1016/j.jtcvs.2009.01.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 12/10/2008] [Accepted: 01/24/2009] [Indexed: 11/20/2022]
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Abstract
Aspergillus can cause several forms of pulmonary disease ranging from colonization to invasive aspergillosis and largely depends on the underlying lung and immune function of the host. This article reviews the clinical presentation, diagnosis, pathogenesis, and treatment of noninvasive forms of Aspergillus infection, including allergic bronchopulmonary aspergillosis (ABPA), aspergilloma, and chronic pulmonary aspergillosis (CPA). ABPA is caused by a hypersensitivity reaction to Aspergillus species and is most commonly seen in patients who have asthma or cystic fibrosis. Aspergillomas, or fungus balls, can develop in previous areas of cavitary lung disease, most commonly from tuberculosis. CPA has also been termed semi-invasive aspergillosis and usually occurs in patients who have underlying lung disease or mild immunosuppression.
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Affiliation(s)
- Brent P Riscili
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Medical Center, Davis Heart and Lung Research Institute, Columbus, OH 43210, USA
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19
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Noukoua Tchuisse C, Ghaye B, Dondelinger RF. Imaging and Treatment of Thoracic Fluid and Gas Collections. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
Administration of antifungals by routes other than that for which the agent was designed or approved have been utilised in attempts to provide directed therapy, reduce adverse effects and improve drug penetration into selected infection sites, such as the central nervous system, lungs and peritoneum. The most widely investigated agent utilising a novel method of drug delivery is amphotericin B. Dose forms for this agent include topicals (aerosol, nasal spray, irrigations, pastes, absorbable sponges, impregnated bone cement and gelatin), oral dosage forms (solutions, suspensions, tablets and so on) and ophthalmic preparations (drops, ointments and injections). Amphotericin B has been administered by routes such as oral, endobronchial, intrathecal, intracisternal, intra-articular, intraperitoneal, ophthalmic and as an antibiotic 'line lock'. Nystatin has been administered as an aerosol, percutaneous paste and bladder washes. Azoles, such as miconazole, fluconazole, ketoconazole and posaconazole, have been administered by novel methods but to a lesser degree. Most of these reports involve miconazole. The dose forms and routes of administration for azoles have included irrigants (bladder, joint), ophthalmic preparations (eye drops, intraocular injections, ointments), impregnated bone cement, endobronchial and intrathecal administration. Finally, both methylene blue (bladder washes) and flucytosine (peritoneal lavage, ophthalmic eye drops) have also been employed. Adequate evaluations of both the safety and efficacy of these therapies are most often hindered by prior or concomitant antifungal therapies, comorbidities and the lack of controlled clinical trials. In addition, the availability of newer treatment options, which demonstrate significant improvement in drug distribution and treatment-related adverse effects make many such novel modes of administration less practical or necessary. In contrast, the inhalation of antifungal aerosols, such as amphotericin B, is rapidly becoming a viable prophylactic option.
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21
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Carette MF, Khalil A, Parrot A. Hémoptysies : principales étiologies et conduite à tenir. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.emcpn.2004.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Affiliation(s)
- C Díaz Sánchez
- Sección de Neumología, Hospital de Cabueñes, Gijón, Asturias, España
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23
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Affiliation(s)
- Ali Nawaz Khan
- North Manchester General Hospital, Department of Diagnostic Imaging, UK.
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24
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Abstract
Aspergillus is a ubiquitous fungus that causes a variety of clinical syndromes in the lung, ranging from aspergilloma in patients with lung cavities, to chronic necrotizing aspergillosis in those who are mildly immunocompromised or have chronic lung disease. Invasive pulmonary aspergillosis (IPA) is a severe and commonly fatal disease that is seen in immunocompromised patients, while allergic bronchopulmonary aspergillosis is a hypersensitivity reaction to Aspergillus antigens that mainly affects patients with asthma. In light of the increasing risk factors leading to IPA, such as organ transplantation and immunosuppressive therapy, and recent advances in the diagnosis and treatment of Aspergillus-related lung diseases, it is essential for clinicians to be familiar with the clinical presentation, diagnostic methods, and approach to management of the spectrum of pulmonary aspergillosis.
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Affiliation(s)
- Ayman O Soubani
- Division of Pulmonary, Critical Care, and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
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25
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Abstract
Aspergillus is a genus of fungi commonly found in all environments. Remarkably, only a few species cause disease and equally remarkably, those same species cause multiple diseases. In the lung, exposure to the fungus, the immunological status of the individual and the condition of the lung determine the pattern of disease. In asthmatic patients and those with cystic fibrosis, allergic bronchopulmonary aspergillosis (ABPA) is a complication that reduces pulmonary function and, in asthmatics, is substantially improved by itraconazole therapy. Patients with pre-existing lung cavities develop aspergillomas (fungal masses inside the cavity). Aspergillomas carry a 40% 5 years survival, and it not clear whether antifungal therapy is helpful. Similar in presentation to aspergilloma is chronic necrotizing pulmonary aspergillosis (CNPA). Development of new or expansion of existing pulmonary cavities with surrounding paracavitary shadowing is the hallmark of CNPA These two entities are probably a continuum of the same pathological process. Patients with CNPA respond to systemic antifungal therapy, but this may need to be lifelong. Surgery is appropriate for isolated aspergillomas, but not pleural or multicavity lesions. Aspergillus empyema is a complication of aspergilloma and CNPA, or surgery for these diseases and is slow to respond to treatment.
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MESH Headings
- Antifungal Agents/therapeutic use
- Aspergillosis/diagnosis
- Aspergillosis/drug therapy
- Aspergillosis/etiology
- Aspergillosis/pathology
- Aspergillosis, Allergic Bronchopulmonary/diagnosis
- Aspergillosis, Allergic Bronchopulmonary/drug therapy
- Aspergillosis, Allergic Bronchopulmonary/etiology
- Aspergillosis, Allergic Bronchopulmonary/pathology
- Chronic Disease
- Cystic Fibrosis/complications
- Empyema
- Humans
- Lung Diseases, Fungal/diagnosis
- Lung Diseases, Fungal/drug therapy
- Lung Diseases, Fungal/etiology
- Lung Diseases, Fungal/pathology
- Necrosis
- Radiography, Thoracic
- Tomography, X-Ray Computed
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Affiliation(s)
- D W Denning
- Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, UK.
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26
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Abstract
Interventional Radiology is a technique based medical specialty, using all available imaging modalities (fluoroscopy, ultrasound, computed tomography, magnetic resonance, angiography) for guidance of interventional techniques for diagnostic or therapeutic purposes. Actual, percutaneous transthoracic needle biopsy includes core needle biopsy besides fine needle aspiration. Any pleural, pulmonary or mediastinal fluid or gas collection is amenable to percutaneous pulmonary catheter drainage. Treatment of haemoptysis of the bronchial artery or pulmonary artery origin, transcatheter embolization of pulmonary arteriovenous malformations and pseudoaneurysms, angioplasty and stenting of the superior vena caval system and percutaneous foreign body retrieval are well established routine procedures, precluding unnecessary surgery. These techniques are safe and effective in experienced hands. Computed tomography is helpful in pre- and postoperative imaging of patients being considered for endobronchial stenting. Many procedures can be performed on an outpatient basis, thus increasing the cost-effectiveness of radiologically guided interventions in the thorax.
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Affiliation(s)
- B Ghaye
- Dept of Medical Imaging, University Hospital Sart Tilman, Liège, Belgium
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Ruiz A, Lonjedo E, Agramunt M, Martínez-Rodrigo JJ, Palmero J. Tratamiento percutáneo con anfotericina B en un caso de aspergilosis pulmonar invasiva. RADIOLOGIA 2001. [DOI: 10.1016/s0033-8338(01)77007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mori T, Ebe T, Isonuma H, Matsumura M, Takahashi M, Kohara T, Miyazaki T, Igari J, Oguri T. Aspergilloma: comparison of treatment methods and prognoses. J Infect Chemother 2000; 6:233-9. [PMID: 11810572 DOI: 10.1007/s101560070009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2000] [Accepted: 08/19/2000] [Indexed: 10/27/2022]
Abstract
We report five cases of aspergilloma. Three patients had a previous history of tuberculosis, including one who fully recovered after resection of the right lower lobe. Four patients were treated mainly with oral itraconazole. Two of these four patients, died, one of massive hemosputa, and one of heart valve disease, while two had a good outcome, although one of them has since developed respiratory insufficiency and has received oxygen therapy. In itraconazole therapy, the daily dose may be 200 mg or more, and the duration of treatment may be 1 year or more. Percutaneous intracavitary instillation of amphotericin B, performed in one patient, showed no efficacy. The efficacy of this treatment may depend on the width and number of drainage bronchi, and on the mechanism of acceleration of degradation of the fungus ball. It is important to carefully choose the therapy for aspergilloma, with due consideration being given to the patient's pulmonary function and general status.
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Affiliation(s)
- T Mori
- Department of Internal Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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29
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Stevens DA, Kan VL, Judson MA, Morrison VA, Dummer S, Denning DW, Bennett JE, Walsh TJ, Patterson TF, Pankey GA. Practice guidelines for diseases caused by Aspergillus. Infectious Diseases Society of America. Clin Infect Dis 2000; 30:696-709. [PMID: 10770732 DOI: 10.1086/313756] [Citation(s) in RCA: 604] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/1999] [Indexed: 11/03/2022] Open
Abstract
Aspergillosis comprises a variety of manifestations of infection. These guidelines are directed to 3 principal entities: invasive aspergillosis, involving several organ systems (particularly pulmonary disease); pulmonary aspergilloma; and allergic bronchopulmonary aspergillosis. The recommendations are distilled in this summary, but the reader is encouraged to review the more extensive discussions in subsequent sections, which show the strength of the recommendations and the quality of the evidence, and the original publications cited in detail. Invasive aspergillosis. Because it is highly lethal in the immunocompromised host, even in the face of therapy, work-up must be prompt and aggressive, and therapy may need to be initiated upon suspicion of the diagnosis, without definitive proof (BIII). Intravenous therapy should be used initially in rapidly progressing disease (BIII). The largest therapeutic experience is with amphotericin B deoxycholate, which should be given at maximum tolerated doses (e.g., 1-1.5 mg/kg/d) and should be continued, despite modest increases in serum creatinine levels (BIII). Lipid formulations of amphotericin are indicated for the patient who has impaired renal function or who develops nephrotoxicity while receiving deoxycholate amphotericin (AII). Oral itraconazole is an alternative for patients who can take oral medication, are likely to be adherent, can be demonstrated (by serum level monitoring) to absorb the drug, and lack the potential for interaction with other drugs (BII). Oral itraconazole is attractive for continuing therapy in the patient who responds to initial iv therapy (CIII). Therapy should be prolonged beyond resolution of disease and reversible underlying predispositions (BIII). Adjunctive therapy (particularly surgery and combination chemotherapy, also immunotherapy), may be useful in certain situations (CIII). Aspergilloma. The optimal treatment strategy for aspergilloma is unknown. Therapy is predominantly directed at preventing life-threatening hemoptysis. Surgical removal of aspergilloma is definitive treatment, but because of significant morbidity and mortality it should be reserved for high-risk patients such as those with episodes of life-threatening hemoptysis, and considered for patients with underlying sarcoidosis, immunocompromised patients, and those with increasing Aspergillus-specific IgG titers (CIII). Surgical candidates would need to have adequate pulmonary function to undergo the operation. Bronchial artery embolization rarely produces a permanent success, but may be useful as a temporizing procedure in patients with life-threatening hemoptysis. Endobronchial and intracavitary instillation of antifungals or oral itraconazole may be useful for this condition. Since the majority of aspergillomas do not cause life-threatening hemoptysis, the morbidity and cost of treatment must be weighed against the clinical benefit. Allergic bronchopulmonary aspergillosis (APBA). Although no well-designed studies have been carried out, the available data support the use of corticosteroids for acute exacerbations of ABPA (AII). Neither the optimal corticosteroid dose nor the duration of therapy has been standardized, but limited data suggest the starting dose should be approximately 0.5 mg/kg/d of prednisone. The decision to taper corticosteroids should be made on an individual basis, depending on the clinical course (BIII). The available data suggest that clinical symptoms alone are inadequate to make such decisions, since significant lung damage may occur in asymptomatic patients. Increasing serum IgE levels, new or worsening infiltrate on chest radiograph, and worsening spirometry suggest that corticosteroids should be used (BII). Multiple asthmatic exacerbations in a patient with ABPA suggest that chronic corticosteroid therapy should be used (BIII). Itraconazole appears useful as a corticosteroid sparing agent (BII). (ABSTRACT TRUNCATED)
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Affiliation(s)
- D A Stevens
- Dept. of Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128-2699, USA.
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30
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Abstract
Infections caused by Aspergillus species consist of many different disease presentations, ranging from relatively benign asthma in atopic disease to life-threatening systemic invasive infections. The spectrum of disease manifestations is determined by a combination of genetic predisposition, host immune system defects, and virulence of the Aspergillus species. For the purposes of this discussion, we will address three principal entities: invasive aspergillosis, both primary and disseminated, pulmonary aspergilloma, and allergic bronchopulmonary aspergillosis. Amphotericin B is the standard of treatment for severe Aspergillus infections, despite the fact that mortality in these patients remains high. Alternative therapies such as combination regimens and itraconazole also have efficacy against Aspergillus infections. We discuss the role of current therapies, the potential role of drugs in development, and the results of ongoing research with combination and immunotherapies. Copyright 2000 Harcourt Publishers Ltd.
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Affiliation(s)
- Tom M. Chiller
- Division of Infectious Diseases, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA
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Saluja S, Henderson KJ, White RI. Embolotherapy in the bronchial and pulmonary circulations. Radiol Clin North Am 2000; 38:425-48, ix. [PMID: 10765399 DOI: 10.1016/s0033-8389(05)70172-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This two-part article first discusses the role of bronchial artery transcatheter embolotherapy in the management of patients with hemoptysis. Following this discussion, the authors review pulmonary arteriovenous malformations, their embolization, follow-up protocols, and outcome criteria as currently practiced at the authors' Vascular Malformation Center.
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Affiliation(s)
- S Saluja
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
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Erasmus JJ, McAdams HP, Rossi S, Kelley MJ. Percutaneous management of intrapulmonary air and fluid collections. Radiol Clin North Am 2000; 38:385-93. [PMID: 10765396 DOI: 10.1016/s0033-8389(05)70169-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The radiologist's role in the management of intrapulmonary air and fluid collections is becoming more important. Improvements in percutaneous interventional techniques now allow the radiologist to offer patients an alternative treatment option with less morbidity and mortality than surgical resection. The use of CT allows optimal catheter placement and enables safe and effective percutaneous evacuation of intrapulmonary collections. In summary, image-guided percutaneous catheter drainage should (1) be the initial procedure performed to diagnose and treat lung abscesses not responding to conservative therapy; and (2) because of its effectiveness and safety, be considered as a treatment option in the management of symptomatic patients with intrapulmonary mycetomas.
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Affiliation(s)
- J J Erasmus
- Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Schnader J, Katz AS, Smith RM, Field SK, Albelda SM. Clinical conference on management dilemmas. An expanding right upper lobe cavity. Chest 1996; 109:829-35. [PMID: 8617097 DOI: 10.1378/chest.109.3.829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- J Schnader
- Department of Medicine of North Shore University Hospital-Cornell University Medical College, Manhasset, NY 11030, USA
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34
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Affiliation(s)
- D W Denning
- Department of Infectious Disease & Tropical Medicine, North Manchester General Hospital, UK
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35
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Torres-Melero J, Torres AJ, Hernando F, Remezal M, Balibrea JL. [Surgical treatment of pulmonary aspergilloma]. Arch Bronconeumol 1995; 31:68-72. [PMID: 7704392 DOI: 10.1016/s0300-2896(15)30966-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pulmonary aspergilloma can now be classified as an opportunistic disease given that Aspergillus tends to colonize preexisting cavities in the lung. Aspergilloma is the usual pleuropulmonary anatomical sign, hemoptysis is the most frequent symptom and a chest film is the simplest diagnostic tool. The advisability of surgery is disputed, particularly in asymptomatic patients and/or those at high surgical risk. We describe 14 patients who underwent surgery in our department, evaluating aspects of their clinical signs, diagnosis, attitude toward treatment and the course of their disease. We believe that for patients with symptomatic pulmonary aspergilloma, the treatment of choice is surgery, preferably lung resection. All patients who do not present contraindications for general surgery can be considered operable.
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Affiliation(s)
- J Torres-Melero
- Departamento de Cirugía, Hospital Clínico Universitario San Carlos, Madrid
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