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Yokota M, Takiguchi J, Tomioka H. The case of huge simple pulmonary aspergilloma that responded remarkably to drug therapy. Respirol Case Rep 2024; 12:e01337. [PMID: 38559904 PMCID: PMC10978068 DOI: 10.1002/rcr2.1337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
The first choice of treatment for simple pulmonary aspergilloma is surgery, but in clinical practice, many cases find surgery difficult. We report a case of simple pulmonary aspergilloma in which significant improvement was observed with pharmacological treatment alone, despite initially presenting with a large fungus ball.
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Affiliation(s)
- Makoto Yokota
- Respiratory MedicineKobe City Hospital Organisation, Kobe City Medical Center West HospitalKobeJapan
| | - Junji Takiguchi
- Respiratory MedicineKobe City Hospital Organisation, Kobe City Medical Center West HospitalKobeJapan
| | - Hiromi Tomioka
- Respiratory MedicineKobe City Hospital Organisation, Kobe City Medical Center West HospitalKobeJapan
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2
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Volpe-Chaves CE, Venturini J, B Castilho S, S O Fonseca S, F Nunes T, T Cunha EA, M E Lima G, O Nunes M, P Vicentini A, V L Oliveira SM, Carvalho LR, Thompson L, P Mendes R, M M Paniago A. Prevalence of chronic pulmonary aspergillosis regarding time of tuberculosis diagnosis in Brazil. Mycoses 2022; 65:715-723. [PMID: 35524507 DOI: 10.1111/myc.13465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/18/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data on the prevalence of chronic pulmonary aspergillosis (CPA) in patients with active or cured tuberculosis (TB) are scarce, mainly due to diagnostic difficulties. The diagnosis of CPA is based on pulmonary symptoms and chest computed tomography (CT) scans and is considered confirmed when there is microbiological or serological evidence of Aspergillus spp. INFECTION OBJECTIVES To estimate the prevalence of CPA in patients treated or undergoing treatment for PTB, seen in two referral hospitals in Mato Grosso do Sul, Brazil. PATIENTS AND METHODS A total of 193 consecutive patients who were treated or previously treated for pulmonary tuberculosis underwent prospective evaluation: a) clinical evaluation; b) chest CT scan; c) sputum examination-culture for fungi and smears for direct mycology; d) detection of anti-Aspergillus fumigatus antibodies using an enzyme-linked immunosorbent assay Platelia® test; and e) anti-Aspergillus spp. antibodies were assessed via a DID test. RESULTS The global prevalence of CPA was 10.9% (95% confidence interval, 7.2-16.1%), but it increased with the time of TB diagnosis. The variables independently associated with CPA were previous pulmonary tuberculosis over 4 years ago and hemoptysis. Cavities, pleural thickening, and the presence of a fungal ball were the most frequent tomographic findings in patients with CPA. CONCLUSIONS The high prevalence observed and its increase over time suggest the need for continuous surveillance of CPA in patients with active or previous pulmonary tuberculosis and throughout life, with clinical, tomographic, and serological evaluations (ELISA) for a timely diagnosis and a better prognosis.
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Affiliation(s)
- Cláudia E Volpe-Chaves
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Regional Hospital of Mato Grosso do Sul, Campo Grande, Brazil
- Maria Aparecida Pedrossian University Hospital, Campo Grande, Brazil
| | - James Venturini
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Suse B Castilho
- Regional Hospital of Mato Grosso do Sul, Campo Grande, Brazil
| | - Simone S O Fonseca
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Regional Hospital of Mato Grosso do Sul, Campo Grande, Brazil
| | - Thiago F Nunes
- Maria Aparecida Pedrossian University Hospital, Campo Grande, Brazil
| | - Eunice A T Cunha
- Central Laboratory of Mato Grosso do Sul (LACEN-MS), Campo Grande, Brazil
| | - Gláucia M E Lima
- Maria Aparecida Pedrossian University Hospital, Campo Grande, Brazil
| | - Maína O Nunes
- Maria Aparecida Pedrossian University Hospital, Campo Grande, Brazil
| | - Adriana P Vicentini
- Mycoses Immunodiagnostic Laboratory, Immunology Section, Adolfo Lutz Institute, São Paulo, Brazil
| | - Sandra M V L Oliveira
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Lídia R Carvalho
- Institute of Biosciences, Botucatu-São Paulo State University (UNESP), Botucatu, Brazil
| | - Luis Thompson
- Department of Medicine, Infectious Diseases Unit, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Rinaldo P Mendes
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Tropical Diseases Department, School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Anamaria M M Paniago
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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3
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Pan X, Yuan Y, Tian Y, Wang J, Li Y, Tian M. Surgical resection of lupus nephritis with pulmonary Aspergillus infection: a case report and review of the literature. J Int Med Res 2022; 50:3000605221095224. [PMID: 35481443 PMCID: PMC9087245 DOI: 10.1177/03000605221095224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report a 58-year-old Asian woman who was diagnosed with systemic lupus
erythematosus (SLE) and lupus nephritis, together with a mixed pulmonary
bacterial and fungal infection including Aspergillus. The
infection did not respond well to the routine administration of anti-bacterial
and anti-fungal drugs, and the patient’s creatinine levels continued to rise and
protein remained in her urine. The patient’s SLE persisted without going into
remission. Finally, surgical resection of the pulmonary aspergilloma brought the
SLE back under control.
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Affiliation(s)
- Xiaoli Pan
- Department of Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Yuan Yuan
- School of Foreign Languages of Zunyi Medical University, Zunyi 563000, China
| | - Yu Tian
- The Zhuhai Campus of Zunyi Medical University, Zunyi 563000, China
| | - Jinjing Wang
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Yida Li
- Department of Research & Development, ZheJiang TianCheng Network Technology Co., Ltd., JinHua 321000, China
| | - Mei Tian
- Department of Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
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4
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Ando E, Nakasuka T, Kubo T, Taniguchi A, Ninomiya K, Kato Y, Ichihara E, Ohashi K, Rai K, Hotta K, Yamane M, Miyahara N, Tabata M, Maeda Y, Kiura K. Pulmonary Aspergilloma and Allergic Bronchopulmonary Aspergillosis Following the 2018 Heavy Rain Event in Western Japan. Intern Med 2022; 61:379-383. [PMID: 34373373 PMCID: PMC8866789 DOI: 10.2169/internalmedicine.7124-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 16-year-old boy with asthma participated in recovery volunteer work following the 2018 heavy rains in Japan. One month later, he experienced chest pain and dyspnea. Chest computed tomography revealed a cavity with a fungal ball, and Aspergillus fumigatus was detected in his bronchoalveolar lavage fluid. He was treated with voriconazole, but new consolidations appeared rapidly. He also experienced allergic bronchopulmonary aspergillosis. After prednisolone prescription, the consolidations improved; however, his asthma worsened. He underwent partial lung resection to avoid allergens, and his symptoms improved. We must recognize cases of infection after a disaster, especially in patients with chronic respiratory diseases.
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Affiliation(s)
- Eri Ando
- Center for Graduate Medical Education, Okayama University Hospital, Japan
- General Internal Medicine, Okayama Medical Center, Japan
| | - Takamasa Nakasuka
- Allergy and Respiratory Medicine, Okayama University Hospital, Japan
| | - Toshio Kubo
- Center for Clinical Oncology, Okayama University Hospital, Japan
| | - Akihiko Taniguchi
- Allergy and Respiratory Medicine, Okayama University Hospital, Japan
| | - Kiichiro Ninomiya
- Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yuka Kato
- Allergy and Respiratory Medicine, Okayama University Hospital, Japan
- Center for Innovative Clinical Medicine, Okayama University Hospital, Japan
| | - Eiki Ichihara
- Allergy and Respiratory Medicine, Okayama University Hospital, Japan
| | - Kadoaki Ohashi
- Allergy and Respiratory Medicine, Okayama University Hospital, Japan
| | - Kammei Rai
- Allergy and Respiratory Medicine, Okayama University Hospital, Japan
- Hospital-based Cancer registry division, Okayama University Hospital, Japan
| | - Katsuyuki Hotta
- Allergy and Respiratory Medicine, Okayama University Hospital, Japan
- Center for Innovative Clinical Medicine, Okayama University Hospital, Japan
| | - Masaomi Yamane
- Departments of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Nobuaki Miyahara
- Allergy and Respiratory Medicine, Okayama University Hospital, Japan
- Department of Medical Technology, Okayama University Graduate School of Health Sciences, Japan
| | - Masahiro Tabata
- Center for Clinical Oncology, Okayama University Hospital, Japan
| | - Yoshinobu Maeda
- Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Katsuyuki Kiura
- Allergy and Respiratory Medicine, Okayama University Hospital, Japan
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Bongomin F, Olum R, Kwizera R, Baluku JB. Surgical management of chronic pulmonary aspergillosis in Africa: A systematic review of 891 cases. Mycoses 2021; 64:1151-1158. [PMID: 34363630 DOI: 10.1111/myc.13359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/29/2022]
Abstract
Chronic pulmonary aspergillosis (CPA) is an emerging fungal infectious disease of public health importance. We conducted a systematic review of studies reporting the outcomes of patients with CPA managed surgically in Africa. A search of Medline, Embase, Web of Science, Google Scholar and African Journals Online was conducted to identify studies indexed from inception to June 2021 that examined surgical management of CPA in Africa. All articles that presented primary data, including case reports and case series, were included. We excluded review articles. A total of 891 cases (557 males (62.5%), mean age 39.3 years) extracted from 27 eligible studies published between 1976 and 2020 from 11 African countries were included. Morocco (524, 59%) and Senegal (99, 11%) contributed the majority of cases. Active or previous pulmonary tuberculosis was reported in 677 (76.0%) cases. Haemoptysis was reported in 682 (76.5%) cases. Lobectomy (either unilateral or bilateral, n = 493, 55.3%), pneumonectomy (n = 154, 17.3%) and segmentectomy (n = 117, 13.1%) were the most frequently performed surgical procedures. Thirty (4.9%) cases from South Africa received bronchial artery embolisation. Empyema (n = 59, 27.4%), significant haemorrhage (n = 38, 173.7%), incomplete lung expansion (n = 26, 12.1%) and prolonged air leak (n = 24, 11.2%) were the most frequent complications. Overall, 45 (5.1%) patients died. The causes of death included respiratory failure (n = 14), bacterial superinfection/sepsis (n = 10), severe haemorrhage (n = 5), cardiopulmonary arrest (n = 3) and complications of chronic obstructive pulmonary disease (n = 3). The cause of death was either unknown or unspecified in 9 cases. We conclude that surgical treatment had very low mortality rates and maybe considered as first-line management option in centres with experience and expertise in Africa.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Ronald Olum
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Richard Kwizera
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda.,Makerere Lung Institute, Kampala, Uganda
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Ray A, Manikanta J, Singh K, Gabra P, Vyas S, Singh G, Xess I, Sethi P, Meena VP, Soneja M, Sinha S, Wig N, Kabra SK. An open-label non-inferiority randomised control trial comparing nebulised amphotericin B with oral itraconazole in patients with pulmonary aspergilloma. Mycoses 2021; 64:1038-1044. [PMID: 34058036 DOI: 10.1111/myc.13329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pulmonary aspergilloma (PA) is a common complication seen in patients with pulmonary tuberculosis sequelae. Antifungal therapy, including oral azoles, is commonly used though only surgical resection offers curative benefit. Local administration of amphotericin B, like intracavitary instillation, has been effective in aspergilloma patients though nebulised amphotericin B (nAB) has never been formally assessed. OBJECTIVE The aim of this prospective, non-inferior, open-label, randomised control trial is to evaluate the efficacy and safety of nebulised amphotericin B compared to oral itraconazole therapy in the treatment of PA. PATIENTS/METHODS Diagnosed cases of PA (n=33) were randomised into the control group receiving oral itraconazole (n=18) and intervention group receiving nebulised amphotericin B (n = 15). Response to treatment was assessed both clinically and radiologically at the end 6 months. RESULTS AND CONCLUSION The number of patients showing overall improvement at the end of 6 months in the control arm(oral itraconazole) vs intervention arm(nebulised amphotericin B) was 65% (95% CI 38.3-85.8) and 67%(95% CI 38.4%-88.2%), respectively, in the intention-to-treat and 79% (95% CI 49.2%-95.3%), and 65% (95% CI 38.4%-88.2%), respectively, in the per-protocol analysis. While there was no statistically significant difference between the intervention and control arm in both the analyses, non-inferiority was shown in the per-protocol but not in the intention-to-treat analysis. No major adverse events were noted in either group; however, a significant proportion of patients receiving nAB reported minor cough (40%), which, however, did not lead to discontinuation of therapy in any patients. Nebulised amphotericin B can be an effective therapeutic option for pulmonary aspergilloma patients.
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Affiliation(s)
- Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jagdeesh Manikanta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Komal Singh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pavan Gabra
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Surabhi Vyas
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Prayas Sethi
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ved Prakash Meena
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - S K Kabra
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
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7
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Giang NT, Dung LT, Hien NT, Thiet TT, Hiep PS, Pho DC, Hung PN. Plombage for Hemoptysis Control in Pulmonary Aspergilloma: Safety and Effectiveness of Forgettable Surgery in High-Risk Patients. Ann Thorac Cardiovasc Surg 2021; 27:10-17. [PMID: 33408306 PMCID: PMC8043030 DOI: 10.5761/atcs.oa.20-00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives: To evaluate plombage surgery for hemoptysis control in pulmonary aspergilloma in high-risk patients. Methods: This study was carried out on 75 pulmonary aspergilloma patients presenting with hemoptysis that underwent a plombage surgery for approximately 7 years (November 2011–September 2018) at Pham Ngoc Thach Hospital. They revisited the hospital 6 months after plombage surgery and considered plombage removal. The group whose plombage was removed was compared with that whose plombage was retained 6 and 24 months after surgery. Results: Hemoptysis reduced significantly after surgery. Hemoptysis ceased in 91.67% of the patients and diminished in 8.33% of the patients 6 months after surgery. Similarly, hemoptysis ceased in 87.32% of the patients and diminished in 12.68% of the patients 24 months after surgery. Body mass index (BMI) index, Karnofsky score, and forced expiratory volume in one second (FEV1) increased. Plombage surgery was performed with operative time of 129.5 ± 36.6 min, blood loss during operation of 250.7 ± 163.1 mL, and the number of table tennis balls of 4.22 ± 2.02. No deaths related to plombage surgery were recorded. Plombage was removed in 29 cases because of patients’ requirements (89.8%), infection (6.8%), and pain (3.4%). There were no patient developing complications after the treatment and there were no statistically significant differences between the two groups. Conclusions: Plombage surgery is safe and effective for hemoptysis control in pulmonary aspergilloma. To minimize the risk of long-term complications, surgeons should remove the plombage 6 months after the initial operation.
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Affiliation(s)
- Nguyen Truong Giang
- Department of Cardiothoracic Surgery, Military Hospital, Vietnam Military Medical University, Ha Noi, Vietnam
| | - Le Tien Dung
- Department of Thoracic Surgery, Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - Nguyen Thanh Hien
- Department of Thoracic Surgery, Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - Truong Thanh Thiet
- Department of Thoracic Surgery, Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - Phan Sy Hiep
- Department of Thoracic Surgery, Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - Dinh Cong Pho
- Department of Infection Control, Military Hospital, Vietnam Military Medical University, Ha Noi, Vietnam
| | - Pham Ngoc Hung
- Department of Epidemiology, Vietnam Military Medical University, Ha Noi, Vietnam.,Department of Training, Vietnam Military Medical University, Ha Noi, Vietnam
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Furuya N, Kojima K, Marushima H, Kakinuma K, Tsunoda A, Koda E, Tsuruoka H, Nishida K, Inoue T, Saji H, Mineshita M. Successful treatment with nivolumab in a patient with lung adenocarcinoma complicated by pulmonary aspergilloma. Thorac Cancer 2020; 11:3391-3395. [PMID: 32941695 PMCID: PMC7605990 DOI: 10.1111/1759-7714.13662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/02/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) are the key drugs used in patients with non‐small cell lung cancer (NSCLC). However, anti‐PD‐1 therapy might worsen chronic infection by reactivating the immune response to infectious diseases. Here, we describe a case of successful treatment with nivolumab in a patient with NSCLC complicated by pulmonary aspergilloma, which was safely treated by surgical resection before administration of nivolumab. In conclusion, to safely treat patients with locally limited chronic pulmonary aspergillosis (CPA), surgical resection should be considered before ICI therapy.
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Affiliation(s)
- Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Koji Kojima
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hideki Marushima
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazutaka Kakinuma
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Akihito Tsunoda
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Eriko Koda
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hajime Tsuruoka
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kohei Nishida
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takeo Inoue
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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9
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Fukada A, Toyoshima M, Akahori D, Suda T. Pulmonary Aspergilloma with Oxalosis. Intern Med 2018; 57:2765-2766. [PMID: 29709953 PMCID: PMC6191597 DOI: 10.2169/internalmedicine.0747-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Atsuki Fukada
- Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Japan
| | - Mikio Toyoshima
- Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Japan
| | - Daisuke Akahori
- Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Japan
| | - Takafumi Suda
- Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
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10
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Kasprzyk M, Pieczyński K, Mania K, Gabryel P, Piwkowski C, Dyszkiewicz W. Surgical treatment for pulmonary aspergilloma - early and long-term results. Kardiochir Torakochirurgia Pol 2017; 14:99-103. [PMID: 28747940 DOI: 10.5114/kitp.2017.68738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 03/13/2017] [Indexed: 11/25/2022]
Abstract
Introduction Pulmonary aspergilloma is a difficult therapeutic problem due to the low effectiveness of conservative treatment and high surgical morbidity. Aim To analyze the early and late results of surgical treatment for pulmonary aspergilloma. Material and methods From 2005 to 2015, 49 patients were treated surgically for pulmonary aspergilloma. Symptoms occurred in 85.7% of cases, including recurrent hemoptysis in 53%. A history of immunosuppressive therapy or chemotherapy was noted in 24.5% of patients. Complex aspergilloma was diagnosed in 79.6% of cases. Immunological test results were positive in 10.2%, and bronchoalveolar lavage samples were positive for Aspergillus species in 18.5% of cases. In 59.2% of patients, the surgical risk was assessed as ASA 3. Thirty seven patients underwent lobectomy, 3 – pneumonectomy, 7 – wedge resection, 1 – decortication, and 1 – cavernostomy. Results In-hospital mortality was 4.1%. Postoperative complications occurred in 63.3% of patients. The most common complications were: prolonged air leak (26.3%), arrhythmias (20.4%), residual pneumothorax (16.3%), respiratory failure (14.3%), atelectasis (12.3%), and bleeding (12.3%). Of the three patients that underwent pneumonectomy, one died, two required repeat thoracotomy because of bleeding, and all three required prolonged mechanical ventilation. Two patients died during the follow-up period. Aspergilloma did not recur in any of the patients who underwent pulmonary resection. Conclusions Due to the high risk of complications, surgical treatment of pulmonary aspergilloma should be restricted to symptomatic patients in whom lobectomy can be performed. The long-term results of surgical treatment are good, preoperative symptoms abate in most patients, and the rate of aspergillosis recurrence is very low.
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11
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He G, Liu W, Gao Z, Gao Z, Gao H, Wang Y. Intervention treatment on massive hemoptysis of pulmonary aspergilloma. Exp Ther Med 2017; 13:2259-2262. [PMID: 28565835 PMCID: PMC5443225 DOI: 10.3892/etm.2017.4230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 02/24/2017] [Indexed: 12/03/2022] Open
Abstract
Retrospective analysis was carried out on intervention treatment and the effects of massive hemoptysis of pulmonary aspergilloma. Twenty-five cases diagnosed as massive hemoptysis of pulmonary aspergilloma were performed with imaging of bronchial arteries and other related blood vessels in order to assess blood vessel type and the number involved in the disease and perform embolotherapy on the offending artery. There were 68 bleeding arteries in 25 cases, of which there were 36 bronchial arteries (52.94%), 15 intercostal arteries (22.06%), 9 internal thoracic arteries (16.17%), 5 inferior phrenic arteries (7.35%), and 3 pulmonary arterial branches (4.41%) and all of them were in embolism condition. For 25 cases, 21 bleeding cases were stopped immediately (84.00%), 3 bleeding cases were stopped after the 2nd embolism, and 1 case had a small amount of hemoptysis after surgery discontinuously, which was stopped after corresponding treatment with no severe complications. Ten cases used polyvinyl alcohol (PVA) particulate embolization solely, 12 cases used PVA with spring coil and 3 cases used PVA, spring coil and N-butyl cyanoacrylate (NBCA) glue. In conclusion, patients who suffer from massive hemoptysis of pulmonary aspergilloma and whose medical treatments are not effective and who are not willing to receive surgical removal, intervention treatment is an effective method. PVA, spring coil and NBCA glue can be effectively used in hemoptysis embolism and pulmonary artery embolism can be considered when systemic embolism is not effective.
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Affiliation(s)
- Guanghui He
- Department of Interventional Therapy, The Second People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China
| | - Wenyu Liu
- Department of Tuberculosis, The Second People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China
| | - Zhiqiang Gao
- Department of Pharmacy, The Second People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China
| | - Zhi Gao
- Department of Interventional Therapy, The Second People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China
| | - Hongsheng Gao
- Department of Interventional Therapy, The Second People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China
| | - Yanjie Wang
- Department of Interventional Therapy, The Second People's Hospital of Weifang, Weifang, Shandong 261041, P.R. China
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Takahashi-Nakaguchi A, Muraosa Y, Hagiwara D, Sakai K, Toyotome T, Watanabe A, Kawamoto S, Kamei K, Gonoi T, Takahashi H. Genome sequence comparison of Aspergillus fumigatus strains isolated from patients with pulmonary aspergilloma and chronic necrotizing pulmonary aspergillosis. Med Mycol 2015; 53:353-60. [PMID: 25851262 DOI: 10.1093/mmy/myv003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aspergillus fumigatus is the Aspergillus species most commonly associated with aspergillosis. Of the various presentations of aspergillosis, one of the most frequently observed in cases involving A. fumigatus pulmonary infections is aspergilloma (PA). In such infections one finds a fungus ball composed of fungal hyphae, inflammatory cells, fibrin, mucus, and tissue debris. Chronic necrotizing pulmonary aspergillosis (CNPA), also known as semi-invasive or invasive aspergillosis, is locally invasive and predominantly seen in patients with mild immunodeficiency or with a chronic lung disease. In the present study, with the aid of a next-generation sequencer, we conducted whole genome sequence (WGS) analyses of 17 strains isolated from patients in Japan with PA and CNPA. A total of 99,088 SNPs were identified by mapping the reads to A. fumigatus genome reference strain Af293, and according to genome-wide phylogenetic analysis, there were no correlations between the whole genome sequence typing results and pathologic conditions of patients. Here, we conducted the first multi-genome WGS study to focus on the A. fumigatus strains isolated from patients with PA and CNPA, and comprehensively characterized genetic variations of strains. WGS approach will help in better understanding of molecular mechanisms of aspergillosis cases caused by A. fumigatus.
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Affiliation(s)
- Azusa Takahashi-Nakaguchi
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8673, Japan
| | - Yasunori Muraosa
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8673, Japan
| | - Daisuke Hagiwara
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8673, Japan
| | - Kanae Sakai
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8673, Japan
| | - Takahito Toyotome
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8673, Japan Diagnostic Center for Animal Health and Food Safety, Obihiro University of Agriculture and Veterinary Medicine, Nishi 2-11 Inada-cho, Obihiro, Hokkaido 080-8555, Japan
| | - Akira Watanabe
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8673, Japan Division of Control and Treatment of Infectious Diseases, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8673, Japan
| | - Susumu Kawamoto
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8673, Japan
| | - Katsuhiko Kamei
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8673, Japan
| | - Tohru Gonoi
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8673, Japan
| | - Hiroki Takahashi
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8673, Japan
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Gupta PR, Jain S, Kewlani JP. A comparative study of itraconazole in various dose schedules in the treatment of pulmonary aspergilloma in treated patients of pulmonary tuberculosis. Lung India 2015; 32:342-6. [PMID: 26180383 PMCID: PMC4502198 DOI: 10.4103/0970-2113.159563] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The optimal dose, duration, and efficacy of itraconazole in Indian patients of pulmonary aspergilloma (PA) are not clearly defined. Therefore, a study was carried out, to resolve these issues in diagnosed cases of PA complicating old treated patients of pulmonary tuberculosis. MATERIALS AND METHODS The study patients randomly received itraconazole either in a fixed dose schedule of 200 mg (group I), 200 mg twice daily (group II) or a variable dose schedule (group III), for 12 months. All the patients were followed up for the entire duration of the study for clinical, radiological, and immunological response. The side effects were recorded as and when reported by the patients and managed symptomatically. RESULTS A total of 60 patients were enrolled, 20, in each group. There were no intergroup differences with regard to age, sex, body weight, smoking status, alcohol intake, symptoms, Potassium hydroxide (KOH) mount, fungal culture, pattern of radiological lesions or anti-aspergillus antibodies (anti-Asp-Ab) titers. The radiological response was poor in group I patients, as compared to the other groups, at two months (P < 0.05). The dose of itraconazole was increased in five of the patients in group I due to poor response. A higher number of group II patients suffered side effects and the dose of itraconazole had to be decreased in three of these patients, but none of the patients on a variable dose schedule required a change in dose schedule. CONCLUSION Thus, a weight-based variable dose schedule of itraconazole was found to be a more effective and safer modality in the management of PA than a fixed dose schedule.
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Affiliation(s)
- Prahlad Rai Gupta
- Department of Respiratory Medicine, NIMS University, Jaipur, Rajasthan, India
| | - Shubhra Jain
- Department of Respiratory Medicine, NIMS University, Jaipur, Rajasthan, India
| | - Jai Prakash Kewlani
- Department of Respiratory Medicine, NIMS University, Jaipur, Rajasthan, India
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