An albino strain of Aspergillus fumigatus causes pulmonary aspergilloma in an individual with normal immune ;system / 中华皮肤科杂志

A 76?year?old female patient complained of right chest pain for three months. CT scan showed a clump?like high?density shadow measuring 4.8 cm × 3.0 cm in size in the dorsal portion of the right lower lobe of the lung. Aspiration biopsy was performed, and biopsy samples were subjected to fungal culture and histopathological examination. Histopathological examination showed chronic granulomatous inflammation with hyaline septate hyphae. After 4?day culture, white villous dense colonies were formed on the Sabouraud′s agar medium. The center of the colonies was slightly elevated with wrinkles or radiating striae on the surface, and the bottom of the colonies was faint yellow in color. Microculture yielded abundant septate branched hyphae, and very few colorless hyaline quasi?circular spores. DNA sequencing of rDNA internal transcribed spacer (ITS) regions and β?tubulin genes was performed to identify the isolate, and antifungal susceptibility testing was carried out in vitro. The MEGA7.0 software was used to build phylogenetic trees of Aspergillus fumigatus complex and its closely related species. The isolate was identified as Aspergillus fumigatus by molecular biologic sequencing. The patient was diagnosed with pulmonary aspergilloma. After administration of itraconazole oral solution and vorionazole tablets, the condition got better obviously.

The experience share of surgical treatment on 24 cases with pulmonary aspergilloma / 中国综合临床

Objective To improve the diagnosis and surgical management of pulmonary aspergilloma.Methods Twenty-four patients underwent surgical treatment for pulmonary aspergilloma were enrolled in our study from April 2005 to May 2012 at the second hospital of Xiamen.The information of all cases was recorded.Results There were 18 males and 6 females in all subjects,and their age ranged from 22 to 67 year.The surgical outcome were 15 lobectomies,3 segmentectomies or wedge resections,1 right upper and middle lobectomy,1 radical debridement,4 pneumonectomy.Results There was no preoperative mortality.Seven cases (29.2％) developed complications in this series including 1 postoperative bleeding,1 bleeding during operation,2 pulmonary infection,1 bronchial fistula,1 pulmonary reexpansion insufficiency,1 wound infection.Conclusion Surgical resection of pulmonary lesion is the most effective method for pulmonary aspergilloma.Moreover strengthening the perioperative management could decrease the morbidity and mortality.

Resección quirúrgica de aspergiloma en paciente inmunosuprimido: presentación de un caso clínico / Surgical resection of aspergilloma in immunosupressed patient: a case report

Aspergillosis refers to the spectrum of disease caused by Aspergillus species. The aspergilloma is the most common and best-recognized form of pulmonary involvement due to Aspergillus; usually developing in a preformed lung cavity and the principal association is with Tuberculosis. The true incidence of aspergilloma is not known. Although frequently asymptomatic, the presence of a fungus ball due to Aspergillus may cause hemoptysis and in cases can be fatal, with a variable mortality ranging between 9 to 30 percent. Aspergilloma usually comes to clinical attention as an incidental finding, thus the diagnosis involve clinical and radiological findings confirmed by pathology. There is no consistent evidence that aspergilloma. Responds to antifungal agents, and these drugs rarely achieve the minimal inhibitory concentrations within the lung cavities. Surgical resection, despite a high morbidity, is the only proven therapy for these cases.

La aspergilosis se refiere al espectro de enfermedades ocasionadas por la especie de Aspergillus. El aspergiloma es la forma más reconocida y común de la afección pulmonar relacionada a dicha especie, generalmente se desarrolla en una cavidad pulmonar pre-existente, la principal asociación es con secuelas de tuberculosis. Se desconoce la incidencia a nivel mundial. La mayoría de los pacientes se manifiestan asintomáticos; en raras ocasiones, debutan con hemoptisis mayor, con una mortalidad variable que oscila entre el 9 a 30 por ciento. El diagnóstico se basa en los hallazgos clínicos, imagenología y confirmados por patología. El tratamiento farmacológico no ha demostrado ser de gran utilidad, en tanto que, la cirugía a pesar de una elevada morbilidad podría ser el tratamiento de elección.

Pulmonary Spergilloma : An Interesting Case.

In many cases, the diagnosis of pulmonary aspergilloma become difficult on the basis of radiological sign by chest X-ray or computed tomography (CT) scan as it can produce wide variety of radiographic changes. Often there is a diagnostic dilemma between lung malignancy and pulmonary aspergilloma. The diagnosis also can be established by sputum examination and culture. In our case, we report a 40-year old male presented with cough and hemoptysis. He was subsequently diagnosed as a case of pulmonary aspergilloma on the basis of evidence of radiological findings mainly.

Uncommon presentation of pulmonary aspergilloma.

Cases of pulmonary aspergilloma without any predisposing factors are rarely reported. Clinical presentation varies from case to case. Here, we report a case of pulmonary aspergilloma in a 60-year-old male patient who was admitted to the Intensive Respiratory Care Unit with spontaneous pneumothorax. The patient had a history of dyspnea on exertion since 9 months and mild haemoptysis since the last 6 months. A computerised tomographic scan of the lungs showed a lesion in the left main bronchus along with obstructive emphysema of the right lung, moderate pneumothorax and mediastinal emphysema. Bronchoscopy was performed and the biopsy samples were processed for histopathological examination and culture on Sabouraud's dextrose agar, which yielded growth of Aspergillus flavus. Repeat sputum samples also yielded the growth of A. flavus . The patient responded to intravenous liposomaamphotericin B and intercostal drainage.

Clinical Characteristics of Pulmonary Aspergilloma / 결핵

BACKGROUND: Pulmonary aspergillomas usually arise from colonization and proliferation of Aspergillus in preexisting cavitary lung disease of any cause. About 15% of patients with tuberculous pulmonary cavities were found to have aspergilloma. We analyzed the clinical features and course of 91 patients with pulmonary aspergllloma. METHODS: During the ten-year period from June 1986 to May 1996, 91 patients whose condition was diagnosed as pulmonary aspergilloma at 4 university hospitals in Taegu city were reviewed. All patients fulfilled one of the following criteria: 1) histologic evidence of aspergilloma within abnormal air space in tissue sections, or 2) a positive Aspergillus serum precipitin test with the radiologic finding of a fungus ball. The histological diagnosis was established in 81 patients(89.0%) and clinical diagnosis in 10 patients(11.0%). RESULTS: 1) The age range was 22 to 65 years, with an average of 45 years. A male and female ratio was 1.7:1 (57men and 34 women). 2) Hemoptysis was far the most frequent symptom(89%), followed by cough, dyspnea, weakness, weight loss, fever, chest pain. 3) In all but 14 cases(15.4%) there had been associated conditions. Pulmonary tuberculosis was far the most frequent underlying condition found(74.7%), followed by bronchiectasis(6.6%), cavitary neoplasm(2.2%), pulmonary sequestration(1.1%). 4) The involved area was usually in the upper lobes ; the right upper lobe was involved in 39(42.9%), the left upper lobe in 31(34.1%), the left lower lobe in 13(14.3%), the right lower lobe in 7(7.7%), and the right middle lobe in 1(1.1%). 5) On standard chest roent geno gram the classic "bell-like" image of a fungus ball was found in 62.6% of the subjects. On CT scan, 88.1% of the subjects in which they were done. 6) The surgical therapy was undertaken in 76 patients, and medical therapy in 15 patients, including 4 patients with intracavitary instillation of amphotericin B. 7) The surgical modality was lobectomy in 55 patients(72.4%), segmentectomy in 16 patients(21.1%), pneumonectomy in 4 patients(5.3%), wedge resection in 1 patient(1.3%). The mortality rate was 3.9% (3 patients) ; 2 patients died of sepsis and 1 died of hemoptysis. The postoperative complications were encountered in 6 patients(7.9%), including each one patient with respiratory failure, bleeding, bronchopleural fistula, empyema, and vocal cord paralysis. 8) In the follow-up cases, each 2 patients of 71 patients with surgical treatment and 10 patients with medical treatment had recurrent hemoptysis. CONCLUISON: During follow-up of the chronic pulmonary disease with abnormal air space, if the standard chest roentgenograms are insufficient to detect a fungus ball, computed tomographic scan and serum precipitin test are likely to aid the diagnosis of patients with suspected pulmonary aspergilloma. A reasonable recommendation for management of a patient with aspergilloma would be to reserve surgical resection for those patients who have had severe, recurrent hemoptysis. And a well controlled cooperative study to the medical treatment such as intracavitary antifungal therapy is further needed.

A Case of Percutaneous Intracavitary Amphotericin B Injection for the Treatment of Hemoptysis due to Pulmonary Aspergilloma / 결핵

Pulmonary Aspergillomas usually arise from proliferation of Aspergillus in preexisting parenchymal cavities.202 college students (99 men, 103 women) aged 18% 26 years. Fasting blood samples were. The most common symptom in this disorder is hemoptysis, which may be minimal in amount or it may be massive & life threatening. The optimum therapy for pulmonary aspergilloma is controversial. The major options available include surgical resection of the lesion, a number of medical therapies, or simple observation of the patient for a time. Surgery is the most effective treatment but it is limited to some patient because most patients haute underlying pulmonary disease. Thus the various form of medical therapy was available with successful result. The authors present a case of percutaneous intracavitary amphoterician B injection for the treatment of pulmonary aspergilloma & its successful effect for the repetitive hemoptysis.

Clinical observation of the pulmonary aspergilloma / 영남의대학술지

The authors conducted a clinical observation of 13 cases of pulmonary aspergilloma at Yeungnam University Hospital from March 1983 to March 1992, and the following results were observed: 1) The male to female ratio was 1 : 1.2, and the age distribution was ranged 30 to 67 years old. 2) All cases were symptomatic : hemoptysis, cough, sputum and dyspnea. Especially, hemoptysis was the presenting compliant in 10 patients (77%) 3) The underlying lung disease were pulmonary tuberculosis in 9, COPD in 5 and bronchiectasis in 2. 3 cases were without underlying disease. 4) According to radiographic appearance, 8 cases had the typical crescent sign and 5 cases were seen nodular lesion. And the lesions of 11 cases were located in both upper lung. 5) 10 cases were treated with surgical resection. Among these cases, 8 cases were alieved and 2 cases, died. And other 3 cases were treated with conservative treatment. We suggest that these findings would be helpful for the diagnosis and treatment of pulmonary aspergilloma and further study might be needed to evaluate the prognosis of pulmonary aspergilloma.

CT and Chest Radiographic Manifestations of Pulmonary Aspergilloma / 实用放射学杂志

Objective To enhance the knowledge of pulmonary aspergilloma on CT and chest radiography. Methods CT scans and chest radiographs of 10 cases with pulmonary aspergilloma were reviewed retrospectively. Of these 10 patients,9 were men,1 was woman, ranged in age from 25～55 years old(means 36.4 years old).Results Of 10 cases,8 cases manifested themselves as an oval or round masses .9 cases were located both upper lobes. Air crescent sign or air ring sign were shown in all 10 cases. The fungus ball could move with the change of patient’s body position in 3 cases.Conclusion A mobile intracavitary mass with air crescent sign or air ring sign is the imaging characteristic of pulmonary aspergilloma.