Endobronchial aspergilloma-a comprehensive literature review with focus on diagnosis and treatment modalities.

Endobronchial aspergilloma (EBA) is a rare manifestation of pulmonary infection with Aspergillus spp. Comprised of hyphae, mucus, and cellular debris, the massive fungus overgrowth can lead to obstructive pneumonitis in large airways, manifesting as cough, dyspnea, hemoptysis, or weight loss. The aim of this paper is to review the literature on endobronchial aspergilloma to further elucidate this disease entity and to classify it as a non-invasive form of pulmonary aspergillosis. A descriptive analysis was performed on articles on PubMed database that contained the key word "endobronchial aspergilloma." A total of 28 cases were obtained. Four articles were excluded as they were not available in the English format. Although EBA is extremely rare, it should be considered in the differential diagnosis of endobronchial masses in immunocompromised patients. There is a potential for the disease entity to progress to tracheobronchitis and fulminant respiratory failure. As such, early detection with bronchoscopy, biopsy, and culture is required to confirm pulmonary aspergillosis. Current treatment regimens remain to be optimized, though piecemeal resection of the mycetoma with bronchoscopic techniques with the addition of systemic antifungals and their combinations has been reported as efficacious.

[Chronic pulmonary aspergillosis].

Chronic pulmonary aspergillosis (CPA) is an overlooked disease category in which delay of diagnosis and treatment is associated with increased mortality. A prerequisite for prognostic optimization of CPA is an increased focus on predisposing factors and patients at risk. Diagnosis of CPA is challenging and requires a systematic approach to assessment and interpretation of findings, both of which are necessary for correct disease classification and selection of targeted antifungal treatment and duration.

Diagnosis, classification, and therapeutic interventions for sinopulmonary Aspergillosis.

INTRODUCTION: Sinopulmonary aspergillosis represents a diverse collection of allergic, invasive, and chronic sinus and respiratory conditions. These diseases can affect patients with and without immune impairment and in some cases may be life-threatening. Areas covered: We review the diagnosis, classification, and therapeutic options available to treat sinopulmonary aspergillosis and look ahead to emerging diagnostic and therapeutic options that may soon play an important role in clinical practice. Expert commentary: Histopathology and tissue culture remain the gold standard for the diagnosis of invasive sinopulmonary aspergillosis, but several new molecular detection methods have recently emerged, including various PCR-based platforms, MALDI-TOF, and lateral flow assays. We examine these methodologies as well as the barriers associated with the standardization, validation, and implementation. We also explore the pipeline of antifungal agents in development to treat sinopulmonary aspergillosis.

[Mixed types of pulmonary aspergillosis].

OBJECTIVE: To describe the clinical features of mixed types of pulmonary aspergillosis (MTPA), and therefore to improve the diagnosis and treatment of MTPA. METHODS: This study retrospectively analyzed 3 patients with MTPA in Peking University First Hospital from November 2010 to 2012. "Invasive pulmonary aspergillosis (IPA), pulmonary aspergilloma, allergic bronchopulmonary aspergillosis (ABPA)" were used as the Chinese and English keywords, to search the literatures from Wanfang database and Pubmed database until to May 2014. RESULTS: There were 3 patients with MTPA, respectively with aspergilloma and IPA (patient 1), ABPA and IPA (patient 2), aspergilloma and IPA (patient 3). The cultures of respiratory secretions of the patients all yielded A.fumigatus. Patient 1 was treated by amphotericin B; Patient 2 was treated by intravenous itraconazole and glucocorticoid; Patient 3 was treated by oral voriconazole and inhaled corticosteroid, and the aspergilloma was surgically removed at the same time. Eventually, patients 1 and 2 died, while the symptoms of patient 3 were significantly improved. Drug sensitivity test of A. fumigatus showed resistance to amphotericin B or itraconazole. By far there was no concept of MTPA in the literatures and there were only 3 relevant case reports. CONCLUSION: MTPA is a new subtype of pulmonary aspergillosis, which is more complicated and severe, and perhaps with drug resistance. MTPA should be treated by comprehensive therapies on the basis of sensitive and effective antifungal drugs.

Chronic pulmonary aspergillosis: an update on diagnosis and treatment.

Chronic pulmonary aspergillosis (CPA) affects individuals with non-systemic or mildly systemic immunodepression or altered pulmonary integrity due to underlying disease. It has been reported with a variety of clinical and radiological patterns. The condition should be distinguished from simple aspergilloma and allergic bronchopulmonary aspergillosis as well as invasive aspergillosis in severely immunocompromised patients. CPA generally requires long-term antifungal treatment and surgery may be considered. Life-threatening haemoptysis may be prevented by bronchial arteriography with embolisation. However, currently there are no documented treatment recommendations for CPA. This review provides an up-to-date practical overview of this condition, including a comprehensive update on diagnosis and management.

[Invasive pulmonary aspergillosis and chronic pulmonary aspergillosis]. / Aspergillose pulmonaire invasive et aspergilttose pulmonaire chronique.

Aspergillus pulmonary infection causes a spectrum of diverse diseases according to host immunity. The two major entities are invasive pulmonary aspergillosis and chronic pulmonary aspergillosis. The later can be divided into aspergilloma, then into chronic cavitary, more or less fibrosing aspergillosis, and finally into chronic necrotizing aspergillosis, or semiinvasive aspergillosis. The present article reviews this complex classification, which is necessary to reflect the diverse clinical aspect of the disease. Allergic broncho-pulmonary aspergillosis (ABPA), which is more a hypersensitivity reaction than an infectious process, will not be discussed here.

[Frequency of pulmonary mycoses determined by analyzing lung secretion samples]. / Micosis pulmonares en pacientes de la Quinta Región: Período 2007-2010.

BACKGROUND: The frequency of pulmonary mycoses has increased in the past few years specially in immunocompromised patients. AIM: To determine the frequency of invasive fungal diseases by analyzing lung secretion samples. MATERIAL AND METHODS: Samples of bronchoalveolar lavage (BAL) tracheal aspiration (TA) and induced sputum (IS) were obtained from patients of five hospitals in the Valparaíso Region for the diagnosis of invasive or non-invasive fungal disease, and pneumocystis (PCP), in the period 2007-2010. Clinical data of patients was obtained reviewing medical records or interviewing attending physicians. The diagnosis considered the clinical condition of the patient (immunocompromised or prior lung damage), computed tomography imaging, direct microscopy and cultures. European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria was used for the diagnosis of invasive fungal diseases. RESULTS: Ninety respiratory samples were received and 39 fungal infections were diagnosed. Eleven were probably invasive, seven were non-invasive and 21 were PCP. All patients with probable invasive disease had neutropenia. Most patients with non-invasive infections had bronchiectasis. Aspergillus fumigatus was the main causing agent in both invasive and non-invasive fungal diseases. Patients with PCP were mostly adults with AIDS and children with leukemia. The total mortality rate of patients with invasive fungal disease was of 73%. No deaths were recorded among patients with non-invasive disease. Among patients with PCP, three of 11 HIV and six of 10 non HIV subjects died. CONCLUSIONS: Aspergillus fumigatus predominates both in invasive and non-invasive pulmonary mycoses. The former has a high mortality. PCP occurred mainly in adult patients with HIV-AIDS.

Micosis pulmonares en pacientes de la Quinta Región: Período 2007-2010 / Frequency of pulmonary mycoses determined by analyzing lung secretion samples

Background: The frequency of pulmonary mycoses has increased in the past few years specially in immunocompromised patients. Aim: To determine the frequency of invasive fungal diseases by analyzing lung secretion samples. Material and Methods: Samples of bronchoalveolar lavage (BAL) tracheal aspiration (TA) and induced sputum (IS) were obtained from patients of five hospitals in the Valparaíso Region for the diagnosis of invasive or non-invasive fungal disease, and pneumocystis (PCP), in the period 2007-2010. Clinical data of patients was obtained reviewing medical records or interviewing attending physicians. The diagnosis considered the clinical condition of the patient (immunocompromised or prior lung damage), computed tomography imaging, direct microscopy and cultures. European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria was used for the diagnosis of invasive fungal diseases. Results: Ninety respiratory samples were received and 39 fungal infections were diagnosed. Eleven were probably invasive, seven were non-invasive and 21 were PCP. All patients with probable invasive disease had neutropenia. Most patients with non-invasive infections had bronchiectasis. Aspergillus fumigatus was the main causing agent in both invasive and non-invasive fungal diseases. Patients with PCP were mostly adults with AIDS and children with leukemia. The total mortality rate of patients with invasive fungal disease was of 73%. No deaths were recorded among patients with non-invasive disease. Among patients with PCP, three of 11 HIV and six of 10 non HIV subjects died. Conclusions: Aspergillus fumigatus predominates both in invasive and non-invasive pulmonary mycoses. The former has a high mortality. PCP occurred mainly in adult patients with HIV-AIDS.

[Analysis of endobronchial aspergillosis in patients without obvious systemic predisposing factors].

BACKGROUND: Endobronchial aspergillosis is still an insufficiently recognized concept. PATIENTS AND METHODS: Ten patients who did not have obvious predisposing factors and parenchymal fungal infection were analyzed. They were confirmed to have endobronchial Aspergillus by histology and culture, and were classified according to the presence of bronchiectasis, allergic reaction, and asthmatic symptom. RESULTS: Bronchiectasis was detected in all 10 patients, IgE elevation (>370 IU/ml) in 7, Aspergillus specific IgE-RAST in 8, eosinophilia in 7, and asthmatic symptom in 5. Cases were classified into allergic bronchopulmonary aspergillosis (ABPA) (5 cases), ABPA not fulfilling Rosenberg's criteria (2 cases), and endobronchial aspergilloma (3 cases). CONCLUSION: We proposed classifying endobronchial aspergillosis without obvious systemic predisposing factors into "ABPA", "ABPA without asthma", "ABPA-S (seropositive)", and "Endobronchial aspergilloma". A fifth subtype of endobronchial aspergillosis containing "saprophyte" is warranted.