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Takeshi Terashima, Taro Shinozaki, Eri Iwami, Takahiro Nakajima, Tatsu Matsuzaki
BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) is an allergic pulmonary disease comprising a complex hypersensitivity reaction to Aspergillus fumigatus. Clinical features of ABPA are wheezing, mucoid impaction, and pulmonary infiltrates. Oral corticosteroids and anti-fungal agents are standard therapy for ABPA, but long-term use of systemic corticosteroids often causes serious side effects. CASE PRESENTATION: A 64-year-old woman was diagnosed with ABPA based on a history of bronchial asthma (from 40 years of age), elevated total IgE, the presence of serum precipitating antibodies and elevated specific IgE antibody to A...
March 27, 2018: BMC Pulmonary Medicine
José-Artur Paiva, Paulo Mergulhão, José Manuel Pereira
PURPOSE OF REVIEW: Filamentous fungi respiratory infections, namely because of Aspergillus, Mucorales, Fusarium, or Scedosporium, show rising incidence and occur more in populations which are not classically immunosuppressed. This and their persistent dismal prognosis are the focus of this review. RECENT FINDINGS: Both an early diagnosis, rooted on a high level of suspicion and based on clinical picture, radiology, cultural microbiological exams, fungal biomarkers, PCR and biopsy, and an early therapy, including immunorecovery, whenever possible, good antifungal selection, and surgery for source control, are paramount to maximize the outcome in these diseases...
April 2018: Current Opinion in Infectious Diseases
Matthew William McCarthy, Thomas J Walsh
The diagnosis and treatment of invasive pulmonary aspergillosis (IPA) are ongoing challenges in clinical practice. While important advances have recently been made, including enhanced diagnostic modalities as well as novel therapeutic and prophylactic options, more effective options are urgently needed as the population of immunocompromised patients continues to expand. Areas covered: In this paper, we review novel approaches to diagnosis of IPA, including multiplex PCR, Matrix Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry and provide a detailed review of the extended-spectrum triazole isavuconazole, which was approved in 2015 to treat IPA...
September 2017: Expert Review of Respiratory Medicine
David Lowes, Khaled Al-Shair, Pippa J Newton, Julie Morris, Chris Harris, Riina Rautemaa-Richardson, David W Denning
Chronic pulmonary aspergillosis (CPA) is a chronic progressive infection that destroys lung tissue in non-immunocompromised patients. Contemporary series suggest 50-85% 5-year mortality, with few prognostic factors identified.A cohort of 387 CPA patients referred to the UK's National Aspergillosis Centre from 1992 to June 2012 was studied until June 2015. The impact of objective and subjective variables including age, sex, previous pulmonary conditions, dyspnoea score, quality of life, serum albumin and C-reactive protein and radiological appearances were assessed using Kaplan-Meier curves, log rank tests and Cox proportional hazards modelling...
February 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Matthew William McCarthy, Daniel Aguilar-Zapata, Vidmantas Petraitis, Thomas J Walsh
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...
March 2017: Expert Review of Respiratory Medicine
José Barberán, Francisco-Javier García-Pérez, Victoria Villena, Alberto Fernández-Villar, Eduardo Malmierca, Cristina Salas, María-José Giménez, Juan-José Granizo, Lorenzo Aguilar
BACKGROUND: A previous study explored factors discriminating colonization and true infection among non-transplant, non-neutropenic patients with repeated Aspergillus spp. isolation from lower respiratory samples. The present study explored the evolution of patients with Aspergillus colonization in that study to determine the percentage of cases progressing to aspergillosis and time to development. METHODS: Clinical records were retrospectively reviewed (for each patient from his end date in the past study) and data from all respiratory processes suffered by patients up to April 2015 were recorded...
January 6, 2017: BMC Infectious Diseases
K F Woolnough, M Richardson, C Newby, M Craner, M Bourne, W Monteiro, S Siddiqui, P Bradding, C H Pashley, A J Wardlaw
BACKGROUND: Immunological biomarkers are the key to the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) and fungal sensitisation, but how these relate to clinically relevant outcomes is unclear. OBJECTIVES: To assess how fungal immunological biomarkers are related to fixed airflow obstruction and radiological abnormalities in moderate to severe asthma. METHODS: Cross-sectional study of 431 asthmatics. Inflammatory biomarkers, lung function and an IgE fungal panel to colonising filamentous fungi, yeasts and fungal aeroallergens were measured...
January 2017: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
Shane R Baistrocchi, Mark J Lee, Melanie Lehoux, Benjamin Ralph, Brendan D Snarr, Robert Robitaille, Donald C Sheppard
Background: Impaired delivery of antifungals to hyphae within necrotic lesions is thought to contribute to therapeutic failure in invasive pulmonary aspergillosis (IPA). We hypothesized that transfusion of leukocytes loaded ex vivo with the lipophilic antifungal posaconazole could improve delivery of antifungals to the sites of established infection and improve outcome in experimental IPA. Methods: The HL-60 leukemia cell line was differentiated to a neutrophil-like phenotype (differentiated HL-60 [dHL-60] cells) and then exposed to a range of posaconazole concentrations...
June 1, 2017: Journal of Infectious Diseases
Ritesh Agarwal, Inderpaul S Sehgal, Sahajal Dhooria, Ashutosh N Aggarwal
Allergic bronchopulmonary aspergillosis (ABPA) is a complex pulmonary disorder characterized by recurrent episodes of wheezing, fleeting pulmonary opacities and bronchiectasis. It is the most prevalent of the Aspergillus disorders with an estimated five million cases worldwide. Despite six decades of research, the pathogenesis, diagnosis and treatment of this condition remains controversial. The International Society for Human and Animal Mycology has formed a working group to resolve the controversies around this entity...
December 2016: Expert Review of Respiratory Medicine
Rose-Anne Lavergne, Taieb Chouaki, Ferry Hagen, Bénédicte Toublanc, Hervé Dupont, Vincent Jounieaux, Jacques F Meis, Florent Morio, Patrice Le Pape
A case of fatal aspergillosis due to a TR46 /Y121F/T289A azole-resistant Aspergillus fumigatus is reported. Environmental investigations at the patient's residence led to the recovery of TR46 /Y121F/T289A isolates, genotypically indistinguishable from the clinical isolate, supporting for the first time the direct role of household as potential source of azole-resistant invasive aspergillosis.
January 1, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Anant Mohan, Pawan Tiwari, Karan Madan, Vijay Hadda, Rosemary Poulose, Ashu S Bhalla, Rohit Khandelwal, Gopi C Khilnani, Randeep Guleria
BACKGROUND: Hemoptysis is common in pulmonary aspergilloma. Current treatment modalities such as surgical resection or bronchial artery embolization (BAE) are limited by lack of technical expertise and risk of recurrence, respectively. We describe our experience of treating aspergilloma and hemoptysis with bronchoscopic instillation of voriconazole. METHODS: We retrospectively reviewed records of patients with symptomatic aspergilloma undergoing bronchoscopic voriconazole instillation...
January 2017: Journal of Bronchology & Interventional Pulmonology
Linna Huang, Hangyong He, Yi Ding, Jingjing Jin, Qingyuan Zhan
INTRODUCTION: The important role of radiological examinations of invasive pulmonary aspergillosis (IPA) in patients with neutropenia has been well studied; however, little is known about IPA in critically ill chronic obstructive pulmonary disease (COPD) patients. OBJECTIVES: To evaluate the value of radiological examinations in the diagnosis and prognosis of invasive bronchial-pulmonary aspergillosis (IBPA) in critically ill COPD patients. METHODS: We included 61 critically ill COPD patients in the intensive care unit (ICU) in a retrospective, single-center cohort study...
February 2018: Clinical Respiratory Journal
Eavan G Muldoon, Anna Sharman, Iain Page, Paul Bishop, David W Denning
BACKGROUND: There are a number of different manifestations of pulmonary aspergillosis. This study aims to review the radiology, presentation, and histological features of lung nodules caused by Aspergillus spp. METHODS: Patients were identified from a cohort attending our specialist Chronic Pulmonary Aspergillosis clinic. Patients with cavitating lung lesions, with or without fibrosis and those with aspergillomas or a diagnosis of invasive aspergillosis were excluded...
August 18, 2016: BMC Pulmonary Medicine
Thomas F Patterson, George R Thompson, David W Denning, Jay A Fishman, Susan Hadley, Raoul Herbrecht, Dimitrios P Kontoyiannis, Kieren A Marr, Vicki A Morrison, M Hong Nguyen, Brahm H Segal, William J Steinbach, David A Stevens, Thomas J Walsh, John R Wingard, Jo-Anne H Young, John E Bennett
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
August 15, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Ashok Shah, Chandramani Panjabi
In susceptible individuals, inhalation of Aspergillus spores can affect the respiratory tract in many ways. These spores get trapped in the viscid sputum of asthmatic subjects which triggers a cascade of inflammatory reactions that can result in Aspergillus-induced asthma, allergic bronchopulmonary aspergillosis (ABPA), and allergic Aspergillus sinusitis (AAS). An immunologically mediated disease, ABPA, occurs predominantly in patients with asthma and cystic fibrosis (CF). A set of criteria, which is still evolving, is required for diagnosis...
July 2016: Allergy, Asthma & Immunology Research
Isobel Ramsay, Rebecca L Gorton, Mauli Patel, Sarita Workman, Andrew Symes, Tanzina Haque, Dianne Irish, Suranjith L Seneviratne, Siobhan O Burns, Emmanuel Wey, David M Lowe
BACKGROUND: Therapeutic immunoglobulins are used as replacement or immunomodulatory therapy, but can transmit clinically important molecules. We investigated hepatitis B virus (HBV) antibodies and galactomannan enzyme immunoassay (GM-EIA) positivity. Detection of HBV core antibody may prompt antiviral prophylaxis when commencing therapy such as rituximab; a positive GM-EIA result prompts investigation or treatment for invasive fungal disease. METHODS: We performed a cross-sectional analysis of HBV serology in 80 patients established (>6 months) on immunoglobulin therapy; prospective analysis of HBV serology in 16 patients commencing intravenous immunoglobulin (IVIG); and pre- and post-infusion analysis of GM-EIA in 37 patients receiving IVIG...
July 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Cendrine Godet, François Laurent, Anne Bergeron, Pierre Ingrand, Catherine Beigelman-Aubry, Boubou Camara, Vincent Cottin, Patrick Germaud, Bruno Philippe, Christophe Pison, Cécile Toper, Marie France Carette, Jean-Pierre Frat, Guillaume Béraud, France Roblot, Jacques Cadranel
BACKGROUND: Long-term antifungal therapy is usually the only treatment option for chronic pulmonary aspergillosis. However, response rates are difficult to compare because the reported clinical, mycologic, or radiologic criteria are not standardized. Objective parameters are therefore needed. To define the most relevant CT imaging variables in assessment of response to treatment, we investigated changes over time in CT imaging variables. METHODS: Changes in CT imaging variables were assessed by systematic analysis of the CT scan findings of 36 patients at diagnosis and 6 months after initiation of treatment...
July 2016: Chest
Koichi Izumikawa
Chronic pulmonary aspergillosis (CPA) is a slowly progressing pulmonary syndrome caused by Aspergillus spp. Specific knowledge regarding the disease entity, diagnosis method, and management is needed. This review focuses on the recent advances in our understanding of CPA. A new clinical disease entity of chronic progressive pulmonary aspergillosis consisting of chronic necrotizing pulmonary aspergillosis and chronic cavitary pulmonary aspergillosis is proposed. Although newer antifungals are not available, evidence describing the treatment of CPA is accumulating...
March 2016: Respiratory Investigation
Desiree Larenas-Linnemann, Sachin Baxi, Wanda Phipatanakul, Jay M Portnoy
Fungus-sensitized patients usually present with symptoms that are similar to symptoms presented by those who are sensitized to other aeroallergens. Therefore, diagnosis and management should follow the same pathways used for patients with allergic conditions in general. The physician should consider that a relationship between fungal exposure and symptoms is not necessarily caused by an IgE-mediated mechanism, even when specific fungal IgE is detected. Until recently, IgE-mediated allergy has been documented only for a limited number of fungi...
May 2016: Journal of Allergy and Clinical Immunology in Practice
Yuma Fukutomi, Hidenori Tanimoto, Hiroshi Yasueda, Masami Taniguchi
Prompt diagnosis of allergic bronchopulmonary mycosis (ABPM) is an important clinical issue in preventing irreversible lung damage. Therefore, a good serological marker for the diagnosis of ABPM is desired in clinical practice. The measurement of IgE antibody to crude Aspergillus fumigatus allergen is considered the first step in screening asthmatic patients for allergic bronchopulmonary aspergillosis (ABPA). However, presence of IgE to A. fumigatus does not always indicate genuine sensitization to A. fumigatus because of cross-reactivity between crude extracts from different fungal sources...
January 2016: Allergology International: Official Journal of the Japanese Society of Allergology
2016-01-09 12:46:35
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