scholarly journals ASPERGILLOSIS

2018 ◽  
Vol 25 (06) ◽  
pp. 971-974
Author(s):  
Javaria Rasheed ◽  
Rushan Hassan ◽  
Muhammad Khalid ◽  
Fauzia Zafar
Keyword(s):  
Cystic Fibrosis ◽  
Aspergillus Fumigatus ◽  
Chronic Lung Disease ◽  
Low Dose ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Treatment Strategies ◽  
Financial Constraint ◽  
Appropriate Treatment ◽  
History Of ◽  
Lung Infiltrates

Allergic bronchopulmonary aspergillosis (ABPA) is an illness caused byhypersensitivity to colonized Aspergillus fumigatus, mostly involving susceptible adult patientswith history of asthma and cystic fibrosis. Timely given appropriate treatment can reduceclinical symptoms, decrease lung infiltrates and stop progression to chronic lung disease. Inliterature review, treatment strategies used in ABPA children are limited. Herein we present acase of 10-year old asthmatic girl who, on developing ABPA, was successfully treated by theuse of low dose corticosteroids combined with itraconazole for 3 months duration. We suggestthat in financial constraint circumstances, ABPA in children can be successfully treated withoutanti-IgE therapy.

scholarly journals High Prevalence of Azole-Resistant Aspergillus fumigatus in Adults with Cystic Fibrosis Exposed to Itraconazole

2011 ◽  
Vol 56 (2) ◽  
pp. 869-874 ◽  
Author(s):  
Pierre-Régis Burgel ◽  
Marie-Thérèse Baixench ◽  
Michaël Amsellem ◽  
Etienne Audureau ◽  
Jeanne Chapron ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Aspergillus Fumigatus ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Previous Treatment ◽  
University Hospital ◽  
Clinical Implications ◽  
Content Type ◽  
Microdilution Method ◽  
Broth Microdilution Method ◽  
High Prevalence

ABSTRACTAspergillus fumigatusis the most frequent fungus found in the sputum of cystic fibrosis (CF) subjects. Itraconazole is prescribed for allergic bronchopulmonary aspergillosis (ABPA) orAspergillusbronchitis in CF subjects. We hypothesized thatA. fumigatusisolates in the sputum of CF subjects with previous exposure to itraconazole was associated with higher prevalence of azole resistance. From June 2010 to April 2011, sputum samples from adult CF subjects at Cochin University Hospital (France) were examined systematically for the detection ofA. fumigatus. MICs ofA. fumigatusisolates against azoles were screened using Etest, and reduced susceptibility to azoles was confirmed using the CLSI broth microdilution method.A. fumigatuswas isolated from the sputum of 131/249 (52.6%) adult CF subjects, and 47/131 (35.9%) subjects had received previous treatment with itraconazole. ReducedA. fumigatussusceptibility to itraconazole (MIC, ≥2 mg/liter) was confirmed in 6/131 (4.6%) subjects. All 6 isolates also had reduced susceptibility to posaconazole (MIC, ≥0.5 mg/liter), and 3/6 isolates had reduced susceptibility to voriconazole (MIC, ≥2 mg/liter). Mutations in thecyp51Agene were detected at positions previously implicated to cause resistance in 5 isolates. Azole-resistantA. fumigatusisolates were found in 5/25 (20%) subjects exposed to itraconazole within the previous 3 years. High rates of azole-resistantA. fumigatusisolates were present in adult CF subjects and were associated with recent itraconazole exposure. Although the clinical implications of these findings will require further studies, the cautious use of itraconazole in adult CF subjects can be recommended.

scholarly journals Management Considerations in Ruptured Isolated Radiculopial Artery Aneurysms

2013 ◽  
Vol 19 (1) ◽  
pp. 60-66 ◽  
Author(s):  
A.C.G.M. Van Es ◽  
P.A. Brouwer ◽  
P.W.A. Willems
Keyword(s):  
Surgical Treatment ◽  
Management Strategy ◽  
Clinical Course ◽  
Treatment Strategies ◽  
The Other ◽  
Posterior Spinal Artery ◽  
Appropriate Treatment ◽  
History Of ◽  
Clinical Paradigm ◽  
Slight Growth

Little is known on the natural history of ruptured isolated aneurysms of the posterior spinal artery (PSA). To date, only a few of such cases have been described in the literature. This paper aims to assess the most appropriate management strategy, based on the available literature and two new cases. In one of these, treatment was postponed until day 33, when angiography showed slight growth of the aneurysm. In the other, conservative treatment, requested by the patient, was successful. From these data, we conclude that treatment strategies for ruptured PSA aneurysms may vary. Aside from the recommendation by others to perform prompt surgical treatment, we suggest an alternative clinical paradigm allowing for the evaluation of the early clinical course. This may preclude the unnecessary treatment of spontaneously regressing lesions and still allows for appropriate treatment for persistent lesions.

scholarly journals Aspergillus fumigatus In-Host HOG Pathway Mutation for Cystic Fibrosis Lung Microenvironment Persistence

mBio ◽  
2021 ◽  
Vol 12 (4) ◽  
Author(s):  
Brandon S. Ross ◽  
Lotus A. Lofgren ◽  
Alix Ashare ◽  
Jason E. Stajich ◽  
Robert A. Cramer
Keyword(s):  
Cystic Fibrosis ◽  
Aspergillus Fumigatus ◽  
Disease Progression ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Clinical Manifestations ◽  
Cystic Fibrosis Lung ◽  
Hog Pathway ◽  
Content Type

Aspergillus fumigatus infection causes a spectrum of clinical manifestations. For individuals with cystic fibrosis (CF), allergic bronchopulmonary aspergillosis (ABPA) is an established complication, but there is a growing appreciation for A. fumigatus airway persistence in CF disease progression.

scholarly journals Prospective Evaluation of Aspergillus fumigatus-Specific IgG in Patients With Cystic Fibrosis

2021 ◽  
Vol 10 ◽  
Author(s):  
Patience Eschenhagen ◽  
Claudia Grehn ◽  
Carsten Schwarz
Keyword(s):  
Cystic Fibrosis ◽  
Aspergillus Fumigatus ◽  
Sensitivity And Specificity ◽  
Statistical Significance ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Control Group ◽  
Opportunistic Fungi ◽  
Significant Difference ◽  
Specific Igg

BackgroundIn Cystic Fibrosis (CF), the airways are often colonized by opportunistic fungi. The most frequently detected mold is Aspergillus fumigatus (Af). Af diseases are associated with significant morbidity and mortality. The most common clinical picture caused by Af is allergic bronchopulmonary aspergillosis (ABPA), triggered by an immunological reaction against Af. Af bronchitis and invasive aspergillosis rarely occur in CF as a result of spore colonization and germination. Since pulmonary mycoses and exacerbations by other pathogens overlap in clinical, radiological, and immunological characteristics, diagnosis still remains a challenge. The search for reliable, widely available biomarkers for Af diseases is therefore still an important task today.ObjectivesAf-specific IgG m3 is broadly available. Sensitivity and specificity data are contradictory and differ depending on the study population. In our prospective study on pulmonary Af diseases in CF, we determined specific IgG m3 in order to test its suitability as a biomarker for acute Af diseases and as a follow-up parameter.MethodsIn this prospective single center study, 109 patients with CF were screened from 2016 to 2019 for Af-associated diseases. According to diagnostic criteria, they were divided into four groups (control, bronchitis, ABPA, pneumonia). The groups were compared with respect to the level of Af-specific IgG (ImmunoCAP Gm3). We performed a receiver operating characteristic (ROC) curve analysis to determine cut-off, sensitivity and specificity. Twenty-one patients could be enrolled for a follow-up examination.ResultsOf the 109 patients, 36 were classified as acute Af-disease (Af bronchitis, ABPA, Af pneumonia). Of these, 21 patients completed follow up-screening. The median Af-specific Gm3 was higher in the acute Af-disease groups. There was a significant difference in Af-specific IgG m3 compared to the control group without acute Af-disease. Overall, there was a large interindividual distribution of Gm3. A cut-off value of 78.05 mg/L for Gm3 was calculated to discriminate controls and patients with ABPA/pneumonia with a specificity of 75% and a sensitivity of 74.6%. The follow up examination of 21 patients showed a decrease of Gm3 in most patients without statistical significance due to the small number of follow up patients.ConclusionAf specific IgG may be a useful biomarker for acute ABPA and Af pneumonia, but not for Af bronchitis in CF. However, due to the large interindividual variability of Gm3, it should only be interpreted alongside other biomarkers. Therefore, due to its broad availability, it could be suitable as a biomarker for ABPA and Af pneumonia in CF, if the results can be supported by a larger multicenter cohort.

scholarly journals Case Report: Allergic Bronchopulmonary Aspergillosis Revealing Asthma

2021 ◽  
Vol 12 ◽  
Author(s):  
Houda Snen ◽  
Aicha Kallel ◽  
Hana Blibech ◽  
Sana Jemel ◽  
Nozha Ben Salah ◽  
...  
Keyword(s):  
Aspergillus Fumigatus ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Acute Bronchitis ◽  
Specific Ige ◽  
High Dose ◽  
Drug Induced ◽  
Pulmonary Disorder ◽  
Oral Corticosteroids ◽  
History Of ◽  
Atypical Presentations

Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder caused by hypersensitivity to Aspergillus which colonizes the airways of patients with asthma and cystic fibrosis. Its diagnosis could be difficult in some cases due to atypical presentations especially when there is no medical history of asthma. Treatment of ABPA is frequently associated to side effects but cumulated drug toxicity due to different molecules is rarely reported. An accurate choice among the different available molecules and effective on ABPA is crucial. We report a case of ABPA in a woman without a known history of asthma. She presented an acute bronchitis with wheezing dyspnea leading to an acute respiratory failure. She was hospitalized in the intensive care unit. The bronchoscopy revealed a complete obstruction of the left primary bronchus by a sticky greenish material. The culture of this material isolated Aspergillus fumigatus and that of bronchial aspiration fluid isolated Pseudomonas aeruginosa. The diagnosis of ABPA was based on elevated eosinophil count, the presence of specific IgE and IgG against Aspergillus fumigatus and left segmental collapse on chest computed tomography. The patient received an inhaled treatment for her asthma and a high dose of oral corticosteroids for ABPA. Her symptoms improved but during the decrease of corticosteroids, the patient presented a relapse. She received itraconazole in addition to corticosteroids. Four months later, she presented a drug-induced hepatitis due to itraconazole which was immediately stopped. During the monitoring of her asthma which was partially controlled, the patient presented an aseptic osteonecrosis of both femoral heads that required surgery. Nine months after itraconazole discontinuation, she presented a second relapse of her ABPA. She received voriconazole for nine months associated with a low dose of systemic corticosteroid therapy with an improvement of her symptoms. After discontinuation of antifungal treatment, there was no relapse for one year follow-up.

Hemorrhagic Retinopathy in a Patient With Cystic Fibrosis

PEDIATRICS ◽  
1978 ◽  
Vol 62 (3) ◽  
pp. 336-338
Author(s):  
Mary E. Rimsza ◽  
Lucy S. Hernried ◽  
Allen M. Kaplan
Keyword(s):  
Cystic Fibrosis ◽  
Lung Disease ◽  
High Altitude ◽  
Chronic Lung Disease ◽  
Retinal Hemorrhages ◽  
History Of ◽  
Chronic Hypoxemia

A 21-year-old woman with a history of chronic lung disease secondary to cystic fibrosis (CF) developed an acute hemorrhagic retinopathy during exposure to moderately high altitude. Although retinal hemorrhages are known to occur in patients with CF, we speculate that the retinopathy in this case was partially related to altitudinal change and that patients with chronic hypoxemia may be predisposed to high-altitude retinopathy at much lower altitudes.

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