Chronic pulmonary aspergillosis - longterm follow-up over 20 years, a case report

Lung resection surgery for non-small-cell lung cancer (NSCLC) is reportedly a risk factor for developing chronic pulmonary aspergillosis (CPA). However, limited data are available regarding the development of CPA during long-term follow-up after lung cancer surgery. This study aimed to investigate the cumulative incidence and clinical factors associated with CPA development after lung cancer surgery. We retrospectively analyzed 3423 patients with NSCLC who (1) underwent surgical resection and (2) did not have CPA at the time of surgery between January 2010 and December 2013. The diagnosis of CPA was based on clinical symptoms, serological or microbiological evidences, compatible radiological findings, and exclusion of alternative diagnoses. The cumulative incidence of CPA and overall survival (OS) were estimated using the Kaplan–Meier method, and a multivariable Cox proportional hazard analysis was performed to identify factors associated with CPA development. Patients were followed-up for a median of 5.83 years with a 72.3% 5-year OS rate. Fifty-six patients developed CPA at a median of 2.68 years after surgery, with cumulative incidences of 0.4%, 1.1%, 1.6%, and 3.5% at 1, 3, 5, and 10 years, respectively. Lower body mass index (BMI), smoking, underlying interstitial lung disease, thoracotomy, development of postoperative pulmonary complications 30 days after surgery, and treatment with both chemotherapy and radiotherapy were independently associated with CPA development. The cumulative incidence of CPA after surgery was 3.5% at 10 years and showed a steadily increasing trend during long-term follow-up. Therefore, increased awareness regarding CPA development is needed especially in patients with risk factors.

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Long-term follow-up: tuberculosis, bronchiectasis and chronic pulmonary aspergillosis

Pneumologia ◽

10.2478/pneum-2019-0020 ◽

2019 ◽

Vol 68 (3) ◽

pp. 138-143

Author(s):

Oxana Munteanu ◽

Dumitru Chesov ◽

Doina Rusu ◽

Irina Volosciuc ◽

Victor Botnaru

Keyword(s):

Past History ◽

Natural Evolution ◽

Pulmonary Aspergillosis ◽

Long Term Follow Up ◽

History Of ◽

Chronic Pulmonary Aspergillosis ◽

The Impact

Abstract Pulmonary sequelae related to tuberculosis (TB) are among the major causes of bronchiectasis in Eastern Europe. The role of bacterial colonisation in the pathogenesis of bronchiectasis has been continuously studied over the last decades, less understood remains the impact of fungal infection, alone or in association with bacterial. Although the data on the development of chronic pulmonary aspergillosis (CPA) secondary to TB are scarce, recent evidence suggests a higher prevalence of CPA in patients with a past history of pulmonary TB than it was previously estimated. We present a case of natural evolution of CPA, with a radiological follow-up, in a patient with post-tuberculous bronchiectasis.

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Pulmonary infection due to Acrophialophora fusispora in a patient with underlying mixed connective tissue disease and chronic pulmonary aspergillosis: A case report and review of literature

Journal de Mycologie Médicale ◽

10.1016/j.mycmed.2020.100932 ◽

2020 ◽

Vol 30 (2) ◽

pp. 100932 ◽

Cited By ~ 1

Author(s):

A. Samaddar ◽

A. Sharma ◽

T. Shrimali

Keyword(s):

Case Report ◽

Connective Tissue ◽

Connective Tissue Disease ◽

Mixed Connective Tissue Disease ◽

Pulmonary Infection ◽

Review Of Literature ◽

Pulmonary Aspergillosis ◽

Chronic Pulmonary Aspergillosis

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Selection of Oral Antifungals for Initial Maintenance Therapy in Chronic Pulmonary Aspergillosis: A Longitudinal Analysis

Clinical Infectious Diseases ◽

10.1093/cid/ciz287 ◽

2019 ◽

Cited By ~ 5

Author(s):

Masato Tashiro ◽

Takahiro Takazono ◽

Tomomi Saijo ◽

Kazuko Yamamoto ◽

Yoshifumi Imamura ◽

...

Keyword(s):

Maintenance Therapy ◽

Cox Regression ◽

Limited Data ◽

Pulmonary Aspergillosis ◽

Cox Regression Analysis ◽

Crude Mortality ◽

Oral Itraconazole ◽

Chronic Pulmonary Aspergillosis ◽

Observation Period

Abstract Background There are limited data for direct comparisons of the efficacy of oral itraconazole (ITCZ) and oral voriconazole (VRCZ) therapy in the treatment of chronic pulmonary aspergillosis (CPA). Methods We conducted a retrospective, follow-up, observational study of CPA patients enrolled in 2 previous multicenter trials. Results Of the 273 CPA patients, 59 and 101 patients started maintenance therapy with oral ITCZ and oral VRCZ, respectively, just after the end of acute intravenous therapy in each trial. At the end of the observation period in this follow-up study (median observation period, 731 days), the percentage of patients who showed improvement was lower in the ITCZ group than in the VRCZ group (18.2% vs 40.0%). However, after including stable patients, the percentages were 50.9% and 52.6%, respectively, in the ITCZ and VRCZ groups, which were not significantly different (P = .652). Multivariable Cox regression analysis showed no significant influence of the choice of initial maintenance treatment (ITCZ or VRCZ) on overall mortality as well as CPA-associated mortality. Multivariable logistic regression showed that oral ITCZ selection for initial maintenance therapy was an independent risk factor for hospital readmission and switching to other antifungal agents (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.3–7.5 and OR, 5.7; 95% CI, 2.0–15.7, respectively). Conclusions Oral VRCZ for initial maintenance therapy showed better effectiveness than oral ITCZ for clinical improvement in CPA patients. There was no difference in crude mortality between initial maintenance therapy with VRCZ and ITCZ, especially in elderly CPA patients.

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