scholarly journals Case Report: Chronic Cavitatory Pulmonary Aspergillosis after COVID-19

2021 ◽  
Author(s):  
Sheetal Chaurasia ◽  
Manjunath Thimmappa ◽  
Saurav Chowdhury
Keyword(s):  
Fungal Infections ◽  
Initial Response ◽  
Lung Damage ◽  
Response To Treatment ◽  
Pulmonary Aspergillosis ◽  
Clinical Syndromes ◽  
Common Causes ◽  
Chronic Pulmonary Aspergillosis ◽  
The Common ◽  
Immunocompetent Patients

Chronic pulmonary aspergillosis can present in four distinct clinical syndromes, one of which is chronic cavitary pulmonary aspergillosis (CCPA). CCPA is generally associated with a mildly immunosuppressed state or, in immunocompetent patients, with structural lung damage. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with reactivation of previous quiescent infections such as tuberculosis and invasive fungal infections, but CCPA in a patient with COVID-19 is rarely reported. Here we present the case of a 57-year-old man with CCPA associated with COVID-19 infection in whom latent aspergilloma was most likely activated after SARS-CoV-2 infection. The patient presented with severe COVID and, after initial response to treatment, started to deteriorate due to reactivation of latent aspergilloma to a more aggressive CCPA form. After confirmation of the diagnosis, the patient was initiated on treatment with voriconazole. He showed a good response to treatment with clinicoradiological response. This case also depicts one of the common causes of clinical deterioration in otherwise recovering COVID-19 patients.

scholarly journals Outpatient parenteral antifungal therapy (OPAT) for invasive fungal infections with intermittent dosing of liposomal amphotericin B

2020 ◽  
Vol 58 (7) ◽  
pp. 874-880
Author(s):  
Robert J van de Peppel ◽  
Alexander Schauwvlieghe ◽  
Ruth Van Daele ◽  
Isabel Spriet ◽  
Jan W van't Wout ◽  
...  
Keyword(s):  
The Netherlands ◽  
Amphotericin B ◽  
Antifungal Therapy ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Initial Response ◽  
Invasive Fungal Infections ◽  
Response To Treatment ◽  
Liposomal Amphotericin B

Abstract Triazole resistant A. fumigatus has been documented in many parts of the world. In the Netherlands, incidence is now above 10% and results in the need for long-term parenteral therapy with liposomal amphotericin B (LAmB). The long terminal half-life of LAmB suggests that intermittent dosing could be effective, making the application of outpatient antifungal therapy (OPAT) possible. Here, we report our experience with the use of OPAT for Invasive Fungal Infections (IFI). All adult patients treated with LAmB with a 2 or 3 times weekly administration via the outpatient departments in four academic tertiary care centers in the Netherlands and Belgium since January 2010 were included in our analysis. Patient characteristics were collected, as well as information about diagnostics, therapy dose and duration, toxicity, treatment history and outcome of the IFI. In total, 18 patients were included. The most frequently used regimen (67%) was 5 mg/kg 3 times weekly. A partial response to the daily treatment prior to discharge was confirmed by CT-scan in 17 (94%) of patients. A favorable outcome was achieved in 13 (72%) patients. Decrease in renal function occurred in 10 (56%) cases but was reversible in all and was treatment limiting in one patient only. The 100-day mortality and 1-year mortality after initiation of OPAT were 0% and 6%, respectively. In a selected population, and after confirmation of initial response to treatment, our data support the use of OPAT with LAmB for treatment of IFI in an intermittent dosing regimen.

Viral, Fungal, and Atypical Infections

2017 ◽  
Author(s):  
Daniel Caroff ◽  
Chanu Rhee
Keyword(s):  
Respiratory Tract Infections ◽  
Clinical Presentation ◽  
Invasive Pulmonary Aspergillosis ◽  
Infectious Agents ◽  
Pulmonary Aspergillosis ◽  
Clinical Syndromes ◽  
Immunosuppressed Patients ◽  
Candida Infections ◽  
Tract Infections ◽  
Immunocompetent Patients

Viral, fungal, and “atypical” bacterial pathogens are important causes of infections in critically ill patients. Many of these pathogens predominantly cause disease in immunosuppressed patients, but immunocompetent patients can also face serious illness or death. Understanding the risk factors and clinical syndromes caused by these pathogens is necessary to quickly identify patients who may need specialized diagnostics and treatment and is an essential component of training for any provider who practices in the intensive care unit. In this review, we discuss the most relevant aspects of clinical presentation, epidemiology, diagnosis, and management of these infectious agents, with a particular focus on respiratory tract infections. New advances in the diagnosis and treatment of influenza, invasive Candida infections, aspergillosis, and Legionella are highlighted. This review contains 3 figures, 5 tables, and 94 references. Key words: Candida, influenza, invasive pulmonary aspergillosis, Legionella pneumophilia, viral pneumonia

Computed tomography assessment of response to treatment in chronic pulmonary aspergillosis

2015 ◽  
Author(s):  
Cendrine Godet ◽  
François Laurent ◽  
Anne Bergeron ◽  
Catherine Begeilman ◽  
Christophe Pison ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Response To Treatment ◽  
Pulmonary Aspergillosis ◽  
Chronic Pulmonary Aspergillosis

scholarly journals Point of care tests for invasive fungal infections: a blueprint for increasing availability in Africa

2021 ◽  
Vol 8 ◽  
pp. 204993612110342
Author(s):  
Iriagbonse Iyabo Osaigbovo ◽  
Felix Bongomin
Keyword(s):  
Fungal Infections ◽  
Point Of Care ◽  
Invasive Fungal Infections ◽  
Antigen Test ◽  
Pulmonary Aspergillosis ◽  
Middle Income ◽  
Middle Income Countries ◽  
Disseminated Histoplasmosis ◽  
Chronic Pulmonary Aspergillosis ◽  
Point Of Care Tests

Invasive fungal infections (IFIs) such as cryptococcosis, disseminated histoplasmosis, and chronic pulmonary aspergillosis are significant causes of morbidity and mortality in Africa. Lack of laboratory infrastructure and laboratory personnel trained in diagnostic mycology hamper prompt detection and management of IFIs on the continent. Point-of-care tests (POCT) obviate the need for complex infrastructure, skilled technicians, and stable electricity and have had major impacts on the diagnosis of bacterial, viral, and parasitic infections in low- and middle-income countries. Over the last 10 years, POCTs for IFIs have become increasingly available and they have the potential to revolutionize the management of these infections if scaled up in Africa. At the beginning of 2021, the World Health Organization (WHO) Essential Diagnostic List (EDL) included a cryptococcal antigen test for the diagnosis of cryptococcosis, Histoplasma antigen test for the diagnosis of disseminated histoplasmosis, and Aspergillus-specific test for the diagnosis of chronic pulmonary aspergillosis. All of these are available in formats that may be used as POCTs and it is hoped that this will improve the diagnosis of these life-threatening IFIs, especially in low- and middle-income countries. This perspective review discusses commercially available POCTs and outlines strategies of a blueprint to achieve their roll-out in Africa. The strategies include raising awareness, conducting research that uncovers the exact burden of IFIs, increasing advocacy, integrating diagnosis of IFIs into existing public health programs, adoption of the WHO EDL at country levels, and improving logistics and supply chains.

CT Imaging Assessment of Response to Treatment in Chronic Pulmonary Aspergillosis

CHEST Journal ◽  
2016 ◽  
Vol 150 (1) ◽  
pp. 139-147 ◽  
Author(s):  
Cendrine Godet ◽  
François Laurent ◽  
Anne Bergeron ◽  
Pierre Ingrand ◽  
Catherine Beigelman-Aubry ◽  
...  
Keyword(s):  
Ct Imaging ◽  
Response To Treatment ◽  
Pulmonary Aspergillosis ◽  
Chronic Pulmonary Aspergillosis

scholarly journals Anogenital Ulcers: An Unusual Manifestation of Invasive Aspergillosis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Pablo Vargas ◽  
Fernando Valenzuela ◽  
Viera Kaplan ◽  
Jacob Yumha ◽  
Montserrat Arceu ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Fungal Infections ◽  
Intensive Therapy ◽  
Hematogenous Spread ◽  
Pulmonary Aspergillosis ◽  
Unusual Manifestation ◽  
Cutaneous Injury ◽  
Invasive Fungal Diseases ◽  
Skin Ulcers ◽  
Immunocompetent Patients

Aspergillus spp. is one of the most ubiquitous fungi but generally does not cause disease in immunocompetent patients. It is the second most frequent agent of opportunistic fungal infections, after Candida albicans, with a rise in its incidence on recent years. Invasive fungal diseases represent an important cause of morbidity and mortality. Its origin can be primary, in relation to a cutaneous injury, or secondary, by extension from contiguous tissues, or by hematogenous spread, usually in the context of pulmonary aspergillosis. In this report, we describe the case of an elderly woman with invasive aspergillosis that manifested with anogenital and skin ulcers, with unfavorable outcome, despite intensive therapy and intravenous antifungals.

scholarly journals Misdiagnosis of chronic pulmonary aspergillosis as pulmonary tuberculosis at a tertiary care center in Uganda: a case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Richard Kwizera ◽  
Andrew Katende ◽  
Felix Bongomin ◽  
Lydia Nakiyingi ◽  
Bruce J. Kirenga
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Outcomes ◽  
Diagnostic Criteria ◽  
Tertiary Care ◽  
Chest Imaging ◽  
Resource Limited Settings ◽  
Pulmonary Aspergillosis ◽  
Resource Limited ◽  
Chronic Pulmonary Aspergillosis ◽  
Hiv Negative

Abstract Background Diagnosis of chronic pulmonary aspergillosis (CPA) is based on a combination of clinical symptomatology, compatible chest imaging findings, evidence of Aspergillus infection and exclusion of alternative diagnosis, all occurring for more than 3 months. Recently, a rapid, highly sensitive and specific point-of-care lateral flow device (LFD) has been introduced for the detection of Aspergillus-specific immunoglobulin (Ig)G, especially in resource-limited settings where CPA is underdiagnosed and often misdiagnosed as smear-negative pulmonary tuberculosis (PTB). Therefore, in our setting, where tuberculosis (TB) is endemic, exclusion of PTB is an important first step to the diagnosis of CPA. We used the recently published CPA diagnostic criteria for resource-limited settings to identify patients with CPA in our center. Case presentation Three Ugandan women (45/human immunodeficiency virus (HIV) negative, 53/HIV infected and 18/HIV negative), with a longstanding history of cough, chest pain, weight loss and constitutional symptoms, were clinically and radiologically diagnosed with PTB and empirically treated with an anti-tuberculous regimen despite negative microbiological tests. Repeat sputum Mycobacteria GeneXpert assays were negative for all three patients. On further evaluation, all three patients met the CPA diagnostic criteria with demonstrable thick-walled cavities and fungal balls (aspergilomas) on chest imaging and positive Aspergillus-specific IgG/IgM antibody tests. After CPA diagnosis, anti-TB drugs were safely discontinued for all patients, and they were initiated on capsules of itraconazole 200 mg twice daily with good treatment outcomes. Conclusions The availability of simple clinical diagnostic criteria for CPA and a LFD have the potential to reduce misdiagnosis of CPA and in turn improve treatment outcomes in resource-limited settings.

scholarly journals Performance of LDBio Aspergillus WB and ICT Antibody Detection in Chronic Pulmonary Aspergillosis

2021 ◽  
Vol 7 (4) ◽  
pp. 311
Author(s):  
Anna Rozaliyani ◽  
Findra Setianingrum ◽  
Sresta Azahra ◽  
Asriyani Abdullah ◽  
Ayu Eka Fatril ◽  
...  
Keyword(s):  
Receiver Operating Curve ◽  
Antibody Detection ◽  
Pulmonary Aspergillosis ◽  
Comparative Performance ◽  
Tuberculosis Patients ◽  
Chronic Pulmonary Aspergillosis ◽  
Screening Assays ◽  
Roc Area ◽  
Flow Detection ◽  
Sensitivity Specificity

The detection of Aspergillus antibody has a key role in the diagnosis of chronic pulmonary aspergillosis. Western blot (WB) and immunochromatography (ICT) lateral flow detection of Aspergillus antibody can be used as confirmatory and screening assays but their comparative performance in TB patients is not known. This study investigated the performance of these assays among 88 post-tuberculosis patients with suspected CPA. Sensitivity, specificity, receiver operating curve (ROC), area under-curve (AUC) and the agreement between two assays were evaluated. Both WB and ICT showed good sensitivity (80% and 85%, respectively) for detection of Aspergillus antibodies. Substantial agreement (0.716) between these assays was also obtained. The highest AUC result (0.804) was achieved with the combination of WB and ICT. The global intensity of WB correlated with the severity of symptoms in CPA group (p = 0.001). The combination of WB and ICT may increase specificity in CPA diagnosis.

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