The effects of antifungal therapy on the recurrence of aspergillus infection after pulmonary aspergilloma resection: a study protocol for a single-center, prospective, non-blind, randomized, 24-month, parallel group study

Background In recent years, the incidence of pulmonary aspergilloma has increased. The harm of aspergilloma is life-threatening massive hemoptysis, and the conventional treatment is surgical treatment. However, whether the antifungal treatment after surgery is required and the course of treatment before and after surgery are still unclear. Methods In this study, patients with pulmonary aspergilloma confirmed pathologically after surgery will be selected as subjects to conduct a single-center, randomized, parallel grouping, prospective, 2-year clinical study. Through regular visits, the recurrence of aspergillus infection, quality of life, lung function indicators, safety of antifungal therapy and other indicators were recorded to evaluate the recurrence risk of aspergillus infection and safety of antifungal agents. Cox proportional risk regression model was used to analyze the influencing factors of antifungal therapy on aspergillus infection recurrence after aspergillus bulbectomy. Cox multiple regression model was used for optimal model fitting, and regression coefficient (β), relative risk (RR) and 95% confidence interval of RR were calculated. Discussion The study will explore whether antifungal therapy could improve the quality of life, reduce the recurrence of aspergillus infection, and ultimately improve the prognosis of patients with aspergilloma. The study results will provide high-quality evidence-based medical evidence for the formulation, revision and optimization of international and domestic clinical guidelines and expert consensus on chronic aspergillus lung disease, effectively improve the clinical treatment effect of aspergilloma, and form the latest concept of diagnosis and treatment of aspergilloma. Trial registration: The trial was registered on the Chinese Clinical Trial Registry website (https://www.chictr.org.cn/showprojen.aspx?proj=33231). Registration number: ChiCTR1800019990.

Surgical Treatment Outcomes of Pulmonary Aspergilloma in Central Chest Institute of Thailand

Background: Pulmonary aspergilloma is a disease from colonization of Aspergillus fumigatus in the lung cavity with a difficult therapeutic problem. Surgery is an aggressive way to treat. Objective: To analyze the early surgical treatment outcomes of pulmonary aspergilloma. Materials and Methods: Fifty-nine patients that underwent surgery for pulmonary aspergilloma in Central Chest Institute of Thailand between January 2015 and August 2019 were reviewed. Patient characteristics and perioperative and operative outcomes were analyzed and reported. Results: The most frequent symptoms were recurrent hemoptysis (54.2%). The main procedure was lobectomy. The most location of aspergilloma were the right upper lobe (38.98%) and left upper lobe (30.50%). The intraoperative blood loss ranged from 140 to 600 mL with a median of 350 mL. The mean hospital stay was 15 days. The mean duration of pleural drainage was 12 days. The mean follow up was 748 days. No intraoperative death. The mortality rate was 3.4%. The recurrence rate was 1.70%, and the overall complication rate was 52.54%. The most frequent early complications were prolonged air leaks (16.90%), treated by conservative treatment. Most late complications were recurrent hemoptysis (8.50%), and the mean occurrence time was 484 days. The reoperation treatment rate for complications was 25.8%. Conclusion: Surgical treatment for aspergilloma can control symptoms, prevent recurrent hemoptysis, and save life. With the significant risk of postoperative complications, surgery should be offered primarily to patients with intense symptoms or medical failure. Keywords: Pulmonary Aspergilloma; Surgical treatment; Pulmonary resection

Pulmonary aspergilloma on transthoracic ultrasound

Purpose Pulmonary aspergilloma affects immunocompromised patients but is also a recurrent condition in patients previously treated for pulmonary tuberculosis. Methods and Results We report the case of a 45-year-old patient with a history of cured pulmonary tuberculosis 15 years earlier in whom we visualized pulmonary aspergilloma by transthoracic lung sonography. Sonography of pulmonary aspergilloma demonstrated an oval cavity with hypoechoic contents and an irregular border, measuring a diameter of 4.7 cm; inside the lesion, a roundish structure with an anechoic rim was discernable. Conclusions The sonographic findings corresponded to chest X-ray and computed tomography imaging in this patient and to previously reported sonographic characteristics of mycotic abscesses in other organs. Lung ultrasound may be a tool to identify pulmonary aspergilloma, especially as a point-of-care imaging tool and where other imaging modalities are inaccessible.