Invasive Pulmonary Aspergillosis after Liver Transplantation: Rapid and Complete Response to Combined and Sequential Antifungal Therapy

2008 ◽  
Vol 9 (1) ◽  
pp. 99-104 ◽  
Author(s):  
Mehmet Fatih Can ◽  
Gokhan Yagci ◽  
Levent Gorenek ◽  
Ergun Tozkoparan ◽  
Ismail Ozerhan ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Antifungal Therapy ◽  
Invasive Pulmonary Aspergillosis ◽  
Complete Response ◽  
Pulmonary Aspergillosis

Invasive pulmonary aspergillosis/pseudomonas

2021 ◽  
Vol 14 (7) ◽  
pp. e236887
Author(s):  
Menaka Mahendran ◽  
Daniel Urbine
Keyword(s):  
Antifungal Therapy ◽  
High Mortality ◽  
Surgical Intervention ◽  
Main Pulmonary Artery ◽  
Invasive Pulmonary Aspergillosis ◽  
Chest Discomfort ◽  
Pulmonary Aspergillosis ◽  
Extensive Disease ◽  
Massive Haemoptysis ◽  
History Of

A 47-year-old Caucasian man on long-standing antifungal therapy for chronic necrotising aspergillosis and a history of recurrent pseudomonas pneumonias presented to the outpatient pulmonary clinic with dyspnoea and chest discomfort for 3 days. A CT angiography of the chest demonstrated angioinvasion from the previously noted left upper lobe cavitary lesion into the left main pulmonary artery, along with new consolidating lesions. Due to the high risk for massive haemoptysis, he was evaluated by thoracic surgery and underwent a successful left pneumonectomy. As invasive pulmonary aspergillosis is associated with high mortality, surgical intervention should always be considered, especially in those who develop extensive disease, despite being on aggressive antifungal therapy. Though minimally described in literature, invasive pulmonary pseudomonas also carries a high mortality risk. In our patient, cultures from the resected lung only demonstrated Pseudomonas aeruginosa.

scholarly journals Combination antifungal therapy for invasive pulmonary aspergillosis

2012 ◽  
Vol 2012 (dec14 1) ◽  
pp. bcr2012007824-bcr2012007824 ◽  
Author(s):  
S. Abdulaziz ◽  
H. Al Jahdali ◽  
S. Baharoon
Keyword(s):  
Antifungal Therapy ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis

scholarly journals Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

2015 ◽  
Vol 47 (1) ◽  
pp. 45-68 ◽  
Author(s):  
David W. Denning ◽  
Jacques Cadranel ◽  
Catherine Beigelman-Aubry ◽  
Florence Ader ◽  
Arunaloke Chakrabarti ◽  
...  
Keyword(s):  
Antifungal Therapy ◽  
Clinical Guidelines ◽  
Bronchial Artery ◽  
Invasive Pulmonary Aspergillosis ◽  
Immunological Response ◽  
Surgical Excision ◽  
Immunocompromised Patients ◽  
Pulmonary Aspergillosis ◽  
Thoracic Imaging ◽  
Chronic Pulmonary Aspergillosis

Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ∼240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include:Aspergillusnodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence ofAspergillusinfection (microscopy or culture from biopsy) or an immunological response toAspergillusspp. and exclusion of alternative diagnoses, all present for at least 3 months.Aspergillusantibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferablyviavideo-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with singleAspergillusnodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up.

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