scholarly journals Chronic Pulmonary Aspergillosis Situation among Post Tuberculosis Patients in Vietnam: An Observational Study

2021 ◽  
Vol 7 (7) ◽  
pp. 532
Author(s):  
Ngoc Thi Bich Nguyen ◽  
Huy Le Ngoc ◽  
Nhung Viet Nguyen ◽  
Luong Van Dinh ◽  
Hung Van Nguyen ◽  
...  
Keyword(s):  
Diagnostic Tools ◽  
Chronic Obstructive ◽  
High Resolution Computed Tomography ◽  
Pulmonary Aspergillosis ◽  
Obstructive Pulmonary Disease ◽  
Female Ratio ◽  
High Burden ◽  
Pleural Thickening ◽  
Number Of Patients ◽  
Chronic Pulmonary Aspergillosis

This study provides a brief view of chronic pulmonary aspergillosis (CPA) in the post-tuberculosis treatment community in Vietnam, a high burden tuberculosis (TB) country. In three months in late 2019, 70 post-TB patients managed at Vietnam National Lung Hospital were enrolled. Of these, 38 (54.3%) had CPA. The male/female ratio was 3/1 (28 males and ten females). CPA patients had a mean age of 59 ± 2.3 years (95%CI 54.4–63.6). The mean Body mass index (BMI) was 19.0 ± 0.5 (18.0–20.0) and 16 of 38 (42.1%) patients had concurrent diseases, the most common of which were chronic obstructive pulmonary disease (COPD) and diabetes. Twenty-six patients (68.4%) developed hemoptysis, 21 (55.3%) breathlessness, and weight loss was seen in 30 (78.9%). Anaemia was seen in 15 (39.5%) and 27 of 38 (71.1%) patients had an elevated C-reactive protein (CRP). The most common radiological findings were multiple cavities (52.6%) and pleural thickening (42.7%), followed by aspergilloma (29.0%) and non-specific infiltrates. There were five of 38 patients (13.2%) with a cavity containing a fungal ball on the chest X-ray, but when the high resolution computed tomography (HRCT) was examined, the number of patients with fungal balls rose to 11 (28.9%). Overall, 34 of 38 (89.5%) cases had an elevated Aspergillus IgG with an optical density ≥ 1, and in 2 cases, it was 0.9–1.0 (5%), borderline positive. In nine patients (23.7%) Aspergillus fumigatus was cultured from sputum. CPA is an under-recognised problem in Vietnam and other high burden TB countries, requiring a different diagnostic approach and treatment and careful management. HRCT and Aspergillus IgG serum test are recommended as initial diagnostic tools for CPA diagnosis.

Chronic Pulmonary Aspergillosis: Prevalence, favouring pulmonary diseases and prognosis

2021 ◽  
pp. 2003345
Author(s):  
Thomas Maitre ◽  
Jonathan Cottenet ◽  
Cendrine Godet ◽  
Adrien Roussot ◽  
Nafiz Abdoul Carime ◽  
...  
Keyword(s):  
Mortality Rates ◽  
Pulmonary Diseases ◽  
Chronic Obstructive ◽  
Distribution Profile ◽  
Pulmonary Aspergillosis ◽  
Cancer History ◽  
Obstructive Pulmonary Disease ◽  
Large Cities ◽  
Chronic Pulmonary Diseases ◽  
Chronic Pulmonary Aspergillosis

Chronic pulmonary aspergillosis (CPA) is an emerging disease in patients with common chronic pulmonary diseases (CPD). While its prevalence is linked to tuberculosis (TB) in endemic countries, epidemiologic and prognostic data are lacking in low TB incidence countries. The aim of this study was to describe these features in CPA patients hospitalised in France between 2009 and 2018.We estimated the prevalence and mortality of hospitalised CPA patients using the French nationwide administrative hospital database. We also assessed the association with CPDs, thoracic interventions, and malnutrition.From 2009 to 2018, 17 290 patients were hospitalised in France for CPA, with an increasing prevalence during this period. Most patients were male (63.5%) with a median age of 65 years at CPA diagnosis, living in farming regions and large cities. The proportion of underlying chronic obstructive pulmonary disease (COPD) and emphysema during the previous 5 years was 44% and 22%, respectively, whereas it was only 3% for both TB and non-TB mycobacterial (NTM) infections. The mortality rates during the first hospitalisation, at 1 year, and at 5 years were 17%, 32%, and 45%, respectively. In multivariate analysis, mortality rates were increased in patients aged over 65 years, males and patients with malnutrition, diabetes, or lung cancer history. The risk of mortality in patients with COPD or emphysema was higher compared to those with previous mycobacterial lung infection.In France CPA is an emerging infection commonly associated with non-mycobacterial CPD. This shift in the distribution profile of underlying CPD will likely worsen CPA mortality.

scholarly journals Predictors of mortality in chronic pulmonary aspergillosis

2016 ◽  
Vol 49 (2) ◽  
pp. 1601062 ◽  
Author(s):  
David Lowes ◽  
Khaled Al-Shair ◽  
Pippa J. Newton ◽  
Julie Morris ◽  
Chris Harris ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Mycobacterial Infection ◽  
Cox Proportional Hazards ◽  
Chronic Obstructive ◽  
Pulmonary Aspergillosis ◽  
Obstructive Pulmonary Disease ◽  
Kaplan Meier ◽  
St George's Respiratory Questionnaire ◽  
Chronic Pulmonary Aspergillosis ◽  
The Impact

Chronic pulmonary aspergillosis (CPA) is a chronic progressive infection that destroys lung tissue in non-immunocompromised patients. Contemporary series suggest 50–85% 5-year mortality, with few prognostic factors identified.A cohort of 387 CPA patients referred to the UK's National Aspergillosis Centre from 1992 to June 2012 was studied until June 2015. The impact of objective and subjective variables including age, sex, previous pulmonary conditions, dyspnoea score, quality of life, serum albumin and C-reactive protein and radiological appearances were assessed using Kaplan–Meier curves, log rank tests and Cox proportional hazards modelling. In samples of patients, retrospective review of time from likely onset of CPA to referral and cause of death were also investigated.Survival was 86%, 62% and 47% at 1, 5 and 10 years, respectively. Increased mortality was associated with nontuberculous mycobacterial infection (hazard ratio 2.07, 95% CI 1.22–3.52; p<0.001) and chronic obstructive pulmonary disease (1.57, 1.05–2.36; p=0.029) as well as higher age (1.053, 1.03–1.07 per year; p<0.001), lower albumin (0.92, 0.87–0.96 per g·L−1), lower activity (1.021, 1.01–1.03 per point increase in St George's Respiratory Questionnaire activity domain; p<0.001) and having one, and especially, bilateral aspergillomas (p<0.001).Several factors impact on mortality of CPA, and can be evaluated as tools to assess CPA prognosis.

scholarly journals Profile of patients admitted in a pulmonology ward and developing Clostridium difficile enterocolitis

Pneumologia ◽  
2019 ◽  
Vol 68 (1) ◽  
pp. 31-36
Author(s):  
Ioana Cojocaru ◽  
Livia Luculescu ◽  
Daniela Negoescu ◽  
Irina Strâmbu
Keyword(s):  
Clostridium Difficile ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Respiratory Infections ◽  
Demographic Data ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Male Predominance ◽  
Number Of Patients ◽  
Lower Intestine

Abstract Clostridium difficile is an anaerobic bacterium than can colonise the lower intestine and cause enterocolitis in susceptible patients. Clostridium difficile infection (CDI) is typically a nosocomial infection, favoured by treatment with antibiotics (especially with broad-spectrum drugs), proton pump inhibitors, but also comorbidities, old age and prolonged hospitalisation. Based on the observation that in the past years, the frequency of nosocomial CDI has increased in the Institute of Pulmonology, Bucharest, this retrospective observational study aimed to analyse the characteristics of admitted patients who develop CDI, in order to identify possible particular features and risk factors. Accordingly, medical files from 80 patients admitted from January 2015 to August 2017 were analysed for demographic data, respiratory diagnosis, comorbidities, blood tests, treatments prescribed, time of CDI onset, evolution and outcome. The number of patients studied was 29 in 2015, 16 in 2016 and 35 in 2017, with slight male predominance. Totally, 54 patients (67.5%) had tuberculosis (pulmonary or pleural), 12 had lung cancer, five had respiratory infections, two had chronic obstructive pulmonary disease and seven had other diseases. All patients but nine were receiving antibiotics: tuberculosis drugs, cephalosporins, fluoroquinolones and beta-lactams. About half of the patients received proton pump inhibitors. Most patients had several comorbidities. Mean time since admittance to onset of diarrhoea was 20 days. CDI was treated with metronidazole or vancomycin. The evolution was favourable in 90% of patients, but eight patients (10%) died This study highlights a high frequency of CDI in patients treated for tuberculosis. Due to insufficient data, no epidemiological consideration could be made. Further studies are needed to assess the relationship among tuberculosis, tuberculosis treatment and CDI.

scholarly journals Frequency and Pattern of Bronchiectasis in Patients with Chronic Obstructive Pulmonary Disease Presenting in a Tertiary Care Hospital

2021 ◽  
Vol 35 (3) ◽  
pp. 54-57
Author(s):  
Asifa Karamat
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Tertiary Care ◽  
Lower Lobe ◽  
The United States ◽  
Diagnostic Tools ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Care Hospital ◽  
Obstructive Pulmonary Disease

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a high burden respiratory issue all over the world. It has high morbidity and mortality in the United States. Bronchiectasis is associated with chronic obstructive pulmonary disease (COPD) and is under diagnosed as diagnostic tools like HRCT though easily available but an expensive test in developing countries like Pakistan. We aim to establish the frequency and patterns of bronchiectasis in patients of COPD. Aims and Objectives: To establish the frequency and pattern of bronchiectasis in COPD in our population so that we can improve patient care and quality of life of these patients. Place and duration of study: We did a cross sectional survey in Department of Pulmonology, Gulab Devi Hospital, Lahore. Study was completed from 1st September 2017 to 28th February 2018. Material & Methods: After taking an informed consent 150 already diagnosed COPD patients were included. Bronchiectasis was seen on high resolution CT scan (HRCT). Data was collected on a structured proforma and analyzed on SPSS version 20. Results: Bronchiectasis was observed in 76 (50.6%) patients of COPD while 74 patients had no bronchiectasis. Out of 76, cylindrical bronchiectasis was seen in 82%. Lower lobe and bilateral involvement was more common. Means of age, gender, exacerbations of COPD, and history of pulmonary tuberculosis were not related to bronchiectasis while pack years of smoking, duration of illness and Modified Medical Research Council (MMRC) Dyspnea Scale were significantly related to bronchiectasis. Conclusion: This is observed that bronchiectasisis quite common (50.6%) in patients of COPD in our population.

scholarly journals Phenotyping of Chronic Obstructive Pulmonary Disease Using the Modified Bhalla Scoring System for High-Resolution Computed Tomography

2013 ◽  
Vol 20 (2) ◽  
pp. 91-96 ◽  
Author(s):  
Baykal Tulek ◽  
Ali Sami Kivrak ◽  
Seda Ozbek ◽  
Fikret Kanat ◽  
Mecit Suerdem
Keyword(s):  
Computed Tomography ◽  
Chronic Obstructive Pulmonary Disease ◽  
High Resolution ◽  
Pulmonary Disease ◽  
Scoring System ◽  
Morphological Changes ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
High Resolution Computed Tomography ◽  
Obstructive Pulmonary Disease

BACKGROUND: Identifying different phenotypes of chronic obstructive pulmonary disease (COPD) is important for both therapeutic options and clinical outcome of the disease.OBJECTIVE: To characterize the phenotypes of COPD according to high-resolution computed tomography (HRCT) findings; and to correlate HRCT scores obtained using the modified Bhalla scoring system with clinical and physiological indicators of systemic inflammation.METHODS: The present study included 80 consecutive patients with stable COPD. HRCT scans were evaluated by two independent radiologists according to the modified Bhalla scoring system.RESULTS: Fifty-four patients exhibited morphological changes on HRCT examination while 26 had no pathological findings. Patients with HRCT findings had lower spirometric measurements and higher levels of inflammation, and reported more exacerbations in the previous year compared with patients with no findings on HRCT. Patients with morphological changes were classified into one of three groups according to their HRCT phenotype(s): emphysema (E) only, E + bronchiectasis (B)/peribronchial thickening (PBT) or B/PBT only. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, C-reactive protein (CRP) levels and the number of exacerbations among the groups were significantly different. Pairwise comparisons between the E only and E+B/PBT groups showed significantly lower FVC, FEV1and FEV1/FVC values, and higher CRP levels and number of exacerbations compared with the B/PBT group. No significant differences were found between the E+B/PBT and the B/PBT groups. An inverse correlation was found between the total HRCT score and FVC, FEV1and FEV1/FVC; the correlation was positive with CRP level, erythrocyte sedimentation rate and number of exacerbations.CONCLUSION: The present study exposed the intimate relationship between phenotype(s) characterized by HRCT and scoring for morphological abnormalities; and clinical and functional parameters and inflammatory markers. The inclusion of HRCT among routine examinations for COPD may provide significant benefits both in the management and prognosis of COPD patients.

CLINICAL STUDY OF POST COVID SYMPTOMS AFTER 1ST WAVE OF COVID 19, AT A TERTIARY HOSPITAL

2021 ◽  
pp. 51-53
Author(s):  
Dilip Pandurang Patil
Keyword(s):  
Chest Pain ◽  
Tertiary Hospital ◽  
Residual Effects ◽  
Chronic Obstructive ◽  
Age Group ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Female Ratio ◽  
Raising Awareness ◽  
Cognitive Disturbances

Background: Early reports suggest residual effects of SARS-CoV-2 infection, such as fatigue, dyspnea, chest pain, cognitive disturbances, arthralgia and decline in quality of life. In present study we aimed to evaluate post covid symptoms after 1st wave of COVID 19 in COVID 19 recovered patients at a tertiary hospital. Present study was Material and Methods: hospital based, descriptive, cross-sectional, questionnaire-based study conducted in Covid 19 positive patients (RT-PCR or Rapid Antigen positive patients) either hospital admitted or home isolation patients, recovered (either RTPCR negative or completed 14 days isolation and no symptoms) came to post covid OPD for follow up, were studied. In present study 101 post Results: COVID 19 recovered patients were studied. Most of patients were from age group 51-60 years (19.8 %) followed by age group 41-50 years (16.83 %). Male patients (65.35 %) were more than female patients (34.65%), male to female ratio was 1.9 :1. Majority of patients received treatment at hospital (75.25%) & were diagnosed by RTPCR (57.43%). Most of patients had recovered from COVID 61-90 days ago (28.71%) followed by 121-150 days ago (19.8%). During acute COVID-19 pneumonia was diagnosed in 36.63 % cases. Other characteristics were intensive care unit admission (14.85 %), oxygen supplementation (21.78 %), noninvasive ventilation (7.92 %) & mechanical ventilation (2.97 %). Pre-existing comorbidities noted were hypertension (12.87 %), thyroid disease (4.95 %), diabetes (3.96 %), chronic obstructive pulmonary disease (3.96 %), h/o kidney failure (1.98 %), active smoker (8.91 %) & former smoker (14.85 %). No regular physical activity was noted in 83.17 %. Post COVID symptoms noted in present study were cough (14.85 %), fatigue (13.86 %), Breathlessness (8.91 %), headaches (5.94 %), myalgia (3.96 %), palpitation (3.96 %), loss of smell sensation (3.96 %), muscle weakness (2.97 %), loss of taste sensation (2.97 %) & chest pain (1.98 %). Most of the Conclusion: COVID-19 survivors experienced mild post-recovery symptoms such as cough, fatigue, breathlessness, headache, myalgia & palpitation. Raising awareness, recognition, research, and multidisciplinary involvement will be considered the cornerstones to manage long-term sequelae of COVID-19 effectively.

Diagnostic Aspects of Chronic Pulmonary Aspergillosis: Present and New Directions

2019 ◽  
Vol 13 (4) ◽  
pp. 292-300 ◽  
Author(s):  
Bayu A. P. Wilopo ◽  
Malcolm D. Richardson ◽  
David W. Denning
Keyword(s):  
Point Of Care ◽  
Fungal Culture ◽  
Pulmonary Aspergillosis ◽  
Pleural Thickening ◽  
Point Of Care Test ◽  
Recent Innovation ◽  
Inappropriate Treatment ◽  
Chronic Pulmonary Aspergillosis ◽  
Diagnostic Approaches ◽  
Similar Appearance

Abstract Purpose of Review Diagnosis of chronic pulmonary aspergillosis (CPA) is important since many diseases have a similar appearance, but require different treatment. This review presents the well-established diagnostic criteria and new laboratory diagnostic approaches that have been evaluated for the diagnosis of this condition. Recent Findings Respiratory fungal culture is insensitive for CPA diagnosis. There are many new tests available, especially new platforms to detect Aspergillus IgG. The most recent innovation is a lateral flow device, a point-of-care test that can be used in resource-constrained settings. Chest radiographs without cavitation or pleural thickening have a 100% negative predictive value for chronic cavitary pulmonary aspergillosis in the African setting. Summary Early diagnosis of CPA is important to avoid inappropriate treatment. It is our contention that these new diagnostics will transform the diagnosis of CPA and reduce the number of undiagnosed cases or cases with a late diagnosis.

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