Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist
Abstract
:1. Introduction
2. Definition and Pathogenesis
3. Epidemiology
4. Underlying Conditions in Chronic Pulmonary Aspergillosis
5. Diagnosis: The Clinical, Radiologic, Immunologic and Microbiologic (CRIM) Approach
5.1. Clinical Diagnosis
5.2. Radiology
5.3. Immunological/Serological Tests
5.4. Microbiological
5.5. Other Relevant Tests
6. Management Approach
- To improve symptoms and patients’ ‘functional status’—quality of life
- To prevent the progressive destruction of lung tissue and the development of pulmonary fibrosis
- To arrest or prevent haemoptysis
- To prevent the emergence of antifungal resistance
- To avoid antifungal toxicity
- To reduce death rates and morbidity
6.1. Simple Aspergilloma
6.2. CCPA and CFPA
6.3. Aspergillus Nodule
7. Prognosis of Treated CPA
8. CPA Recurrence
9. CPA Mortality and Predictors
10. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Author (Reference) | Year | Country | Population | CPA Prevalence | Comment |
---|---|---|---|---|---|
Page et al. [30] | 2019 | Uganda | 284 patients previously treated for PTB | 6.3% | CPA was significantly more common in those with chest radiography cavitation (26% vs. 0.8%) and less frequent in HIV co-infected patients (3% vs. 6.7%) |
Oladele et al. [25] | 2017 | Nigeria | 208 patients at end of TB treatment or being treated for smear-negative PTB | 8.7%: 6.5% in HIV-positive and 14.5% in HIV-negative | 153 (73.6%) were HIV-positive |
Hedayati et al. [31] | 2015 | Iran | 124 patients with TB (94 current and 30 previous TB) | 13.7%: 2.4% aspergilloma and 14% CCPA | 38.7% had residual cavities after TB |
Underlying Condition | Frequency |
---|---|
Tuberculosis | 17–80% |
COPD ± Emphysema | 30–50% |
NTM infection | <20% |
Pneumothorax or bullous lung disease | 9–20% |
ABPA | 12–18% |
Pulmonary fibrocystic sarcoidosis | 9–17% |
Lung irradiation | ~5% |
Rheumatoid arthritis | 2–4% |
Ankylosing spondylitis | <5% |
None | 2–10% |
Criteria | ESCMID/ERS/ECMM [42] | IDSA [43] | GFIF II (GAFFI) [32] | ||
---|---|---|---|---|---|
1 | One or more cavities with or without a fungal ball present or nodules on thoracic imaging | All present for ≥3 months | Three months of chronic pulmonary symptoms or chronic illness or progressive radiographic abnormalities, with cavitation, pleural thickening, pericavitary infiltrates and sometimes a fungus ball | Weight loss, persistent cough and/or haemoptysis | All present for ≥3 months |
2 | Direct evidence of Aspergillus infection or an immunological response to Aspergillus spp. | - | Aspergillus IgG antibody elevated or other microbiological data | A positive Aspergillus IgG assay result or other evidence of Aspergillus infection. | - |
3 | Exclusion of alternative diagnosis | - | No or minimal immunocompromise, usually with one or more underlying pulmonary disorders | Chest images showing progressive cavitary infiltrates and/or a fungal ball and/or pericavitary fibrosis or infiltrates or pleural thickening; and | - |
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Bongomin, F.; Asio, L.G.; Baluku, J.B.; Kwizera, R.; Denning, D.W. Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist. J. Fungi 2020, 6, 75. https://doi.org/10.3390/jof6020075
Bongomin F, Asio LG, Baluku JB, Kwizera R, Denning DW. Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist. Journal of Fungi. 2020; 6(2):75. https://doi.org/10.3390/jof6020075
Chicago/Turabian StyleBongomin, Felix, Lucy Grace Asio, Joseph Baruch Baluku, Richard Kwizera, and David W. Denning. 2020. "Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist" Journal of Fungi 6, no. 2: 75. https://doi.org/10.3390/jof6020075