Successful treatment of invasive pulmonary aspergillosis in an immunocompetent host

Immunocompromised individuals are susceptible to pulmonary Aspergillus infection, but invasive Aspergillus infection is extremely rare in the presence of normal immunity. A case of invasive pulmonary aspergillosis in an immunocompetent 57-year-old female who was successfully treated with liposomal amphotericin-B is reported here.     

支气管哮喘合并侵袭性肺曲霉菌病5例并文献复习

目的 提高对支气管哮喘患者合并侵袭性肺曲霉菌病的诊断及治疗.方法 分析2010年1月至2011年5月在我院呼吸科住院的5例支气管哮喘并侵袭性肺曲霉菌病患者的病例资料,同时结合相关文献进行复习.结果 5例患者确诊2例,临床诊断3例.痰培养4例查见曲霉菌,2例支气管镜检查病理形态学及特殊染色结果符合曲霉菌感染.影像学表现呈多样性.5例患者均接受伏立康唑治疗,其中2例死亡.结论 支气管哮喘患者合并侵袭性肺曲霉菌病临床表现缺乏特异性.早期诊断和尽早抗曲霉菌治疗可降低死亡率.     

Unusual radiological presentation and rapid fatal progression of invasive pulmonary aspergillosis in an immunocompetent young patient

Invasive aspergillosis occurs very rarely in immunocompetent hosts. We describe a 21-year-old female with no obvious immunosuppression or underlying lung disease, who presented with minimal symptoms and bilateral hilar prominence on chest X-ray. Invasive aspergillosis was diagnosed on an open lung biopsy. She deteriorated in the ensuing 2 weeks and died of a sudden massive haemoptysis. This initial radiological abnormality and the rapid clinical course of the disease in young immunocompetent patients have not been previously reported.     

52例侵袭性肺曲霉菌病临床分析

目的分析侵袭性肺曲霉菌病(IPA)的临床特征。方法对52例IPA患者的基础疾病、宿主因素、临床特征、治疗及转归进行回顾性分析。结果原发性IPA共8例,均获治愈;44例继发性IPA患者,治愈35例,死亡9例。恶性肿瘤放化疗、器官移植、慢性阻塞性肺病急性加重者中,继发性IPA的发病率较高,其临床表现主要有发热、咳嗽、咳痰、喘息、呼吸困难、咯血。IPA患者的肺CT改变呈多样性,并呈动态演变。结论原发性IPA一般预后良好,继发性IPA好发于免疫缺陷的患者,临床表现缺乏特异性,肺CT具备一定的特征,结合宿主因素,为早期治疗提供诊断依据,从而改善预后。     

不同免疫状态下肺曲霉菌感染24例临床分析

目的探讨不同免疫状态下肺曲霉菌感染的临床特点、治疗及预后因素。方法回顾性分析2000年1月至2010年3月北京协和医院有组织病理或者培养证据确诊肺曲霉菌感染的24例病例资料。结果免疫正常组7例,免疫缺陷组17例。和免疫正常组相比,免疫缺陷组病程短(<1个月更多见,88.2%对14.3%),发热症状常见(88.2%对28.6%),咯血少见(11.8%对71.4%),差异均有统计学意义。免疫正常组影像表现为单发病灶者占57.1%高于免疫缺陷组患者(11.8%,P<0.05)。免疫缺陷组主要用药物治疗,免疫正常组中57.1%手术切除。免疫正常组均存活;免疫缺陷组病死率为52.9%,并且死亡可能与存在严重合并症,免疫缺陷宿主因素不能纠正以及外周血淋巴细胞下降等因素有关。结论不同免疫状态的肺曲菌感染患者临床表现及影像表现不同。免疫缺陷的肺曲霉菌感染患者预后差,其中有严重合并症、宿主因素不能纠正、外周血淋巴细胞下降可能与预后不良有关。治疗应根据患者的免疫状态而有所不同。     

慢性阻塞性肺疾病合并侵袭性肺曲霉病病例报告并文献回顾

目的:结合文献总结慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉病(IPA)患者的临床特征,提高早期诊治水平。方法:对1例经支气管镜肺活检确诊的重度COPD合并IPA患者的临床资料进行分析,并回顾复习有关文献。结果:COPD合并IPA患者严重呼吸困难多见。本例患者胸部CT可见中央型支气管扩张、小结节影、不典型渗出影,血清半乳甘露聚糖抗原检测(GM试验)及1.3-β-D葡聚糖检测(G试验)阳性。经支气管镜肺活检病理学检查见曲菌丝及炎症细胞浸润。结论:COPD合并IPA诊断困难,病死率高,综合分析临床表现、影像学、微生物学及血清学检查结果是提高诊断率、改善预后的有效手段。若临床情况允许,应尽早进行支气管镜等有创检查确定诊断。     

侵袭性肺曲霉病1例并文献复习

目的提高对侵袭性肺曲霉病的临床、胸部影像学、病原学和病理改变的认识。方法对1例经病理证实的侵袭性肺曲霉病患者的职业、临床表现、胸部X线、CT、气管镜和病理资料并结合文献进行回顾性分析。结果侵袭性肺曲霉病的临床表现缺乏特异性，典型的影像学检查显示胸膜下单发或多发结节状或斑片状阴影，并呈动态变化。GM试验用于诊断侵袭性肺曲霉病具快速灵敏的特点；侵袭性肺曲霉病的病理可见由大小规范，呈两分叉（Y形）的分隔菌丝引起的特征性的血管侵害，也可以表现为局限性肉芽肿或广泛化脓性肺炎。结论侵袭性肺曲霉病的临床表现和影像学改变非常复杂，在诊断中需要综合患者的各种临床资料（包括临床症状、放射学、血清学检查和病理）。     

Higher risk for influenza‐associated pulmonary aspergillosis (IAPA) in asthmatic patients: A Swiss multicenter cohort study on IAPA in critically ill influenza patients

BackgroundInfluenza‐associated pulmonary aspergillosis (IAPA) is an important complication of severe influenza with high morbidity and mortality.MethodsWe conducted a retrospective multicenter study in tertiary hospitals in Switzerland during 2017/2018 and 2019/2020 influenza seasons. All adults with PCR‐confirmed influenza infection and treatment on intensive‐care unit (ICU) for >24 h were included. IAPA was diagnosed according to previously published clinical, radiological, and microbiological criteria. We assessed risk factors for IAPA and predictors for poor outcome, which was a composite of in‐hospital mortality, ICU length of stay ≥7 days, mechanical ventilation ≥7 days, or extracorporeal membrane oxygenation.ResultsOne hundred fifty‐eight patients (median age 64 years, 45% females) with influenza were included, of which 17 (10.8%) had IAPA. Asthma was more common in IAPA patients (17% vs. 4% in non‐IAPA, P = 0.05). Asthma (OR 12.0 [95% CI 2.1–67.2]) and days of mechanical ventilation (OR 1.1 [1.1–1.2]) were associated with IAPA. IAPA patients frequently required organ supportive therapies including mechanical ventilation (88% in IAPA vs. 53% in non‐IAPA, P = 0.001) and vasoactive support (75% vs. 45%, P = 0.03) and had more complications including ARDS (53% vs. 26%, P = 0.04), respiratory bacterial infections (65% vs. 37%, P = 0.04), and higher ICU‐mortality (35% vs. 16.4%, P = 0.05). IAPA (OR 28.8 [3.3–253.4]), influenza A (OR 3.3 [1.4–7.8]), and higher SAPS II score (OR 1.07 [1.05–1.10]) were independent predictors of poor outcome.InterpretationHigh clinical suspicion, early diagnostics, and therapy are indicated in IAPA because of high morbidity and mortality. Asthma is likely an underappreciated risk factor for IAPA.     

Clinical study of invasive pulmonary aspergillosis following influenza A H1N1

This study to analyze the clinical characteristics of patients with invasive pulmonary aspergillosis (IPA) following influenza A (H1N1) infection.We retrospectively analyzed 10 cases with IPA following H1N1 infection. The clinical manifestations, laboratory examination results, chest computed tomography, and treatments were analyzed.Clinical manifestations: all 10 cases had typical flu-like symptoms at the onset of the disease, among which 7 patients developed dyspnea in the late stage, and 8 patients had hemoptysis. Laboratory examination: the absolute and percentage of peripheral blood lymphocytes in all 10 patients were declined, among which 5 cases were with decreased CD3⁺ CD4⁺ T cells/lymphocytes; 9 cases with increased bronchoalveolar lavage fluid galactomannan; 6 cases with increased serum galactomannan; 1 case with bronchoalveolar lavage fluid cultured aspergillus fumigatus; and 2 cases with aspergillus by second-generation sequencing. Chest computed tomography: all patients showed multiple diffused ground-glass opacities at the beginning, along with linear or reticular interstitial changes. Two cases had multiple subarachnoid nodules with halo signs, 3 cases had consolidation in multiple segments of both lungs, 2 cases had cavities, and 4 cases were with pleural effusion. Treatment: 10 patients were treated with antiviral and anti-Aspergillus drugs after admission. Four patients received respiratory support. All 10 cases were cured and discharged.Early diagnosis of IPA in influenza A (H1N1) patients is the key to successful treatment.     

Invasive aspergillosis localised to the colon presenting as toxic megacolon

Primary gut involvement by Aspergillus is an exceedingly rare and often a fatal complication of intensive chemotherapy in patients with acute leukaemia. We report a 46-yr-old patient with granulocytic sarcoma of the testis. He received acute myeloid leukaemia type treatment with ADE chemotherapy (Cytosine Arabinoside, Daunorubicin and Etoposide). While neutropenic he presented with pyrexia, abdominal pain and massive abdominal distention. He was treated with intravenous antibiotics and antifungals according to our usual institutional protocol without any response. He was found to have toxic megacolon on plain X-ray and subsequently underwent total colectomy and ileostomy. The colon histology showed Aspergillus fungal hyphae infiltrating the bowel wall. There was no any evidence of pulmonary, hepatic, splenic or renal lesions on the computerised tomography scan. Following colectomy, he was treated with 2 wk of antifungal treatment. He recovered well and was discharged home. The increased awareness, high degree of clinical suspicion of unusual presentation and early surgical intervention with aggressive antifungal treatment, has a key role in the management of these rare and often fatal cases.     

Clinical and radiological features of invasive pulmonary aspergillosis in transplant recipients and neutropenic patients

S.Y. Park, S.‐H. Kim, S.‐H. Choi, H. Sung, M.‐N. Kim, J.H. Woo, Y.S. Kim, S.‐K. Park, J.‐H. Lee, K.‐H. Lee, S.‐G. Lee, D.J. Han, S.‐O. Lee. Clinical and radiological features of invasive pulmonary aspergillosis in transplant recipients and neutropenic patients.
Transpl Infect Dis 2010: 12: 309–315. All rights reserved Abstract: Invasive pulmonary aspergillosis (IPA) is an important cause of mortality in transplant recipients and in patients with neutropenia. Although IPA has been studied extensively in neutropenic patients, there are limited data on IPA in recipients of solid organ transplants (SOTs). We compared the clinical features and radiologic findings of 27 SOT recipients with IPA with those of 35 neutropenic patients with IPA. The SOT recipients were more likely than neutropenic patients to show peribronchial consolidation (31% vs. 7%; P=0.03) or ground‐glass opacity (38% vs. 7%; P=0.007) and less likely to have fever (22% vs. 80%; P<0.001), macro‐nodules (35% vs. 67%; P=0.02), mass‐like consolidation (27% vs. 67%; P=0.004), halo signs (8% vs. 56%; P<0.001), or air‐crescent signs (0% vs. 22%; P=0.01).     

Invasive pulmonary aspergillosis in non‐neutropenic patients with and without underlying disease: A single‐centre retrospective analysis of 52 subjects

Background and objective: Invasive pulmonary aspergillosis (IPA) remains a life‐threatening infection in patients with prolonged neutropenia. Few data are available on IPA in non‐neutropenic patients without underlying immunocompromising conditions. Methods: All non‐neutropenic patients managed at the institution for a proven and probable IPA over the last 10 years were reviewed retrospectively, and the difference between non‐neutropenic patients with and without underlying disease was investigated. Results: Among 52 cases of IPA analysed here, 33 were histologically proven; 19 were probable. Forty‐two (80.8%) patients had underlying diseases; 10 (19.2%) patients had no any underlying diseases. There is a significant difference in seasonal distribution among patients with underlying conditions (P = 0.026), but no seasonal difference was found in the other group (P = 0.622). The only significant difference in symptoms between the two groups was fever (P = 0.015). Radiological findings were non‐specific in the two groups. Despite treatment, the overall crude mortality rate among 52 patients was 39%. The overall mortality rate in patients with underlying disease was 45%, while that in patients without underlying conditions was 11%. A Cox multivariate analysis showed that organ failure (hazard ratios: 8.739, 95% CI: 3.770–20.255; P = 0.000) was independently associated with overall mortality. Conclusions: Clinical features of IPA are not well known in non‐neutropenic patients, especially in those without underlying conditions. In this study, organ failure was associated with a lower rate of survival of non‐neutropenic patients with IPA.     

半乳甘露聚糖在侵袭性肺曲霉感染大鼠模型诊断中的意义

目的观察半乳甘露聚糖（GM）在大鼠侵袭性肺曲霉菌感染（IPA）模型不同体液标本不同时间点检测的意义。方法建立大鼠IPA模型,收集不同时间的血浆、支气管肺泡灌洗液（BALF）和尿液标本,检测GM含量,同时进行肺组织病理检查和真菌学培养。结果实验组感染第1、3、5天血浆GM实验平均敏感性分别为58.30%、66.67%、83.33%,BALF分别为66.67%、91.67%、100%,与对照组比较均有统计学差异。所有72只实验大鼠的血浆与BALF标本GM敏感性分别为69.44%、86.11%,特异性分别为100%、100%,阳性预测值分别为100%、100%,阴性预测值分别为68.57%、82.76%。尿液GM检测共5例阳性,敏感性13.89%,特异性100%。血浆及BALF检测GM值随感染天数增加呈升高趋势。结论BALF标本GM检测与血浆标本GM检测具有同样意义,均有助于IPA的早期诊断。     

两性霉素B治疗COPD合并侵袭性肺曲霉菌病的相关性研究

目的对比两性霉素B与伊曲康唑治疗C0PD合并侵袭性肺曲霉菌病(IPA)的临床疗效、不良反应及治疗费用。方法对比研究我院两性霉素B治疗COPD合并IPA的52例患者诊疗过程与伊曲康唑治疗COPD合并IPA的25例患者诊疗过程。结果两性霉素B治疗COPD合并IPA有效率70.2%,不良反应发生率53.1%,主要是低血钾(44.7%),寒战发热(31.9%),中位疗程29天,治疗经费1820元,7例中途放弃治疗(14.9%);伊曲康唑治疗COPD合并IPA有效率68.4%,不良反应发生率10.5%,均为轻度肝功能异常(5.3%),中位疗程26天,治疗经费28000元,6例中途放弃治疗(24%)。结论与伊曲康唑相比,两性霉素B治疗COPD合并IPA疗效肯定,不良反应发生率高,但无严重不良反应,且治疗经费低,患者能坚持治疗,是较为安全有效的一线抗真菌药物。