Invasive Pulmonary Aspergillosis

Semin Respir Crit Care Med 2020; 41: 080-098 DOI: 10.1055/s-0039-3401990Invasive pulmonary aspergillosis (IPA) remains difficult to diagnose and to treat. Most common risk factors are prolonged neutropenia, hematopoietic stem cell or solid organ transplantation, inherited or acquired immunodeficiency, administration of steroids or other immunosuppressive agents including monoclonal antibodies and new small molecules used for cancer therapy. Critically ill patients are also at high risk of IPA. Clinical signs are unspecific. Early computed tomography (CT)-scan identifies the two main aspects, angioinvasive and airway invasive aspergillosis. Although CT-scan findings are not fully specific they usually allow early initiation of therapy before mycological confirmation of the diagnosis. Role of 18F-fludeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) is discussed. Confirmation is based on microscopy and culture of respiratory samples, histopathology in case of biopsy, and importantly by detection of Aspergillus galactomannan using an immunoassay in serum and bronchoalveolar lavage fluid. Deoxyribonucleic acid detection by polymerase chain reaction is now standardized and increases the diagnosis yield. Two point of care tests detecting an Aspergillus glycoprotein using a lateral flow assay are also available. Mycological results allow classification into proven (irrespective of underlying condition), probable or possible (for cancer and severely i...
Source: Seminars in Respiratory and Critical Care Medicine - Category: Respiratory Medicine Authors: Tags: Review Article Source Type: research

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Abstract Invasive pulmonary aspergillosis (IPA) remains difficult to diagnose and to treat. Most common risk factors are prolonged neutropenia, hematopoietic stem cell or solid organ transplantation, inherited or acquired immunodeficiency, administration of steroids or other immunosuppressive agents including monoclonal antibodies and new small molecules used for cancer therapy. Critically ill patients are also at high risk of IPA. Clinical signs are unspecific. Early computed tomography (CT)-scan identifies the two main aspects, angioinvasive and airway invasive aspergillosis. Although CT-scan findings are not fu...
Source: Respiratory Care - Category: Respiratory Medicine Authors: Tags: Semin Respir Crit Care Med Source Type: research
Checkpoint inhibitor (CPI) immunotherapy has ushered cancer treatment to a potential curative era. However, the unchecked immune responses may lead to vital organ damage that requires an immunosuppressive therapy and carries a high risk of opportunistic infections1. Here we present an unusual case of necrotizing soft tissue infection secondary to Aspergillus fumigatus in a patient with solid tumor treated with immunosuppressants due to immune related adverse events (irAEs).
Source: Journal of Infection - Category: Infectious Diseases Authors: Tags: Letter to the Editor Source Type: research
Authors: Dandachi D, Wilson Dib R, Fernández-Cruz A, Jiang Y, Chaftari AM, Hachem R, Raad I Abstract BACKGROUND: The characteristics and management of invasive pulmonary aspergillosis (IPA) in patients with hematologic malignancies are well known, but IPA in patients with solid tumours is not well described. METHODS: We retrospectively reviewed all Aspergillus-positive cultures at a tertiary cancer center during 2004-2017. We identified 101 patients with IPA and solid tumours. We analyzed the association between clinical features and treatment and 12-week mortality and response to antifungal therapy. ...
Source: Annals of Medicine - Category: Internal Medicine Tags: Ann Med Source Type: research
Publication date: Available online 1 October 2019Source: Journal of Hospital InfectionAuthor(s): Rita Wilson Dib, Melissa C. Khalil, Johny Fares, Ray Y. Hachem, Ying Jiang, Anne-Marie Chaftari, Issam I. RaadSummaryBackgroundInvasive pulmonary aspergillosis (IPA) is commonly associated with haematologic malignancies but also occurs with solid tumors.AimComparing the diagnostic approaches and therapeutic outcomes for IPA between patients with haematologic malignancies and solid cancers.MethodsWe conducted a retrospective study evaluating consecutive cases of proven and probable IPA from 2004 to 2016. We included patients>...
Source: Journal of Hospital Infection - Category: Infectious Diseases Source Type: research
We report an unusual case of a patient with persistent cough and dyspnoea in the context of prior chemoradiotherapy for primary lung cancer who was subsequently found to have invasive tracheobronchial aspergillosis of the distal trachea and proximal of right main bronchus. Invasive tracheobronchial aspergillosis is a rare disease with most reported cases in the literature occurring in immunocompromised hosts. We report an unusual case of a patient with persistent cough and dyspnoea in the context of prior chemoradiotherapy for primary lung cancer. Chest computed tomography (CT) demonstrated an abnormal soft tissue mass sur...
Source: Respirology Case Reports - Category: Respiratory Medicine Authors: Tags: Case Report Source Type: research
We report the case of a 37-year-old female patient, without past medical history, with multicystic lung disease in a context of chronic abdominal pain, fatigue and weight loss. After several months of diagnostic delay, pathological examination of surgical lung biopsies led to the diagnosis of secondary deposits of pancreatic cancer. The clinical and radiogical situation deteriorated quickly with the development of alveolar consolidation and Aspergillus superinfection was then diagnosed. This case illustrates the value of an early decision to undertake surgical lung biopsy in the work-up of multicystic lung disease when can...
Source: Revue des Maladies Respiratoires - Category: Respiratory Medicine Tags: Rev Mal Respir Source Type: research
Invasive aspergillosis (IA) is a life-threatening infection that mainly occurs in immunocompromised patients. Here, we compared the novel Aspergillus-specific galactomannoprotein (GP) enzyme-linked immunosorbent assay (ELISA) (Euroimmun Medizinische Labordiagnostika AG) to the established Platelia Aspergillus galactomannan (GM) ELISA (Bio-Rad Laboratories) for the detection of IA. A total of 267 serum samples from 45 cases of proven and 4 episodes of probable IA (according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Inf...
Source: Journal of Clinical Microbiology - Category: Microbiology Authors: Tags: Mycology Source Type: research
We examined the relationship between the metabolic processes of carbon catabolite repression (CCR), nitrogen catabolite repression (NCR) and virulence in a variety of A. fumigatus clinical isolates. A considerable amount of heterogeneity with respect to the degree of CCR and NCR was observed and a positive correlation between NCR and virulence in a neutropenic mouse model of pulmonary aspergillosis (PA) was found. Isolate Afs35 was selected for further analysis and compared to the reference strain A1163, with both strains presenting the same degree of virulence in a neutropenic mouse model of PA. Afs35 metabolome analysis ...
Source: Frontiers in Microbiology - Category: Microbiology Source Type: research
Conclusions In conclusion, articles in this Research Topic made a very significant contribution to our understanding of the role played by environmental factors, dysbiotic conditions, and infections in triggering diseases. Since this is a rapidly expanding area of research, many other factors contributing to the onset of these diseases are not covered here. We are confident, however, that further studies will expand the list as well as bring a better understanding of mechanisms involved in the onset of autoimmune and autoinflammatory diseases. Author Contributions All authors listed have made a substantial, direct and i...
Source: Frontiers in Microbiology - Category: Microbiology Source Type: research
Conclusion: This prospective multicenter study provides information on the current incidence and outcome of IFD in the real life setting. Practice variation between the centers may help to ultimately improve antifungal management in children at highest risk for IFDs. Introduction Available data on the incidence and outcome of invasive fungal diseases (IFD) in children treated for a hematological malignancy or undergoing allogeneic hematopoietic stem cell transplantation (HSCT) are mostly based on single site, retrospective studies or on studies performed prior to the availability of newer compounds such as broad-sp...
Source: Frontiers in Microbiology - Category: Microbiology Source Type: research
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