Open AccessDiagnosis and treatment of chronic pulmonary aspergillosis: clinical guidelines of European Society for Clinical Microbiology and Infectious Diseases and European Respiratory Society
Author(s) -
D. W. Denning,
Jaques Cadranel,
Cathérine Beigelman-Aubry,
Florence Ader,
A. Chakrabarti,
Stijn Blot,
Andrew J. Ullmann,
George Dimοpoulos
Publication year - 2017
Publication title -
pulʹmonologiâ
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.126
H-Index - 6
eISSN - 2541-9617
pISSN - 0869-0189
DOI - 10.18093/0869-0189-2016-2-6-665-7679
Subject(s) - aspergillosis , aspergilloma , medicine , aspergillus fumigatus , allergic bronchopulmonary aspergillosis , aspergillus , chronic granulomatous disease , intensive care medicine , immunology , antibody , biology , immunoglobulin e , botany
Chronic pulmonary aspergillosis (CPA) is infrequent respiratory disease which is difficult for diagnosis and can complicate other respiratory diseases and conditions. Currently, there are about 240,000 CPA patients in Europe. The most prevalent variant of CPA is chronic cavitary pulmonary aspergillosis (CCPA) which could progress to chronic fibrosing pulmonary aspergillosis (CFPA) when is untreated. Aspergillus nodules and single aspergilloma are less frequent clinical variants of this disease. All clinical variants of aspergillosis could be found in nonimmunocompromised patients with different underlying pulmonary disorders. Subacute invasive pulmonary aspergillosis, which was referred to as chronic necrotising pulmonary aspergillosis, is the most rapidly progressive clinical variant of the infection ( 90% of patients. Aspergilloma should be resected if technically possible; videoassisted thoracic surgery is preferable. Chronic cavitary pulmonary aspergillosis requires longterm oral antifungal therapy to improve the patients' health and respiratory symptoms, to arrest haemoptysis and prevent the disease progression. Azole serum concentration and drug interaction should be thoroughly monitored to avoid toxic effects. Haemoptysis could be arrested using therapy with tranexamic acid or bronchial artery embolization; surgical resection of the lung is rarely required. Haemoptysis could indicate therapeutic failure and / or resistance to antifungals. Patients with a single Aspergillus nodule need antifungal therapy only if surgical resection is impossible. Antifungal therapy could be beneficial in patients with multiple Aspergillusis nodules; these patients need careful followup.