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Results of surgery for chronic pulmonary Aspergillosis, optimal antifungal therapy and proposed high risk factors for recurrence--a National Centre's experience.

Farid S, Mohamed S, Devbhandari M, Kneale M, Richardson M, Soon SY, Jones MT, Krysiak P, Shah R, Denning DW, Rammohan K - J Cardiothorac Surg (2013)

Bottom Line: The procedures included lobectomy 50% (n = 15), pneumonectomy 10% (n = 3), sublobar resection 27% (n = 8), decortication 7% (n = 2), segmentectomy 3% (n = 1), thoracoplasty 3% (n = 1), bullectomy and pleurectomy 3% (n = 1), 6% (n = 2) lung transplantation for associated disease.Recurrence of CCPA was noted in 8 patients (26%), most having prior CCPA (75%).Taurolidine 2% was active against all 9 A. fumigatus isolates and used for pleural decontamination during surgery.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Surgery for pulmonary aspergillosis is infrequent and often challenging. Risk assessment is imprecise and new antifungals may ameliorate some surgical risks. We evaluated the medical and surgical management of these patients, including perioperative and postoperative antifungal therapy.

Methods: Retrospective study of patients who underwent surgery for pulmonary aspergillosis between September 1996 and September 2011.

Results: 30 patients underwent surgery with 23 having a preoperative tissue diagnosis while 7 were confirmed post-resection. The median age was 57 years (17-78). The commonest presenting symptoms were cough (40%, n = 12) and haemoptysis (43%, n = 13). Twelve (40%) patients had simple aspergilloma (including 2 with Aspergillus nodules) while the remaining 18 (60%) had chronic cavitary pulmonary aspergillosis (CCPA) (complex aspergilloma). Most of the patients had underlying lung disease: tuberculosis (20%, n = 6), asthma (26%, n = 8) and COPD (20%, n = 6). The procedures included lobectomy 50% (n = 15), pneumonectomy 10% (n = 3), sublobar resection 27% (n = 8), decortication 7% (n = 2), segmentectomy 3% (n = 1), thoracoplasty 3% (n = 1), bullectomy and pleurectomy 3% (n = 1), 6% (n = 2) lung transplantation for associated disease. Median hospital stay was 9.5 days (3-37). There was no operative and 30 day mortality. Main complications were prolonged air leak (n = 7, 23%), empyema (n = 6, 20%), respiratory failure requiring tracheostomy /reintubation (n = 4, 13%). Recurrence of CCPA was noted in 8 patients (26%), most having prior CCPA (75%). Taurolidine 2% was active against all 9 A. fumigatus isolates and used for pleural decontamination during surgery.

Conclusions: Surgery in patients with chronic pulmonary aspergillosis offered good outcomes with an acceptable morbidity in a difficult clinical situation; recurrence is problematic.

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A: Examples of different types of chronic pulmonary aspergillosis aspergillus nodule; B: Simple aspergilloma; C: Chronic cavitary pulmonary aspergillosis (CCPA).
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Figure 1: A: Examples of different types of chronic pulmonary aspergillosis aspergillus nodule; B: Simple aspergilloma; C: Chronic cavitary pulmonary aspergillosis (CCPA).

Mentions: Aspergillosis refers to a spectrum of disease caused by Aspergillus species. This spectrum includes patients with asthma or cystic fibrosis who have allergic bronchopulmonary aspergillosis (ABPA) which is thought to affect over 4 million people worldwide [1]. In immunocompromised and critically ill patients invasive pulmonary aspergillosis (IPA) is relatively common and often fatal, and estimated to affect over 200,000 people worldwide [2]. In non-immunocompromised patients chronic pulmonary aspergillosis (CPA) (including those with an aspergilloma) may occur in those who have suffered a pulmonary insult such as tuberculosis, sarcoidosis, pneumothorax etc. [3]. The older term chronic necrotizing pulmonary aspergillosis mostly refers to those with subacute IPA. Within the spectrum of CPA are simple aspergilloma, chronic cavitary pulmonary aspergillosis, chronic fibrosing pulmonary aspergillosis and Aspergillus nodule [3,4] (Table 1) (Figure 1). There are estimated to be about 1.2 million cases of CPA following TB [5], perhaps 33-50% of the global total of patients with CPA.


Results of surgery for chronic pulmonary Aspergillosis, optimal antifungal therapy and proposed high risk factors for recurrence--a National Centre's experience.

Farid S, Mohamed S, Devbhandari M, Kneale M, Richardson M, Soon SY, Jones MT, Krysiak P, Shah R, Denning DW, Rammohan K - J Cardiothorac Surg (2013)

A: Examples of different types of chronic pulmonary aspergillosis aspergillus nodule; B: Simple aspergilloma; C: Chronic cavitary pulmonary aspergillosis (CCPA).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750592&req=5

Figure 1: A: Examples of different types of chronic pulmonary aspergillosis aspergillus nodule; B: Simple aspergilloma; C: Chronic cavitary pulmonary aspergillosis (CCPA).
Mentions: Aspergillosis refers to a spectrum of disease caused by Aspergillus species. This spectrum includes patients with asthma or cystic fibrosis who have allergic bronchopulmonary aspergillosis (ABPA) which is thought to affect over 4 million people worldwide [1]. In immunocompromised and critically ill patients invasive pulmonary aspergillosis (IPA) is relatively common and often fatal, and estimated to affect over 200,000 people worldwide [2]. In non-immunocompromised patients chronic pulmonary aspergillosis (CPA) (including those with an aspergilloma) may occur in those who have suffered a pulmonary insult such as tuberculosis, sarcoidosis, pneumothorax etc. [3]. The older term chronic necrotizing pulmonary aspergillosis mostly refers to those with subacute IPA. Within the spectrum of CPA are simple aspergilloma, chronic cavitary pulmonary aspergillosis, chronic fibrosing pulmonary aspergillosis and Aspergillus nodule [3,4] (Table 1) (Figure 1). There are estimated to be about 1.2 million cases of CPA following TB [5], perhaps 33-50% of the global total of patients with CPA.

Bottom Line: The procedures included lobectomy 50% (n = 15), pneumonectomy 10% (n = 3), sublobar resection 27% (n = 8), decortication 7% (n = 2), segmentectomy 3% (n = 1), thoracoplasty 3% (n = 1), bullectomy and pleurectomy 3% (n = 1), 6% (n = 2) lung transplantation for associated disease.Recurrence of CCPA was noted in 8 patients (26%), most having prior CCPA (75%).Taurolidine 2% was active against all 9 A. fumigatus isolates and used for pleural decontamination during surgery.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Surgery for pulmonary aspergillosis is infrequent and often challenging. Risk assessment is imprecise and new antifungals may ameliorate some surgical risks. We evaluated the medical and surgical management of these patients, including perioperative and postoperative antifungal therapy.

Methods: Retrospective study of patients who underwent surgery for pulmonary aspergillosis between September 1996 and September 2011.

Results: 30 patients underwent surgery with 23 having a preoperative tissue diagnosis while 7 were confirmed post-resection. The median age was 57 years (17-78). The commonest presenting symptoms were cough (40%, n = 12) and haemoptysis (43%, n = 13). Twelve (40%) patients had simple aspergilloma (including 2 with Aspergillus nodules) while the remaining 18 (60%) had chronic cavitary pulmonary aspergillosis (CCPA) (complex aspergilloma). Most of the patients had underlying lung disease: tuberculosis (20%, n = 6), asthma (26%, n = 8) and COPD (20%, n = 6). The procedures included lobectomy 50% (n = 15), pneumonectomy 10% (n = 3), sublobar resection 27% (n = 8), decortication 7% (n = 2), segmentectomy 3% (n = 1), thoracoplasty 3% (n = 1), bullectomy and pleurectomy 3% (n = 1), 6% (n = 2) lung transplantation for associated disease. Median hospital stay was 9.5 days (3-37). There was no operative and 30 day mortality. Main complications were prolonged air leak (n = 7, 23%), empyema (n = 6, 20%), respiratory failure requiring tracheostomy /reintubation (n = 4, 13%). Recurrence of CCPA was noted in 8 patients (26%), most having prior CCPA (75%). Taurolidine 2% was active against all 9 A. fumigatus isolates and used for pleural decontamination during surgery.

Conclusions: Surgery in patients with chronic pulmonary aspergillosis offered good outcomes with an acceptable morbidity in a difficult clinical situation; recurrence is problematic.

Show MeSH
Related in: MedlinePlus