Chronic cavitary and Fibrosing pulmonary and pleural aspergillosis: Case series, proposed nomenclature change, and review
Chronic cavitary and Fibrosing pulmonary and pleural aspergillosis: Case series, proposed nomenclature change, and review
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DOI：
10.1086/376526
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发表时间：
2003-10-01
影响因子：
11.8
通讯作者：
Sambatakou, H
中科院分区：
文献类型：
--
作者：
Denning, DW;Riniotis, K;Sambatakou, H
我们描述了 18 名非免疫功能低下的慢性肺曲霉病患者。病程从几个月到 112 年不等。所有 18 名患者均患有肺部疾病。体重减轻、慢性咳嗽（通常伴有咯血和气短）、疲劳和胸痛是最常见的症状。所有 18 名患者均出现空洞，通常是多个空洞，且位于肺的 1 个或两个上叶，随着时间的推移，空洞不断扩大，有或没有管腔内真菌球。所有这些都具有可检测到的曲霉沉淀素和炎症标记物。 78% 的患者总免疫球蛋白 E 水平升高，64% 的患者曲霉特异性免疫球蛋白 E 水平升高。定向肺活检显示慢性炎症、坏死或肉芽肿，无菌丝侵袭。伊曲康唑抗真菌治疗使 71% 的患者病情好转或稳定，但常见复发。 γ 干扰素治疗对 3 名患者有效。在唑类无反应者中，静脉注射两性霉素 B (80%) 随后注射伊曲康唑有中等反应。手术消除了疾病，但术后胸膜曲霉菌病是不可避免的。良好的长期医疗结果的指标是轻度症状、薄壁静止空洞、残留胸膜纤维化和正常炎症标志物。
We describe 18 nonimmunocompromised patients with chronic pulmonary aspergillosis. Duration of the disease ranged from several months to 112 years. All 18 patients had prior pulmonary disease. Weight loss, chronic cough (often with hemoptysis and shortness of breath), fatigue, and chest pain were the most common symptoms. All 18 patients had cavities, usually multiple and in 1 or both upper lobes of the lung, that expanded over time, with or without intraluminal fungal balls. All had detectable Aspergillus precipitins and inflammatory markers. Elevated levels of total immunoglobulin E were seen in 78% of patients and of Aspergillus-specific immunoglobulin E in 64%. Directed lung biopsies showed chronic inflammation, necrosis, or granulomas without hyphal invasion. Antifungal therapy with itraconazole resulted in 71% of patients improved or stabilized, with relapse common. Interferon-gamma treatment was useful in 3 patients. In azole nonresponders, modest responses to intravenous amphotericin B (80%) followed by itraconazole were seen. Surgery removed disease but postoperative pleural aspergillosis was inevitable. Indicators of good long-term medical outcomes were mild symptoms, thin-walled quiescent cavities, residual pleural fibrosis, and normal inflammatory markers.