阻塞性气管、支气管曲菌病.doc

Ann Acad Med Singapore. 2000 Mar;29(2):246-8.A case report of Aspergillus hypersensitivity syndrome with obstructing bronchial aspergillosis.Lee P, Goh SK, Yap WM, Chan CC.Department of Respiratory Medicine, Tan Tock Seng Hospital, Singapore.INTRODUCTION: A 62-year-old Indian male with diabetes mellitus presented with atypical, overlap features of Aspergillus hypersensitivity syndrome and obstructing bronchial aspergillosis. CLINICAL PICTURE: He was febrile and tachypnoeic with diffuse crepitations and wheezing. Chest X-ray was normal but eosinophil count was 2900/mm3 and Ig E 10,000 IU/ml. TREATMENT AND OUTCOME: He responded initially to high dose steroid therapy but deteriorated subsequently from extensive mucus plugging of the bronchial tree which resulted in respiratory failure and death. He was HIV-negative. CONCLUSION: Culture and histologic examination of bronchoscopically identified tracheobronchial mucus plugs should be performed as early treatment may be life-saving.Publication Types: Case ReportsPMID: 10895348 PubMed - indexed for MEDLINERev Mal Respir. 1990;7(6):609-12.Related Articles, Links Endobronchial aspergillosis associated with a carcinoid tumorArticle in FrenchQuoix E, Gasser B, Apprill M, Gourdon C, Pauli G, Roegel E.Pavillon Laennec, CHRU Strasbourg.We report a case of a 62 year old man who presented with effort dyspnoea accompanied by a cough and haemoptysis. The chest radiograph of the thorax showed atelectasis of the right upper lobe. Bronchoscopy showed evidence of a tumour like mass obstructing the right bronchus and this revealed itself to be a mass of organised fibrinous deposit in granulation tissue containing numerous colonies of Aspergillus. In fact it appeared to be an obstructive Aspergillus bronchitis, with a pseudo-tumour appearance attached to a carcinoid tumour which was obstructing the apical segment of the right upper lobe. Obstructive Aspergillus bronchitis makes up only a small percentage of overall respiratory disease caused by Aspergillus. They pose a problem of differential diagnosis with bronchopulmonary aspergillosis which is much more frequent.Publication Types: Case ReportsPMID: 2270353 PubMed - indexed for MEDLINE Am. J. Respir. Crit. Care Med., Vol 151, No. 6, 06 1995, 2109-2115. Review of fungus-induced asthmatic reactionsHF Kauffman, JF Tomee, TS van der Werf, JG de Monchy and GK Koeter Department of Allergology, University Hospital, Groningen, The Netherlands. Fungus-induced obstructive airway disease in atopic individuals can be differentiated into two categories: first, uncomplicated asthmatic reactions due to high but transient exposure to fungal spores (fungal asthma), resulting in a TH2-type response with immunoglobulin E- mediated reactions and eosinophilic inflammation; and second, a more complex asthmatic reaction due to colonization of the mucus-epithelial surface by virulent protease-producing fungi. The latter condition stimulates as exaggerated immunological response including all subclasses of antibodies directed against the microorganism and an intense eosinophilic infiltrate of the airways. The authors propose that the exaggerated inflammatory response in allergic bronchopulmonary fungosis damages epithelial cells and underlying tissue cells, resulting in inefficient elimination of the microorganisms and damage to matrix proteins of the lung tissue by proteases released by both the fungi and degranulating eosinophils. The positive effects of corticosteroids in the treatment of allergic bronchopulmonary aspergillosis probably results from the dampening of the inflammatory response and an increase of the efficiency of killing the fungi. Sensitization to fungi is high in childhood and declines rapidly with age, suggesting that younger children may be less proficient in clearing fungi from the airways. We propose that insufficient treatment of fungal asthma may result in damage to the bronchial mucosa and formation of bronchiectasis. Rev Mal Respir. 2005 Nov;22(5 Pt 1):811-4.Related Articles, Links Aspergillus bronchitis and aspergilloma treated successfully with voriconazoleArticle in FrenchFreymond N, Le Loch JB, Devouassoux G, Harf R, Rakotomalala A, Pacheco Y.Service de Pneumologie et dImmunologie Clinique, Centre Hospitalier Lyon Sud, Pierre Benite, France. nathalie.freymondchu-lyon.frINTRODUCTION: Aspergillus fumigatus is a ubiquitous soil-dwelling organism, which can cause both aspergillomas which develop in a preformed lung cavity, and aspergillus bronchitis. The two pathologies can occasionally co-exist, notably in patients with of cystic fibrosis. CASE REPORT: We describe a 57 year old patient, with diffuse bronchiectasis, who developed aspergillus bronchitis as well as an aspergilloma complicating a cavity caused by an atypical mycobacterial infection. After one month of therapy with voriconazole the aspergilloma had decreased in size and the endobronchial changes had resolved. CONCLUSION: This case report illustrates that in addition to its established role for the treatment of invasive aspergillosis, voriconazole is a promising new therapy for the treatment of aspergilloma and aspergillus bronchitis.PMID: 16272984 PubMed - in process Rev Pneumol Clin. 2004 Jun;60(3):166-70.Related Articles, Links An unusual cause of acute respiratory distress: obstructive bronchial aspergillosisArticle in FrenchMargery J, Perez JP, Vaylet F, Bordier E, Dot JM, Saint-Blancard P, Bonnichon A, Guigay J, Pats B, LHer P.Service des Maladies Respiratoires, Hopital dInstruction des Armees Percy, 101, avenue Henri-Barbusse, BP 406, 92140 Clamart. j.margerywanadoo.frWe report the case of a 77-Year-old immunocompetent woman who required intensive care for acute dyspnea revealing complete atelectasia of the left lung related to an aspergillus mycelium plug blocking the principal bronchus. The clinical course was favorable after deobstruction by thermocoagulation and oral itraconazole given for six Months. The patient was free of parenchymatous or endobronchial sequelae. Adjuvant oral corticoid therapy was given temporarily during the second Month of treatment when signs of transition towards allergic aspergillosis developed. Four Months after discontinuing the antifungal treatment, the patient developed a new episode of acute dyspnea caused by atelectasia limited to the right lower lobe. Treatment by itraconazole was resumed and continued as long-term therapy. No recurrence has been observed for eighteen Months. The diagnostic and therapeutic problems raised by Aspergillus fumigatus are well known in the immunocompromised subject, but can also be encountered in the immunocompetent subject.Publication Types: Case ReportsPMID: 15292826 PubMed - indexed for MEDLINE Tuberk Toraks. 2004;52(2):179-82.Related Articles, Links A case report of endobronchial semi-invasive aspergillosis.Kadakal F, Uysal MA, Ozgul MA, Elibol S, Urer N, Gurses A, Yilmaz V.Yedikule Training and Research Hospital for Chest Disease and Thoracic Surgery, Istanbul, Turkey.Pulmonary aspergillosis may be classified under three main categories. These are invasive pulmonary aspergillosis, allergic bronchopulmonary aspergillosis and aspergilloma. Sometimes more than one form of the disease may be present at the same time. Semi-invasive aspergillosis is different from aspergilloma in that there is local invasion of the lung tissue. We have observed a previously healthy 42 year old female with a solitary pulmonary nodule on her radiograms. A diagnosis of endobronchial semi-invasive aspergillosis was established in this patient. We aimed to present this case report with a review of the literature.Publication Types: Case Reports Review PMID: 15241704 PubMed - indexed for MEDLINE Yonsei Med J. 2000 Jun;41(3):422-5.Related Articles, Links A case of endobronchial aspergilloma.Kim JS, Rhee Y, Kang SM, Ko WK, Kim YS, Lee JG, Park JM, Kim SK, Kim SK, Lee WY, Chang J.Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.Pulmonary aspergillosis may be classified under three categories, depending upon whether the host is atopic or immunocompromised: invasive aspergillosis, allergic bronchopulmonary aspergillosis (ABPA) or aspergilloma. However, it is not always possible to effectively categorize this disease. We experienced a case of endobronchial aspergilloma, which was difficult to categorize, in a healthy male patient. The chest X-ray and computed tomography showed an ill-defined nodule mimicking lung cancer. Fiberoptic bronchoscopy revealed an aspergilloma without cavity formation in the left lower laterobasal segmental bronchial orifice. The aspergilloma was removed and the patients symptoms were relieved. We present this unusual case with a review of the literature.Publication Types: Case ReportsEur Respir J. 1995 Mar;8(3):477-80.Related Articles, Links Three cases of bronchial stump aspergillosis: unusual clinical presentations and beneficial effect of oral itraconazole.Noppen M, Claes I, Maillet B, Meysman M, Monsieur I, Vincken W.Respiratory Division, Academic Hospital, University of Brussels, Belgium.Bronchial stump aspergillosis (BSA), i.e. Aspergillus infection of bronchial granulation tissue surrounding endobronchial suture threads, is a very rare variant of localized suppurative bronchial Aspergillus infection. The majority of reported cases have occurred within one year after lung surgery. We present three more patients, in whom BSA occurred very late (4.5, 6 and 7 yrs) after pulmonary resection. Other unusual features were: complete absence of symptoms in one patient, and simultaneous occurrence of aspergilloma in another. Removal of the endobronchial suture probably constitutes the key therapy for BSA. In all three of our patients oral itraconazole resulted in clinical, histological and microbiological improvement. In conclusion, BSA should be considered in the differential diagnosis of haemoptysis occurring up to 7 yrs after lung surgery, although an asymptomatic presentation is possible. Furthermore, BSA can be associated with other clinical presentations of Aspergillus infection, e.g. aspergilloma. Finally, long-term oral itraconazole therapy may represent a valid alternative when removal of the suture is not feasible.Publication Types: Case ReportsPMID: 7789500 PubMed - indexed for MEDLINE Pediatr Pulmonol. 1993 Jul;16(1):69-73.Related Articles, Links Unusual form of endobronchial Aspergillosis in a patient with cystic fibrosis.Sammut PH, Howard ST, Linder J, Colombo JL.Department of Pediatrics, University of Nebraska Medical Center, Omaha 68198-5190.The isolation of Aspergillus fumigatus from airway secretions from patients with cystic fibrosis (CF) is common and usually denotes asymptomatic colonization or allergic broncho-pulmonary aspergillosis (ABPA). A 12-year-old boy with CF acutely developed moderately severe symptoms of unremitting cough, fever, dyspnea, weight loss, and cyanosis. Chest radiographs demonstrated widespread unilateral infiltrates and volume loss. By bronchoscopy tenacious mucous plugs were seen occluding the left lower lobe bronchus. Cultures from sputum and sequential bronchoalveolar lavage grew Aspergillus fumigatus, but other significant criteria for diagnosing ABPA were lacking. No improvement was seen with a 3 week course of systemic corticosteroid and antibiotic therapy. Treatment with amphotericin B and short-term mechanical ventilation resulted in rapid resolution of all symptoms. This form of endobronchial aspergillosis has not been described previously.Publication Types: Case ReportsPMID: 8414745 PubMed - indexed for MEDLINE Chest. 1994 May;105(5):1314-23.Related Articles, Links Comment in: Chest. 1995 Aug;108(2):587-8. Chest. 1995 Mar;107(3):886. Endobronchial lesions in HIV-infected individuals.Judson MA, Sahn SA.Medical University of South Carolina, Division of Pulmonary and Critical Care Medicine, Charleston.Endobronchial manifestations of HIV infection are rare. The endobronchial appearance and clinical pr