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Clinical and laboratory profile of chronic pulmonary aspergillosis: a retrospective study

Abstract

Introduction

Chronic pulmonary aspergillosis (CPA) is a type of semi-invasive aspergillosis seen mainly in immunocompetent individuals. These are slow, progressive, and not involved in angio-invasion compared with invasive pulmonary aspergillosis. The predisposing factors being compromised lung parenchyma owing to chronic obstructive pulmonary disease and previous pulmonary tuberculosis. As not many studies have been conducted in CPA with respect to clinical and laboratory profile, the study was undertaken to examine the profile in our population.

Patients and methods

This was a retrospective study. All patients older than 18 years, who had evidence of pulmonary fungal infection on chest radiography or computed tomographic scan, from whom the Aspergillus sp. was isolated from respiratory sample (broncho-alveolar wash, bronchoscopic sample, etc.) and diagnosed with CPA from 2008 to 2016, were included in the study.

Results

A total of 30 patients were included in the study. Most patients presented with pulmonary symptoms like cough with expectoration, hemoptysis, fever, breathlessness, and chest pain. Among the systemic comorbid conditions, diabetes mellitus was the most common (7/30), and nearly 50% (14/30) of the patients had a history of pulmonary tuberculosis. Among the hematological parameters, a significant difference was observed in hemoglobin, total leukocyte count, differential leukocyte count, and erythrocyte sedimentation rate. In all the four dead patients, the cause of death was respiratory failure and all patients were previously treated for pulmonary tuberculosis.

Conclusion

When a patient with pre-existing lung disease like chronic obstructive pulmonary disease or old tuberculosis cavity presents with cough with expectoration, breathlessness, and hemoptysis, CPA should be considered as the first differential diagnosis.

References

  1. Soubani AO, Chandrasekar PH. The clinical spectrum of pulmonary aspergillosis. Chest 2002; 121: 1988–1999.

    Article  Google Scholar 

  2. Patterson TF. Aspergillus specie. In Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 7th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2010. 3241–3255

    Google Scholar 

  3. Meyer RD. Aspergillus specie. In Gorbach SL, Bartlett JG, Blacklow NR, editors. Infectious diseases. 3rd ed. Philadelphia, PA: W. B. Saunders Lippincott Williams & Wilkins; 2004. 2212–2218

    Google Scholar 

  4. Segal BH, Walsh TJ. Current approaches to diagnosis and treatment of invasive aspergillosis. Am J Respir Crit Care Med 2006; 173: 707–717.

    Article  CAS  Google Scholar 

  5. Denning DW, Pleuvry A, Cole DC. Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ 2011; 89: 864–872.

    Article  Google Scholar 

  6. Soubani AO, Khanchandani G, Ahmed HP. Clinical significance of lower respiratory tract aspergillus culture in elderly hospitalized patients. Eur J Clin Microbiol Infect Dis 2004; 23: 491–494.

    Article  CAS  Google Scholar 

  7. Denning DW. Chronic forms of pulmonary aspergillosis. Clin Microbiol Infect 2001; 7: 25–31.

    Article  Google Scholar 

  8. Denning D. Chronic aspergillosis. In Latgé J, Steinbach W, editors. Aspergillus fumigatus and Aspergillosis. 1st ed. Washington, DC: ASM Press; 2009. 319–331.

  9. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008; 46: 1813–1821.

    Article  Google Scholar 

  10. Caillot D, Casasnovas O, Bernard A, Couaillier JF, Durand C, Cuisenier B, et al. Improved management of invasive pulmonary aspergillosis in neutropenic patients using early thoracic computed tomographic scan and surgery. J Clin Oncol 1997; 15: 139–147.

    Article  CAS  Google Scholar 

  11. Marty FM, Koo S. Role of (I→3)-ββ-D-Glucan in the diagnosis of invasive aspergillosis. Med Mycol 2009; 47: 233–240.

    Article  Google Scholar 

  12. Jhun BW, Jeon K, Eom JS, Lee JH, Suh GY, Kwon OJ, et al. Clinical characteristics and treatment outcomes of chronic pulmonary aspergillosis. Med Mycol 2013; 51: 811–817.

    Article  Google Scholar 

  13. Denning DW, Cadranel J, Aubry CB, Ader F, Chakrabarti A, Blot S, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J 2016; 47: 45–68.

    Article  CAS  Google Scholar 

  14. Jakribettu RP, Boloor R, Kinila S, Kuruvilla TS. Pulmonary aspergillosis: atypical presentation in immunocompetent individuals. Ann Trop Med Public Health 2013; 6: 327–330.

    Article  Google Scholar 

  15. Agarwal R, Denning DW, Chakrabarti A. Estimation of the burden of chronic and allergic pulmonary aspergillosis in India. PLoS ONE 2014; 9: e114745.

  16. Zmeili OS, Soubani AO. Pulmonary aspergillosis: a clinical update. QJM 2007; 100: 317–334.

    Article  CAS  Google Scholar 

  17. Grahame-Clarke CN, Roberts CM, Empey DW. Chronic necrotizing pulmonary aspergillosis and pulmonary phycomycosis in cystic fibrosis. Respir Med 1994; 88: 465–468.

    Article  CAS  Google Scholar 

  18. Lin SJ, Schranz J, Teutsch SM. Aspergillosis case-fatality rate: systematic review of the literature. Clin Infect Dis 2001; 32: 358–366.

    Article  CAS  Google Scholar 

  19. Saraceno JL, Phelps DT, Ferro TJ, Futerfas R, Schwartz DB. Chronic necrotizing pulmonary aspergillosis: approach to management. Chest 1997; 112: 541–548.

    Article  CAS  Google Scholar 

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Correspondence to Ramakrishna Pai Jakribettu MD.

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Jakribettu, R.P., George, T., Abraham, S. et al. Clinical and laboratory profile of chronic pulmonary aspergillosis: a retrospective study. Egypt J Bronchol 13, 109–113 (2019). https://doi.org/10.4103/ejb.ejb_35_18

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