Chronic Aspergillosis of the Lungs: Unravelling the Terminology and Radiology

Abstract

The propensity for Aspergillus spp. to cause lung disease has long been recognised but the satisfactory classification of these disorders is challenging. The problems caused by invasive disease in severely neutropenic patients, saprophytic infection of pre-existing fibrotic cavities and allergic reactions to Aspergillus are well documented. In contrast, a more chronic form of Aspergillus-related lung disease that has the potential to cause significant morbidity and mortality is under-reported. The symptoms of this form of Aspergillus infection may be non-specific and the radiologist may be the first to suspect a diagnosis of chronic pulmonary aspergillosis. The current review considers the classification conundrums in diseases caused by Aspergillus spp. and discusses the typical clinical and radiological profile of patients with chronic pulmonary aspergillosis.

Key Points

• The classification of Aspergillus -related lung disease is mired in confusion.

• The chronic form of Aspergillus infection is associated with significant morbidity and mortality.

• Progressive consolidation and cavitation with intracavitary material is the radiological hallmark.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. 1.

    Sluyter T (1847) De vegetalibus organismi animalis parasitis. Diss Inaug Berlin

  2. 2.

    Kradin RL, Mark EJ (2008) The pathology of pulmonary disorders due to Aspergillus spp. Arch Pathol Lab Med 132:606–614

    PubMed  Google Scholar 

  3. 3.

    Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al (2008) Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 46:327–360

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Georgiadou SP, Sipsas NV, Marom EM, Kontoyiannis DP (2011) The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts. Clin Infect Dis 52:1144–1155

    PubMed Central  Article  PubMed  Google Scholar 

  5. 5.

    Marom EM, Kontoyiannis DP (2011) Imaging studies for diagnosing invasive fungal pneumonia in immunocompromised patients. Curr Opin Infect Dis 24:309–314

    Article  PubMed  Google Scholar 

  6. 6.

    Denning DW, Pleuvry A, Cole DC (2011) Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Org 86:864–872

    Article  Google Scholar 

  7. 7.

    Johnson J (1987) Pulmonary aspergillosis. Sem Respir Med 9:187–199

    Article  Google Scholar 

  8. 8.

    Buckingham SJ, Hansell DM (2003) Aspergillus in the lung: diverse and coincident forms. Eur Radiol 13:1786–1800

    Article  PubMed  Google Scholar 

  9. 9.

    Hemphill RA (1946) Mycotic lung infection. Am J Med 1:708

    CAS  Article  PubMed  Google Scholar 

  10. 10.

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

    Article  Google Scholar 

  11. 11.

    Leggat PO, De Krester DM (1968) Aspergillus pneumonia in association with an aspergilloma. Brit J Dis Chest 62:147–150

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Ein ME, Wallace RJ Jr, Williams TW Jr (1979) Allergic bronchopulmonary aspergillosis-like syndrome consequent to aspergilloma. Am Rev Respir Dis 119:811–820

    CAS  PubMed  Google Scholar 

  13. 13.

    Shah A, Khan ZU, Chaturvedi S, Ramchandran S, Randhawa HS, Jaggi OP (1989) Allergic bronchopulmonary aspergillosis with coexistent aspergilloma: a long-term followup. J Asthma 26:109–115

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Safirstein BH (1973) Aspergilloma consequent to allergic bronchopulmonary aspergillosis. Am Rev Respir Dis 108:940–943

    CAS  PubMed  Google Scholar 

  15. 15.

    Henderson AH (1968) Allergic aspergillosis: review of 32 cases. Thorax 23:501–512

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  16. 16.

    Greene R (1981) The pulmonary aspergilloses: three distinct entities or a spectrum of disease. Radiology 140:527–530

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Ganassini A, Cazzadori A (1995) Invasive pulmonary aspergillosis complicating allergic bronchopulmonary aspergillosis. Respir Med 89:143–145

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Hinson KFW, Moon AJ, Plummer NS (1952) Broncho-pulmonary aspergillosis: a review and a report of eight new cases. Thorax 7:317–333

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  19. 19.

    Macartney JN (1964) Pulmonary aspergillosis: a review and a description of three new cases. Thorax 19:287–297

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  20. 20.

    Fraser RS (1993) Pulmonary aspergillosis: pathologic and pathogenetic features. Pathol Annu 28:231–277

    PubMed  Google Scholar 

  21. 21.

    Gefter WB, Weingrad TR, Epstein DM, Ochs RH, Miller WT (1981) “Semi-invasive” pulmonary aspergillosis: a new look at the spectrum of Aspergillus infections of the lung. Radiology 140:313–321

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Denning DW, Riniotis K, Dobrashian R, Sambatakou H (2003) Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review. Clin Infect Dis 37:S265–S280

    Article  PubMed  Google Scholar 

  23. 23.

    Smith NLD, Denning DW (2014) Clinical implications of interferon gamma genetic and epigenetic variants. Immunology 143:499–511

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Murdock BJ, Shreiner AB, Mcdonald RA, Osterholzer JJ, White ES, Toews GB et al (2011) Coevolution Of TH1, TH2, and TH17 responses during repeated pulmonary exposure to Aspergillus fumigatus conidia. Infect Immun 79:125–135

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  25. 25.

    Smith NL, Denning DW (2011) Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J 37:865–872

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Nam H-S, Jeon K, Um S-W, Suh GY, Chung MP, Kim H et al (2010) Clinical characteristics and treatment outcomes of chronic necrotizing pulmonary aspergillosis: a review of 43 cases. Int J Infect Dis 14:E479–E482

    Article  PubMed  Google Scholar 

  27. 27.

    Ohba H, Miwa S, Shirai M, Kanai M, Eifuku T, Suda T et al (2012) Clinical characteristics and prognosis of chronic pulmonary aspergillosis. Respir Med 106:724–729

    Article  PubMed  Google Scholar 

  28. 28.

    Camara B, Reymond E, Saint-Raymond C, Roth H, Brenier-Pinchart MP, Pinel C et al (2014) Characteristics and outcomes of chronic pulmonary aspergillosis: a retrospective analysis of a tertiary hospital registry. Clin Respir J. doi:10.1111/crj.12105

    PubMed  Google Scholar 

  29. 29.

    Izumikawa K, Tashiro M, Kohno S (2012) Management of chronic aspergillosis. Ann N Y Acad Sci 1272:40–48

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Yousem SA (1997) The histological spectrum of chronic necrotizing forms of pulmonary aspergillosis. Hum Pathol 28:650–656

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Schweer KE, Bangard C, Hekmat K, Cornely OA (2013) Chronic pulmonary aspergillosis. Mycoses. doi:10.1111/myc.12152

    PubMed  Google Scholar 

  32. 32.

    Libshitz HI, Atkinson GW, Israel HL (1974) Pleural thickening as a manifestation of Aspergillus suprinfection. Am J Roentgenol 120:883–886

    CAS  Article  Google Scholar 

  33. 33.

    Meredith HC, Cogan BM, Mclaulin B (1978) Pleural aspergillosis. AJR Am J Roentgenol 130:164–166

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Sansom HE, Baque-Juston MC, Wells AU, Hansell DM (2000) Lateral cavity wall thickening as an early radiographic sign of mycetoma formation. Eur Radiol 10:387–390

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Franquet T, Giménez A, Cremades R, Domingo P, Plaza V (2000) Spontaneous reversibilty of “pleural thickening” in a patient with semi-invasive pulmonary aspergillosis: radiographic and CT findings. Eur Radiol 10:722–724

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Frankel SK, Cool CD, Lynch DA, Brown KK (2004) Idiopathic pleuroparenchymal fibroelastosis: description of a novel clinicopathologic entity. Chest 26:2007–2013

    Article  Google Scholar 

  37. 37.

    Becker CD, Gil J, Padilla ML (2008) Idiopathic pleuroparenchymal fibroelastosis: an unrecognized or misdiagnosed entity? Mod Pathol 21:784–787

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Reddy TL, Tominaga M, Hansell DM, Von Der Thusen J, Rassl D, Parfrey H et al (2012) Pleuroparenchymal fibroelastosis: a spectrum of histopathological and imaging phenotypes. Eur Respir J 40:377–385

    Article  PubMed  Google Scholar 

  39. 39.

    Piciucchi S, Tomassetti S, Casoni G, Sverzellati N, Carloni A, Dubini A et al (2011) High resolution CT and histological findings in idiopathic pleuroparenchymal fibroelastosis: features and differential diagnosis. Resp Res 12:1–5

    Article  Google Scholar 

  40. 40.

    Hafeez I, Muers MF, Murphy SA, Evans EGV, Barton RC, McWhinney P (2000) Non-tuberculous mycobacterial lung infection complicated by chronic necrotising pulmonary aspergillosis. Thorax 55:717–719

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  41. 41.

    Zoumot Z, Boutou AK, Gill SS, Van Zeller M, Hansell DM, Wells AU et al (2014) Mycobacterium avium complex infection in non-cystic fibrosis bronchiectasis. Respirology 19:714–722

    Article  PubMed  Google Scholar 

  42. 42.

    Johnston IDA (1988) Mycobacterium xenopi infection and aspergilloma. Tubercle 69:139–143

    CAS  Article  PubMed  Google Scholar 

  43. 43.

    Choudat D, Horreard P, Pretet S, Grosset J, Toty L (1986) Superinfection by Aspergillus fumigatus of a pulmonary lesion caused by Mycobacterium xenopi. Tubercle 67:71–74

    CAS  Article  PubMed  Google Scholar 

  44. 44.

    Böllert FGE, Sime PJ, Macnee W, Crompton GK (1994) Pulmonary Mycobacterium malmoense and aspergillus infection: a fatal combination? Thorax 49:521–522

    PubMed Central  Article  PubMed  Google Scholar 

  45. 45.

    Hansell DM, Bankier AA, Macmahon H, Mcloud TC, Müller NL, Remy J (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246:697–722

    Article  PubMed  Google Scholar 

  46. 46.

    Franquet T, Müller NL, Giménez A, Domingo P, Plaza V, Bordes R (2000) Semiinvasive pulmonary aspegillosis in chronic obstructive pulmonary disease: radiologic and pathologic findings in nine patients. AJR 174:51–56

    CAS  Article  PubMed  Google Scholar 

  47. 47.

    Kim SY, Lee KS, Han J, Kim J, Kim TS, Choo SW et al (2000) Semiinvasive pulmonary aspergillosis: CT and pathologic findings in six patients. AJR 174:795–798

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Sambatakou H, Dupont B, Lode H, Denning DW (2006) Voriconazole treatment for subacute invasive and chronic pulmonary aspergillosis. Am J Med 119:527

    Article  PubMed  Google Scholar 

  49. 49.

    Koyama K, Ohshima N, Suzuki J, Kawashima M, Takeda K, Ando T et al (2014) Recurrence of chronic pulmonary aspergillosis after discontinuation of maintenance treatment by antifungal triazoles. J Infect Chemother 20:375–379

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgements

Professor David M. Hansell is the recipient of a National Institute of Health Senior Investigator Award. The scientific guarantor of this publication is Dr. Sujal R. Desai. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No statistical methods were necessary for this paper. Institutional review board approval was not required because the submitted manuscript is a review article. Methodology: not applicable. The submitted manuscript is a review article.

Author information

Affiliations

Authors

Corresponding author

Correspondence to S. R. Desai.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Desai, S.R., Hedayati, V., Patel, K. et al. Chronic Aspergillosis of the Lungs: Unravelling the Terminology and Radiology . Eur Radiol 25, 3100–3107 (2015). https://doi.org/10.1007/s00330-015-3690-7

Download citation

Keywords

  • Aspergillosis
  • Chronic necrotising pulmonary aspergillosis
  • Imaging, diagnostic
  • Tomography, x-ray computed
  • Nomenclature