Skip to main content
SpringerLink
Log in
Book cover

Respiratory Regulation - Clinical Advances pp 225–236Cite as

Pulmonary Aspergillosis: Therapeutic Management and Prognostic Factors from 16 Years of Monocenter Experience

  • Conference paper
  • First Online:

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 755))

Abstract

Twenty three patients of the University Hospital Bonn were reviewed following surgical procedures for pulmonary aspergilloma, including the choice of antifungal therapy, diagnostic findings, decision-making in treatment, and treatment outcomes of the past 16 years. We used pathological records to identify aspergilloma patients. A review of patients’ records and follow-up phone calls to patients, families, or general practitioners were done. Data collected from 1995 to 2011 included patients with aspergilloma (n = 15), multiple aspergillomas (n = 2) and chronic necrotizing pulmonary aspergillosis (n = 6). Classification and diagnosis were based on pathological records. The decision to use systemic antimycotic therapy was based on perioperative findings suspecting parenchymal involvement of the fungal infection. Seventeen patients received systemic antimycotic chemotherapy. Compared with the use of Amphotericin B, newer drugs such as voriconazol, caspofungin, or posaconazol showed no better result in the morbidity and mortality of the patients. Postoperative complications requiring extended therapy and/or prolonged ICU stay (>48 h) were seen in 12 (52.2%) patients. During follow-up there were ten deaths; one death (4.4%) from aspergillus-associated sepsis, nine deaths from patients’ underlying diseases (n = 4 within <3 months, n = 6 within >3 months of follow-up). In conclusion, in our cohort, immunocompromised patients with no documented preexisting lung-cavities were most likely to develop pulmonary aspergilloma. Postoperative morbidity (52.2%) was high, but related mainly to patient co-morbidity; postoperative mortality was reasonably low. Patients showing classical symptoms or immunocompromised patients should be considered for surgery. Encapsulated Aspergilloma without invasion of surrounding parenchyma requires no antifungal chemotherapy.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  • Aslam, P. A., Eastridge, C. E., & Hughes, F. A. (1971). Aspergillosis of the lung-an eighteen-year experience. Chest, 59, 28–32.

    Article  PubMed  CAS  Google Scholar 

  • Babatasi, G., Massetti, M., Chapelier, A., Fadel, E., Macchiarini, P., Khayat, A., & Dartevelle, P. (2000). Surgical treatment of pulmonary aspergilloma: Current outcome. The Journal of Thoracic and Cardiovascular Surgery, 119, 906–912.

    Article  PubMed  CAS  Google Scholar 

  • Battaglini, J. W., Murray, G. F., Keagy, B. A., Starek, P. J., & Wilcox, B. R. (1985). Surgical management of symptomatic pulmonary aspergilloma. The Annals of Thoracic Surgery, 39, 512–516.

    Article  PubMed  CAS  Google Scholar 

  • Caidi, M., Kabiri, H., Al Aziz, S., El Maslout, A., & Benosman, A. (2006). Surgical treatment of pulmonary aspergilloma 278 cases. Presse Médicale, 35, 1819–1824.

    Article  Google Scholar 

  • Chen, J. C., Chang, Y. L., Luh, S. P., Lee, J. M., & Lee, Y. C. (1997). Surgical treatment for pulmonary aspergilloma: A 28 year experience. Thorax, 52, 810–813.

    Article  PubMed  CAS  Google Scholar 

  • Csekeo, A., Agócs, L., Egerváry, M., & Heiler, Z. (1997). Surgery for pulmonary aspergillosis. European Journal of Cardio-Thoracic Surgery, 12, 876–879.

    Article  PubMed  CAS  Google Scholar 

  • Daly, R. C., Pairolero, P. C., Piehler, J. M., Trastek, V. F., Payne, W. S., & Bernatz, P. E. (1986). Pulmonary aspergilloma. Results of surgical treatment. The Journal of Thoracic and Cardiovascular Surgery, 92, 981–988.

    PubMed  CAS  Google Scholar 

  • Dixon, D. M., Mcneil, M. M., Cohen, M. L., Gellin, B. G., & La Montagne, J. R. (1996). Fungal infections: A growing threat. Public Health Reports, 111, 226–235.

    PubMed  CAS  Google Scholar 

  • El Oakley, R., Petrou, M., & Goldstraw, P. (1997). Indications and outcome of surgery for pulmonary aspergilloma. Thorax, 52, 813–815.

    Article  PubMed  CAS  Google Scholar 

  • Franquet, T., Müller, N. L., Giménez, A., Guembe, P., De la Torre, J., & Bagué, S. (2001). Spectrum of pulmonary aspergillosis: Histologic, clinical, and radiologic findings. Radiographics, 21, 825–837.

    PubMed  CAS  Google Scholar 

  • Fukuda, T., Boeckh, M., Carter, R. A., Sandmaier, B. M., Maris, M. B., Maloney, D. G., Martin, P. J., Storb, R. F., & Marr, K. A. (2003). Risks and outcomes of invasive fungal infections in recipients of allogeneic hematopoietic stem cell transplants after nonmyeloablative conditioning. Blood, 102, 827–833.

    Article  PubMed  CAS  Google Scholar 

  • Garvey, J., Crastnopol, P., Weisz, D., & Khan, F. (1977). The surgical treatment of pulmonary aspergillomas. The Journal of Thoracic and Cardiovascular Surgery, 74, 542–547.

    PubMed  CAS  Google Scholar 

  • Groll, A. H., Shah, P. M., Mentzel, C., Schneider, M., Just-Nuebling, G., & Huebner, K. (1996). Trends in the postmortem epidemiology of invasive fungal infections at a university hospital. Journal of Infection, 33, 23–32.

    Article  PubMed  CAS  Google Scholar 

  • Itoh, T., Yamada, H., Yamaguchi, A., Kawamata, N., Kakei, M., Nozoe, S., & Tanaka, H. (1995). Percutaneous intracavitary antifungals for a patient with pulmonary aspergilloma; with a special reference to in vivo efficacies and in vitro susceptibility results. Internal Medicine, 34, 85–88.

    Article  PubMed  CAS  Google Scholar 

  • Jewkes, J., Kay, P. H., Paneth, M., & Citron, K. M. (1983). Pulmonary aspergilloma: Analysis of prognosis in relation to haemoptysis and survey of treatment. Thorax, 38, 572–578.

    Article  PubMed  CAS  Google Scholar 

  • Kappe, R., & Rimek, D. (2004). Antibody detection in patients with invasive aspergillosis. Mycoses, 47(Suppl 1), 55–59.

    Article  PubMed  Google Scholar 

  • Kim, Y. T., Kang, M. C., Sung, S. W., & Kim, J. H. (2005). Good long-term outcomes after surgical treatment of simple and complex pulmonary aspergilloma. The Annals of Thoracic Surgery, 79, 294–298.

    Article  PubMed  Google Scholar 

  • Lass-Flörl, C., & Dierich, M. P. (2004). Epidemiology and prevention of pulmonary aspergillosis in patients with hematological malignancies. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 47, 379–383.

    Article  PubMed  Google Scholar 

  • Latgé, J. P. (1999). Aspergillus fumigatus and aspergillosis. Clinical Microbiology Reviews, 12, 310–350.

    PubMed  Google Scholar 

  • Lopes Da Silva, R., Ribeiro, P., Abreu, N., Ferreira, T., Fernandes, T., Monteiro, A., Costa, F., Caldas, J., Silva, M., Carande, L., Ferreira, G., Conduto, A., Cruz, E., Sousa, M. H., Rodrigues, A. S., Costa, I., Veiga, J., & De Sousa, A. B. (2010). Early diagnosis of invasive aspergillosis in neutropenic patients. Comparison between serum galactomannan and polymerase chain reaction. Clinical Medicine Insights: Oncology, 4, 81–88.

    Article  PubMed  CAS  Google Scholar 

  • Massard, G., Roeslin, N., Wihlm, J. M., Dumont, P., Witz, J. P., & Morand, G. (1992). Pleuropulmonary aspergilloma: Clinical spectrum and results of surgical treatment. The Annals of Thoracic Surgery, 54, 1159–1164.

    Article  PubMed  CAS  Google Scholar 

  • McCarthy, D. S., & Pepys, J. (1973). Pulmonary aspergilloma–clinical immunology. Clinical Allergy, 3, 57–70.

    Article  PubMed  CAS  Google Scholar 

  • Munk, P. L., Vellet, A. D., Rankin, R. N., Müller, N. L., & Ahmad, D. (1993). Intracavitary aspergilloma: Transthoracic percutaneous injection of amphotericin gelatin solution. Radiology, 188, 821–823.

    PubMed  CAS  Google Scholar 

  • Regnard, J. F., Icard, P., Nicolosi, M., Spagiarri, L., Magdeleinat, P., Jauffret, B., & Levasseur, P. (2000). Aspergilloma: A series of 89 surgical cases. The Annals of Thoracic Surgery, 69, 898–903.

    Article  PubMed  CAS  Google Scholar 

  • Safirstein, B. H. (1973). Aspergilloma consequent to allergic bronchopulmonary aspergillosis. American Review of Respiratory Disease, 108, 940–943.

    PubMed  CAS  Google Scholar 

  • Saraceno, J. L., Phelps, D. T., Ferro, T. J., Futerfas, R., & Schwartz, D. B. (1997). Chronic necrotizing pulmonary aspergillosis: Approach to management. Chest, 112, 541–548.

    Article  PubMed  CAS  Google Scholar 

  • Schulte, T., Welcker, K., Schatz, J., & Branscheid, D. (2005). Surgical treatment of pulmonary aspergilloma. Mycoses, 48(Suppl 1), 46–50.

    Article  PubMed  Google Scholar 

  • Soltanzadeh, H., Wychulis, A. R., Sadr, F., Bolanowski, P. J., & Neville, W. E. (1977). Surgical treatment of pulmonary aspergilloma. Annals of Surgery, 186, 13–16.

    Article  PubMed  CAS  Google Scholar 

  • Soubani, A. O., & Chandrasekar, P. H. (2002). The clinical spectrum of pulmonary aspergillosis. Chest, 121, 1988–1999.

    Article  PubMed  Google Scholar 

  • Stamatis, G., & Greschuchna, D. (1988). Surgery for pulmonary aspergilloma and pleural aspergillosis. Thoracic and Cardiovascular Surgeon, 36, 356–360.

    Article  PubMed  CAS  Google Scholar 

  • Tsubura, E. (1997). Multicenter clinical trial of itraconazole in the treatment of pulmonary aspergilloma. Pulmonary aspergilloma study group. Kekkaku, 72, 557–564.

    PubMed  CAS  Google Scholar 

  • Ueda, H., Okabayashi, K., Ondo, K., & Motohiro, A. (2001). Analysis of various treatments for pulmonary aspergillomas. Surgery Today, 31, 768–773.

    Article  PubMed  CAS  Google Scholar 

  • Von Eiff, M., Roos, N., Schulten, R., Hesse, M., Zühlsdorf, M., & Van de Loo, J. (1995). Pulmonary aspergillosis: Early diagnosis improves survival. Respiration, 62, 341–347.

    Article  Google Scholar 

  • Walsh, T. J., Anaissie, E. J., Denning, D. W., Herbrecht, R., Kontoyiannis, D. P., Marr, K. A., Morrison, V. A., Segal, B. H., Steinbach, W. J., Stevens, D. A., Van Burik, J. A., Wingard, J. R., Patterson, T. F., Society, I. D., & Infectious Diseases Society of America. (2008). Treatment of aspergillosis: Clinical practice guidelines of the Infectious Diseases Society of America. Clinical Infectious Diseases, 46, 327–360.

    Article  PubMed  CAS  Google Scholar 

  • Yamada, H., Kohno, S., Koga, H., Maesaki, S., & Kaku, M. (1993). Topical treatment of pulmonary aspergilloma by antifungals. Relationship between duration of the disease and efficacy of therapy. Chest, 103, 1421–1425.

    Article  PubMed  CAS  Google Scholar 

  • Yeghen, T., Kibbler, C. C., Prentice, H. G., Berger, L. A., Wallesby, R. K., McWhinney, P. H., Lampe, F. C., & Gillespie, S. (2000). Management of invasive pulmonary aspergillosis in hematology patients: A review of 87 consecutive cases at a single institution. Clinical Infectious Diseases, 31, 859–868.

    Article  PubMed  CAS  Google Scholar 

  • Zmeili, O. S., & Soubani, A. O. (2007). Pulmonary aspergillosis: A clinical update. QJM: Monthly Journal of the Association of Physicians, 100, 317–334.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest: The authors declare no conflicts of interest in relation to this article.

Author information

Authors and Affiliations

  1. Medical Clinic II, Division of Pneumology, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    Stefan Pabst & Dirk Skowasch

  2. Clinic for Surgery, University Hospital of Bonn, Bonn, Germany

    Michael Krüger, Jens Bürmann & Marcel Kaminski

  3. Institute for Pathology, University Hospital of Bonn, Bonn, Germany

    H. Zhou

Authors
  1. Stefan Pabst
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Krüger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dirk Skowasch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jens Bürmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marcel Kaminski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefan Pabst .

Editor information

Editors and Affiliations

  1. Medical Research Center, Respiratory Research, Polish Academy of Sciences, Pawinskiego 5, Warsaw, 02-106, Poland

    Mieczyslaw Pokorski

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media Dordrecht

About this paper

Cite this paper

Pabst, S., Krüger, M., Skowasch, D., Zhou, H., Bürmann, J., Kaminski, M. (2013). Pulmonary Aspergillosis: Therapeutic Management and Prognostic Factors from 16 Years of Monocenter Experience. In: Pokorski, M. (eds) Respiratory Regulation - Clinical Advances. Advances in Experimental Medicine and Biology, vol 755. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-4546-9_29

Download citation

Publish with us

Policies and ethics

Search

Navigation