Clinical Features, Treatment Outcome and Potential risk Factors for Recurrence Among Patients with Chronic Pulmonary Aspergillosis in a Resource-limited Setting: A Retrospective Observational Study.

Publisher: Kluwer Academic Country of Publication: Netherlands NLM ID: 7505689 Publication Model: Electronic Cited Medium: Internet ISSN: 1573-0832 (Electronic) Linking ISSN: 0301486X NLM ISO Abbreviation: Mycopathologia Subsets: MEDLINE

Publication: Dordrecht : Kluwer Academic
Original Publication: [The Hague, W. Junk]

Antifungal Agents*/therapeutic use ; Pulmonary Aspergillosis*/drug therapy ; Pulmonary Aspergillosis*/diagnosis ; Recurrence*; Aged ; Female ; Humans ; Male ; Middle Aged ; Bronchoalveolar Lavage Fluid/microbiology ; Chronic Disease ; Galactose/analogs & derivatives ; Mannans/analysis ; Resource-Limited Settings ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Voriconazole/therapeutic use ; Voriconazole/administration & dosage

Objective: To evaluate the clinical characteristics and treatment outcomes of patients with chronic pulmonary aspergillosis (CPA) and to determine risk factors for disease recurrence.
Methods: A total of 43 patients with CPA (mean ± SD age: 61.4 ± 10.5 years, 83.7% were males) were included in this retrospective study. Data on demographic, clinical and disease-related characteristics, galactomannan (GM) test positivity in bronchoalveolar lavage (BAL) samples, histopathological diagnosis, imaging (CT) findings and CPA forms, antifungal therapy, recurrence rate and time to recurrence were recorded.
Results: Chronic obstructive pulmonary disease (COPD;76.7%) was the leading predisposing factor, and the aspergillus nodule (37.2%) was the most prevalent CPA form.GM test positivity was noted in 89.7% (35/39) of BAL samples. Median duration of voriconazole treatment was 180 days. CPA recurrence was noted in 14.0% of patients, while the comorbid tuberculosis sequela (66.7% vs. 16.2%, p = 0.02) and mild immunosuppressive disorder (100.0% vs. 51.4%, p = 0.032) were significantly more common in patients with recurrence vs. those without recurrence. Recurrence rate was 50.0% (3 of 6 patients) in patients with simple aspergilloma, and ranged from 0.0% to 25.0% in those with other CPA forms. Treatment duration and time to recurrence ranged 70-270 days and 1.1-37 months, respectively in simple aspergilloma, while they were ranged 150-180 days and 30-43.3 months, respectively in other CPA forms.
Conclusions: Our findings indicate the importance of considering CPA in differential diagnosis in patients with predisposing conditions, and emphasize the tuberculosis sequela, immunosuppressive disorder and the certain CPA forms managed with shorter duration of antifungal therapy (i.e., simple aspergilloma) as the potential risk factors of CPA recurrence.
(© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

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Keywords: CPA forms; Chronic pulmonary aspergillosis; Clinical characteristics; Recurrence; Treatment outcome

0 (Antifungal Agents)
11078-30-1 (galactomannan)
X2RN3Q8DNE (Galactose)
0 (Mannans)
JFU09I87TR (Voriconazole)

Date Created: 20240822 Date Completed: 20240822 Latest Revision: 20241014

20250114

10.1007/s11046-024-00884-9

39172211