Underlying conditions of chronic pulmonary aspergillosis: a report of 108 cases_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Pei ^1,2 , SU Xin ¹ ,  SHI Yi ¹

1. Department of Respiratory and Critical Care Medicine, Nanjing General Hospital of People's Liberation Army, Nanjing, Jiangsu 210002, P. R. China;
2. Department of Respiratory Medicine, Taikang Xianling Drum Tower Hospital, Nanjing, Jiangsu 210046, P. R. China;

Corresponding author：

SHI Yi, Email: shiyi56@163.com

Keywords：

Chronic pulmonary aspergillosis; Chronic necrotizing pulmonary aspergillosis; Pulmonary tuberculosis; Bronchiectasis; Chronic obstructive pulmonary disease; Diabetes; Glucocorticoid

DOI：

10.7507/1671-6205.201801004

Video：

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Objective To describe the underlying conditions of chronic pulmonary aspergillosis (CPA). Methods A retrospective study was performed. Details of the clinical, imaging features, and the underlying conditions of CPA patients admitted to a tertiary university teaching hospital from January 2009 to December 2016 were extracted from clinical records. The classification distribution of CPA, and underlying conditions were analyzed. Results Among the 108 CPA patients, 87 cases had underlying conditions, 21 cases had no underlying conditions. Seventy two (66.7%) patients were engaged in agriculture, the proportion of which was significantly higher in the cases without underlying conditions (85.7% vs. 62.1%). Chronic necrotizing pulmonary aspergillosis (CNPA) was the most common type of these CPA cases. The cases without underlying conditions had significantly more proportion of CNPA than the cases with underlying conditions (85.7% vs. 62.1%). The cases with systemic underlying conditions had significantly more proportion of CNPA than the cases only with pulmonary underlying conditions (82.8% vs. 51.7%). Chronic cavity pulmonary aspergillosis (24/108, 22.2%) only existed in the cases with pulmonary underlying conditions. Underlying conditions were identified in 87 cases of CPA, with 85.1% (74/87) pulmonary and 33.3% (29/87) systemic underlying diseases. Previous tuberculosis mycobacterial infection, bronchiectasis and chronic obstructive pulmonary disease were the most common pulmonary underlying conditions (40.2%, 39.1% and 35.6%, respectively). Diabetes (16.1%) and glucocorticoid using (13.8%) were the most two common systemic underlying conditions. Conclusions CPA can occur in patients with and without underlying diseases. CNPA is the most common type of these CPA, the proportion of which is higher in cases without underlying conditions and cases with systemic underlying conditions. Farming maybe the risk factors of CPA. Chronic pulmonary primary diseases are the most common underlying conditions. The most common systemic factors are diabetes and glucocorticoid using.

Citation： LI Pei, SU Xin, SHI Yi. Underlying conditions of chronic pulmonary aspergillosis: a report of 108 cases. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(4): 348-353. doi: 10.7507/1671-6205.201801004 Copy

1.	Desai SR, Hedayati V, Patel K, et al. Chronic aspergillosis of the lungs: unravelling the terminology and radiology. Eur Radiol, 2015, 25(10): 3100-3107.
2.	Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax, 2014, 70(3): 270-277.
3.	Patterson KC, Strek ME. Diagnosis and treatment of pulmonary aspergillosis syndromes. Chest, 2014, 146(5): 1358-1368.
4.	Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J, 2016, 47(1): 45-68.
5.	Godet C, Philippe B, Laurent F, et al. Chronic pulmonary aspergillosis: an update on diagnosis and treatment. Respiration, 2014, 88(2): 162-174.
6.	Smith NL, Denning DW. Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J, 2011, 37(4): 865-872.
7.	Denning DW, Pleuvry A, Cole DC. Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ, 2011, 89(12): 864-872.
8.	Denning DW, Pleuvry A, Cole DC. Global burden of chronic pulmonary aspergillosis complicating sarcoidosis. Eur Respir J, 2013, 41(3): 621-626.
9.	Felton TW, Baxter C, Moore CB, et al. Efficacy and safety of posaconazole for chronic pulmonary aspergillosis. Clin Infect Dis, 2010, 51(12): 1383-1391.
10.	Nam HS, Jeon K, Um SW, et al. Clinical characteristics and treatment outcomes of chronic necrotizing pulmonary aspergillosis: a review of 43 cases. Int J Infect Dis, 2010, 14(6): e479-e482.
11.	Muldoon EG, Sharman A, Page I, et al. Aspergillus nodules; another presentation of chronic pulmonary aspergillosis. BMC Pulm Med, 2016, 16(1): 123.
12.	Kang EY, Kim DH, Woo OH, et al. Pulmonary aspergillosis in immunocompetent hosts without underlying lesions of the lung: radiologic and pathologic findings. Am J Roentgenol, 2002, 178(6): 1395-1399.
13.	Sagan D, Gozdziuk K. Surgery for pulmonary aspergilloma in immunocompetent patients: no benefit from adjuvant antifungal pharmacotherapy. Ann Thorac Surg, 2010, 89(5): 1603-1610.
14.	Cadrane J, Philipp B, Hennequi C, et al. Voriconazole for chronic pulmonary aspergillosis: a prospective multicenter trial. Eur J Clin Microbiol Infect Dis, 2012, 31(11): 3231-3239.
15.	Nakamoto K, Takayanagi N, Kanauchi T, et al. Prognostic factors in 194 patients with chronic necrotizing pulmonary aspergillosis. Intern Med, 2013, 52(7): 727-734.
16.	Jung SW, Kim MW, Cho SK, et al. A case of endobronchial aspergilloma associated with foreign body in immunocompetent patient without underlying lung disease. Tuberc Respir Dis (Seoul), 2013, 74(5): 231-234.
17.	Sridhar V, Rajagopalan N, Shivaprasad C, et al. Acute community acquired Aspergillus pneumonia in a presumed immunocompetent host. BMJ Case Rep, 2012, 2012.
18.	Ergene U, Akcali Z, Ozbalci D, et al. Disseminated aspergillosis due to Aspergillus niger in immunocompetent patient: a case report. Case Rep Infect Dis, 2013, 2013: 385190.
19.	Latge JP. Aspergillus fumigatus and aspergillosis. Clin Microbiol Rev, 1999, 12(2): 310-350.
20.	Russell K, Broadbridge C, Murray S, et al. Gardening can seriously damage your health. Lancet, 2008, 371(9629): 2056.
21.	Jung N, Mronga S, Schroth S, et al. Gardening can induce pulmonary failure: Aspergillus ARDS in an immunocompetent patient, a case report. BMC Infect Dis, 2014, 14(1): 600.
22.	Aspergilloma and residual tuberculous cavities--the results of a resurvey. Tubercle, 1970, 51(3): 227-245.
23.	Sambatakou H, Pravica V, Hutchinson IV, et al. Cytokine profiling of pulmonary aspergillosis. Int J Immunogenet, 2006, 33(4): 297-302.
24.	Kelleher P, Goodsall A, Mulgirigama A, et al. Interferon-gamma therapy in two patients with progressive chronic pulmonary aspergillosis. Eur Respir J, 2006, 27(6): 1307-1310.
25.	Carvalho A, Pasqualotto AC, Pitzurra L, et al. Polymorphisms in toll-like receptor genes and susceptibility to pulmonary aspergillosis. J Infect Dis, 2008, 197(4): 618-621.
26.	Vaid M, Kaur S, Sambatakou H, et al. Distinct alleles of mannose-binding lectin (MBL) and surfactant proteins A (SP-A) in patients with chronic cavitary pulmonary aspergillosis and allergic bronchopulmonary aspergillosis. Clin Chem Lab Med, 2007, 45(2): 183-186.
27.	He Q, Li H, Rui Y, et al. Pentraxin 3 gene polymorphisms and pulmonary aspergillosis in chronic obstructive pulmonary disease patients. Clin Infect Dis, 2018, 66(2): 261-267.
28.	Chen JC, Chang YL, Luh SP, et al. Surgical treatment for pulmonary aspergilloma: a 28 year experience. Thorax, 1997, 52(9): 810-813.
29.	Park CK, Jheon S. Results of surgical treatment for pulmonary aspergilloma. Eur J Cardiothorac Surg, 2002, 21(5): 918-23.
30.	Babatasi G, Massetti M, Chapelier A, et al. Surgical treatment of pulmonary aspergilloma: current outcome. J Thorac Cardiovasc Surg, 2000, 119(5): 906-912.
31.	Demir A, Gunluoglu MZ, Turna A, et al. Analysis of surgical treatment for pulmonary aspergilloma. Asian Cardiovasc Thorac Ann, 2006, 14(5): 407-411.
32.	Lee JG, Lee CY, Park IK, et al. Pulmonary aspergilloma: analysis of prognosis in relation to symptoms and treatment. J Thorac Cardiovasc Surg, 2009, 138(4): 820-825.
33.	Kohno S, Izumikawa K, Ogawa K, et al. Intravenous micafungin versus voriconazole for chronic pulmonary aspergillosis: a multicenter trial in Japan. J Infect, 2010, 61(5): 410-418.
34.	Jhun BW, Jeon K, Eom JS, et al. Clinical characteristics and treatment outcomes of chronic pulmonary aspergillosis. Med Mycol, 2013, 51(8): 811-817.
35.	Denning DW, Riniotis K, Dobrashian R, et al. Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review. Clin Infect Dis, 2003, 37 Suppl 3: S265-S280.
36.	Sambatakou H, Dupont B, Lode H, et al. Voriconazole treatment for subacute invasive and chronic pulmonary aspergillosis. Am J Med, 2006, 119(6): 527.e17-e24.
37.	Ohba H, Miwa S, Shirai M, et al. Clinical characteristics and prognosis of chronic pulmonary aspergillosis. Respir Med, 2012, 106(5): 724-729.
38.	Shoemark A, Ozerovitch L, Wilson R. Aetiology in adult patients with bronchiectasis. Respir Med, 2007, 101(6): 1163-70.
39.	Li AM, Sonnappa S, Lex C, et al. Non-CF bronchiectasis: does knowing the aetiology lead to changes in management. Eur Respir J, 2005, 26(1): 8-14.
40.	Tsang KW, Lam SK, Lam WK, et al. High seroprevalence of Helicobacter pylori in active bronchiectasis. Am J Respir Crit Care Med, 1998, 158(4): 1047-1051.
41.	Guan WJ, Gao YH, Xu G, et al. Aetiology of bronchiectasis in Guangzhou, southern China. Respirology, 2015, 20(5): 739-748.
42.	Camuset, J, Nunes, H, Dombret, MC, et al. Treatment of chronic pulmonary aspergillosis by voriconazole in nonimmunocompromised patients. Chest, 2007, 131(5): 1435-1441.
43.	Chawla K, Kosaraju K, Rayasam S, et al. Clinico-microbiological profile of chronic pulmonary aspergillosis from a tertiary care centre in southern India. J Clin Diagn Res, 2013, 7(12): 2712-2715.
44.	Camara B, Reymond E, Saint-Raymond C, et al. Characteristics and outcomes of chronic pulmonary aspergillosis: a retrospective analysis of a tertiary hospital registry. Clin Respir J, 2015, 9(1): 65-73.
45.	Bulpa P, Dive A, Sibille Y. Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease. Eur Respir J, 2007, 30(4): 782-800.
46.	Guinea J, Torres-Narbona M, Gijon P, et al. Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome. Clin Microbiol Infect, 2010, 16(7): 870-877.
47.	Xu H, Li L, Huang WJ, et al. Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: a case control study from China. Clin Microbiol Infect, 2012, 18(4): 403-408.
48.	Chen QK, Jiang GN, Ding JA. Surgical treatment for pulmonary aspergilloma: a 35-year experience in the Chinese population. Interact Cardiovasc Thorac Surg, 2012, 15(1): 77-80.

1. Desai SR, Hedayati V, Patel K, et al. Chronic aspergillosis of the lungs: unravelling the terminology and radiology. Eur Radiol, 2015, 25(10): 3100-3107.
2. Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax, 2014, 70(3): 270-277.
3. Patterson KC, Strek ME. Diagnosis and treatment of pulmonary aspergillosis syndromes. Chest, 2014, 146(5): 1358-1368.
4. Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J, 2016, 47(1): 45-68.
5. Godet C, Philippe B, Laurent F, et al. Chronic pulmonary aspergillosis: an update on diagnosis and treatment. Respiration, 2014, 88(2): 162-174.
6. Smith NL, Denning DW. Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J, 2011, 37(4): 865-872.
7. Denning DW, Pleuvry A, Cole DC. Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ, 2011, 89(12): 864-872.
8. Denning DW, Pleuvry A, Cole DC. Global burden of chronic pulmonary aspergillosis complicating sarcoidosis. Eur Respir J, 2013, 41(3): 621-626.
9. Felton TW, Baxter C, Moore CB, et al. Efficacy and safety of posaconazole for chronic pulmonary aspergillosis. Clin Infect Dis, 2010, 51(12): 1383-1391.
10. Nam HS, Jeon K, Um SW, et al. Clinical characteristics and treatment outcomes of chronic necrotizing pulmonary aspergillosis: a review of 43 cases. Int J Infect Dis, 2010, 14(6): e479-e482.
11. Muldoon EG, Sharman A, Page I, et al. Aspergillus nodules; another presentation of chronic pulmonary aspergillosis. BMC Pulm Med, 2016, 16(1): 123.
12. Kang EY, Kim DH, Woo OH, et al. Pulmonary aspergillosis in immunocompetent hosts without underlying lesions of the lung: radiologic and pathologic findings. Am J Roentgenol, 2002, 178(6): 1395-1399.
13. Sagan D, Gozdziuk K. Surgery for pulmonary aspergilloma in immunocompetent patients: no benefit from adjuvant antifungal pharmacotherapy. Ann Thorac Surg, 2010, 89(5): 1603-1610.
14. Cadrane J, Philipp B, Hennequi C, et al. Voriconazole for chronic pulmonary aspergillosis: a prospective multicenter trial. Eur J Clin Microbiol Infect Dis, 2012, 31(11): 3231-3239.
15. Nakamoto K, Takayanagi N, Kanauchi T, et al. Prognostic factors in 194 patients with chronic necrotizing pulmonary aspergillosis. Intern Med, 2013, 52(7): 727-734.
16. Jung SW, Kim MW, Cho SK, et al. A case of endobronchial aspergilloma associated with foreign body in immunocompetent patient without underlying lung disease. Tuberc Respir Dis (Seoul), 2013, 74(5): 231-234.
17. Sridhar V, Rajagopalan N, Shivaprasad C, et al. Acute community acquired Aspergillus pneumonia in a presumed immunocompetent host. BMJ Case Rep, 2012, 2012.
18. Ergene U, Akcali Z, Ozbalci D, et al. Disseminated aspergillosis due to Aspergillus niger in immunocompetent patient: a case report. Case Rep Infect Dis, 2013, 2013: 385190.
19. Latge JP. Aspergillus fumigatus and aspergillosis. Clin Microbiol Rev, 1999, 12(2): 310-350.
20. Russell K, Broadbridge C, Murray S, et al. Gardening can seriously damage your health. Lancet, 2008, 371(9629): 2056.
21. Jung N, Mronga S, Schroth S, et al. Gardening can induce pulmonary failure: Aspergillus ARDS in an immunocompetent patient, a case report. BMC Infect Dis, 2014, 14(1): 600.
22. Aspergilloma and residual tuberculous cavities--the results of a resurvey. Tubercle, 1970, 51(3): 227-245.
23. Sambatakou H, Pravica V, Hutchinson IV, et al. Cytokine profiling of pulmonary aspergillosis. Int J Immunogenet, 2006, 33(4): 297-302.
24. Kelleher P, Goodsall A, Mulgirigama A, et al. Interferon-gamma therapy in two patients with progressive chronic pulmonary aspergillosis. Eur Respir J, 2006, 27(6): 1307-1310.
25. Carvalho A, Pasqualotto AC, Pitzurra L, et al. Polymorphisms in toll-like receptor genes and susceptibility to pulmonary aspergillosis. J Infect Dis, 2008, 197(4): 618-621.
26. Vaid M, Kaur S, Sambatakou H, et al. Distinct alleles of mannose-binding lectin (MBL) and surfactant proteins A (SP-A) in patients with chronic cavitary pulmonary aspergillosis and allergic bronchopulmonary aspergillosis. Clin Chem Lab Med, 2007, 45(2): 183-186.
27. He Q, Li H, Rui Y, et al. Pentraxin 3 gene polymorphisms and pulmonary aspergillosis in chronic obstructive pulmonary disease patients. Clin Infect Dis, 2018, 66(2): 261-267.
28. Chen JC, Chang YL, Luh SP, et al. Surgical treatment for pulmonary aspergilloma: a 28 year experience. Thorax, 1997, 52(9): 810-813.
29. Park CK, Jheon S. Results of surgical treatment for pulmonary aspergilloma. Eur J Cardiothorac Surg, 2002, 21(5): 918-23.
30. Babatasi G, Massetti M, Chapelier A, et al. Surgical treatment of pulmonary aspergilloma: current outcome. J Thorac Cardiovasc Surg, 2000, 119(5): 906-912.
31. Demir A, Gunluoglu MZ, Turna A, et al. Analysis of surgical treatment for pulmonary aspergilloma. Asian Cardiovasc Thorac Ann, 2006, 14(5): 407-411.
32. Lee JG, Lee CY, Park IK, et al. Pulmonary aspergilloma: analysis of prognosis in relation to symptoms and treatment. J Thorac Cardiovasc Surg, 2009, 138(4): 820-825.
33. Kohno S, Izumikawa K, Ogawa K, et al. Intravenous micafungin versus voriconazole for chronic pulmonary aspergillosis: a multicenter trial in Japan. J Infect, 2010, 61(5): 410-418.
34. Jhun BW, Jeon K, Eom JS, et al. Clinical characteristics and treatment outcomes of chronic pulmonary aspergillosis. Med Mycol, 2013, 51(8): 811-817.
35. Denning DW, Riniotis K, Dobrashian R, et al. Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review. Clin Infect Dis, 2003, 37 Suppl 3: S265-S280.
36. Sambatakou H, Dupont B, Lode H, et al. Voriconazole treatment for subacute invasive and chronic pulmonary aspergillosis. Am J Med, 2006, 119(6): 527.e17-e24.
37. Ohba H, Miwa S, Shirai M, et al. Clinical characteristics and prognosis of chronic pulmonary aspergillosis. Respir Med, 2012, 106(5): 724-729.
38. Shoemark A, Ozerovitch L, Wilson R. Aetiology in adult patients with bronchiectasis. Respir Med, 2007, 101(6): 1163-70.
39. Li AM, Sonnappa S, Lex C, et al. Non-CF bronchiectasis: does knowing the aetiology lead to changes in management. Eur Respir J, 2005, 26(1): 8-14.
40. Tsang KW, Lam SK, Lam WK, et al. High seroprevalence of Helicobacter pylori in active bronchiectasis. Am J Respir Crit Care Med, 1998, 158(4): 1047-1051.
41. Guan WJ, Gao YH, Xu G, et al. Aetiology of bronchiectasis in Guangzhou, southern China. Respirology, 2015, 20(5): 739-748.
42. Camuset, J, Nunes, H, Dombret, MC, et al. Treatment of chronic pulmonary aspergillosis by voriconazole in nonimmunocompromised patients. Chest, 2007, 131(5): 1435-1441.
43. Chawla K, Kosaraju K, Rayasam S, et al. Clinico-microbiological profile of chronic pulmonary aspergillosis from a tertiary care centre in southern India. J Clin Diagn Res, 2013, 7(12): 2712-2715.
44. Camara B, Reymond E, Saint-Raymond C, et al. Characteristics and outcomes of chronic pulmonary aspergillosis: a retrospective analysis of a tertiary hospital registry. Clin Respir J, 2015, 9(1): 65-73.
45. Bulpa P, Dive A, Sibille Y. Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease. Eur Respir J, 2007, 30(4): 782-800.
46. Guinea J, Torres-Narbona M, Gijon P, et al. Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome. Clin Microbiol Infect, 2010, 16(7): 870-877.
47. Xu H, Li L, Huang WJ, et al. Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: a case control study from China. Clin Microbiol Infect, 2012, 18(4): 403-408.
48. Chen QK, Jiang GN, Ding JA. Surgical treatment for pulmonary aspergilloma: a 35-year experience in the Chinese population. Interact Cardiovasc Thorac Surg, 2012, 15(1): 77-80.

Chinese Journal of Respiratory and Critical Care Medicine

Underlying conditions of chronic pulmonary aspergillosis: a report of 108 cases

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