Abstract
Chronic pulmonary aspergillosis (CPA) is a spectrum of several progressive disease manifestations caused by Aspergillus species in patients with underlying structural lung diseases. Duration of symptoms longer than three months distinguishes CPA from acute and subacute invasive pulmonary aspergillosis. CPA affects over 3 million individuals worldwide. Its diagnostic approach requires a thorough Clinical, Radiological, Immunological and Mycological (CRIM) assessment. The diagnosis of CPA requires (1) demonstration of one or more cavities with or without a fungal ball present or nodules on chest imaging, (2) direct evidence of Aspergillus infection or an immunological response to Aspergillus species and (3) exclusion of alternative diagnoses, although CPA and mycobacterial disease can be synchronous. Aspergillus antibody is elevated in over 90% of patients and is the cornerstone for CPA diagnosis. Long-term oral antifungal therapy improves quality of life, arrests haemoptysis and prevents disease progression. Itraconazole and voriconazole are alternative first-line agents; voriconazole is preferred for patients with contra-indications to itraconazole and in those with severe disease (including large aspergilloma). In patients co-infected with tuberculosis (TB), it is not possible to treat TB with rifampicin and concurrently administer azoles, because of profound drug interactions. In those with pan-azole resistance or intolerance or progressive disease while on oral triazoles, short-term courses of intravenous liposomal amphotericin B or micafungin is used. Surgery benefits patients with well-circumscribed simple aspergillomas and should be offered earlier in low-resource settings.
Highlights
Aspergillus is one of the oldest known genera of fungi first described by a Roman Catholic clergyman and biologist Pier Antonio Micheli in 1729 [1]
Inevitable repeated exposure of persons to A. fumigatus conidia, the most frequent etiologic immune dysregulation in the pathogenesis of Chronic pulmonary aspergillosis (CPA) and its progression remains a subject of further agent of CPA, and the small diameter (3–5 μm) of these conidia facilitate their penetration into the investigation [20,21]
Considering CPA represents a spectrum of diseases, its optimal management will vary depending on the clinical presentation of the patient and the radiological phenotype of the disease, i.e., Aspergillus nodule, simple aspergilloma, chronic cavitary pulmonary aspergillosis (CCPA) and chronic fibrosing pulmonary aspergillosis (CFPA)
Summary
Aspergillus is one of the oldest known genera of fungi first described by a Roman Catholic clergyman and biologist Pier Antonio Micheli in 1729 [1]. A small group of patients, especially those with moderate immunosuppression (poorly controlled diabetes, alcohol excess and liver cirrhosis) develop sub-acute invasive aspergillosis (SAIA)—a less active invasive disease that progresses over days to weeks (
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