Abstract
<i>Background</i>: Aspergilloma is the localized form of pulmonary colonization by Aspergillus species, which often hosted within a pre-existing cavitary lesion. The Aspergilloma (commonly known as mycetoma or fungus ball) consists of fungal hyphae, aggregates of inflammatory cells, fibrin threads, and destructed tissues debris. Aspergillus Fumigatu is the commonest species responsible for such lesions. In this study, over 20 years, data were collected for examination, on the outcomes of surgery for pulmonary Aspergilloma. <i>Methods</i>: Retrospective study of 54 patients, dating from January 1996 and December, 2015. Each patient’s preoperative, diagnostic, operative, postoperative and follow up data was collected for analysis. <i>Results</i>: Findings of 54 patients who underwent surgery for Aspergilloma, 47 had clinical diagnosis. While remaining 7 were confirmed post-resection. The median age was 46.3±7.8 (aged 17-64 years). Risk assessment identified that greater probability for the Left Lung to be infected and increase if gender was male (2.6:1). The main presentation was hemoptysis, seen in 70.4% of cases, while symptoms of cough and expectoration occurred in 83.3% of them. The most prevalent predisposing factor was tuberculosis (TB), present in 57.4% of cases. The indication for surgery was recurrent hemoptysis, asymptomatic simple Aspergilloma and complex Aspergilloma. All the patients underwent pulmonary resection, with 82.5% of cases having lobectomy. The main postoperative complication was prolonged air leak 29.6% (16/54). The in-hospital mortality rate was 7.5% (6/54) patients. Conclusion: Surgery offered to Aspergilloma patients (fungus ball) brought beneficial results with an acceptable morbidity. The mortality observed within these cases, was predominantly due to high risk patients, with complex Aspergillosis. Recommendations for a multidisciplinary approach, in future cases, are paramount for better selection criteria.
Highlights
The relevant laboratory tests revealed seropositive results in 64.8% and positive culture from protected bronchial lavage patients (35.1%). In this series majority of patients underwent lobectomy, except 7 patients had wedge resection, the mean operative time was 140±15.6 min (75-220), two patients went to the ICU with packs to control apical adhesions bleeding and were re-explored 48 hours later
The aspergilloma is composed of fungal hyphae, aggregates of inflammatory cells, fibrin threads, and destructed tissues debris, which usually hosted within a pre-existing lung cavitary lesion like tuberculosis, sarcoidosis, histoplasmosis or bullous emphysema and fibrotic lung disease
The surgical options are few but over 2 decades, surgery for Asperigllosis became less invasive and less challenging might be due to nationwide eradication of tuberculosis
Summary
Aspergillus Fumigatu is the commonest species responsible for such lesions Another form; allergic bronchopulmonary Aspergillosis which represents immunologic response to non-invasive species, while the ‘disseminated Aspergillosis’ is well recognized as a life-threatening infection in immunocompromised patients, both acquired and inherited or under chronic immunosuppression therapy mostly with steroids. In such cases, the pathology is multicenteric and the surgical option is limited. Aspergilloma is the localized form of pulmonary colonization by Aspergillus species, which often hosted within a pre-existing cavitary lesion. Over 20 years, data were collected for examination, on the outcomes of surgery for pulmonary Aspergilloma. Recommendations for a multidisciplinary approach, in future cases, are paramount for better selection criteria
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