Abstract
Invasive pulmonary aspergillosis (IPA) is an infection that often occurs in immunocompromised patients and has a high mortality rate. In recent years, the reported incidence of IPA in the context of chronic obstructive pulmonary disease (COPD) has seemingly increased. The combination of factors such as long-term corticosteroid use, increasing rate of bacterial exacerbations over time, lung immune imbalance, and malnutrition are responsible for the emergence of IPA in COPD patients. A diagnosis of IPA in COPD patients is difficult to make, which explains the delay in antifungal therapy and the high mortality rate. The purpose of this study is to increase the recognition and improve the outcomes associated with this situation through the description of our case. In patients in which IPA is suspected, comprehensive analysis of their clinical manifestations, imaging, microbiology and serological examination results are effective means of increasing the rate of reliable diagnosis. If the patient’s condition permits, a pathological specimen should be obtained as soon as possible.
Highlights
RESULTSAspergillus fumigatus is a saprophytic fungus that is capable of causing a wide range of conditions, including allergic bronchopulmonary aspergillosis (ABPA), aspergillomas and invasive aspergillosis (IA)
We will describe the clinical characteristics of a patient with chronic obstructive pulmonary disease (COPD) combined with invasive pulmonary aspergillosis (IPA) who were diagnosed by fiberoptic bronchoscopy in our hospital to improve our understanding of this disease
Patients with other underlying conditions, especially COPD, are receiving increasingly more attention. Such patients might have increased susceptibility to invasive fungal infection for several reasons: (a) the common use of long-term or repeated short-term steroids, (b) frequent hospitalization and broad-spectrum antibiotic treatment, leading to selective pressure, which favors fungal pathogens, (c) structural changes in the lung architecture related to the pulmonary condition, and (d) comorbid conditions such as diabetes mellitus or malnutrition [4]
Summary
RESULTSAspergillus fumigatus is a saprophytic fungus that is capable of causing a wide range of conditions, including allergic bronchopulmonary aspergillosis (ABPA), aspergillomas and invasive aspergillosis (IA). IA is the most common and the most severe This opportunistic disease occurs predominantly in immunocompromised hosts such as those with hematologic malignancy, allogenic bone marrow transplantation, solid organ transplantation and late-stage HIV infection, etc. An 83-year-old woman with a history of exposure to biofuels and stage IV COPD in group D who was under treatment with inhaled corticosteroids (250μg of fluticasone twice daily for more than 6 years) and intravenous systemic methylprednisolone (40-80 mg per day intermittently) was hospitalized due to the exacerbation of dyspnea and fever. She had a history of hypertension, diabetes mellitus and cardiac insufficiency
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