Diagnosis Of Aspergilloma Research Articles

MDR PATIENT AND DM WITH CAVITARY FUNGUS BALL DUE TO HAEMOPTOE RECURRENT: A CASE REPORT

A 53-year-old man was admitted to Drs. H. Amri Tambunan Hospital with complaints of extreme weakness since today, coughing up blood was found 3 days every time he coughed. Right chest pain like stabbing is found 4 days. Nausea is found 3 days, vomiting is found just today, the contents of what is eaten, decreased appetite and weight are found. The patient is currently taking MDR anti-tuberculosis drugs. Physical examination showed chest wall retraction, weak peristalsis in the abdomen. Thorax examination revealed right Koch Pulmonum or right pulmonary TB with right Aspergillosis/fungus ball of right superior lobe. Lab examination showed that the patient was diabetic. Surgical lobectomy was performed to find a mass of 3 cm in diameter, white-white grey-brown in color, spongy in consistency. The diagnosis of aspergilloma was confirmed by microscopic examination. Tuberculosis and type 2 DM have impaired immunity due to insulin resistance, this is exacerbated by malnutrition which results in ineffective absorption of anti-tuberculosis drugs. This condition makes patients susceptible to fungal infections such as Aspergillus sp. Patients need to maintain blood glucose levels and improve nutritional status to improve their treatment prognosis. Lobectomy surgery on the superior lobe of the right lung also promotes a better prognosis in treatment.

Endovascular management of hemoptysis in a known case of tetralogy of fallot and tuberculosis complicated with aspergilloma: a case report

BackgroundHemoptysis is a life-threatening complication due to bleeding either from hypertrophied bronchial arteries or enlarged non-bronchial systemic collaterals, having multiple etiologies. Bronchial artery embolization (BAE) is a minimally invasive modality of management that can effectively manage moderate-to-severe hemoptysis.Case presentationWe report the case of a 25-year-old female with moderate-to-severe hemoptysis. There was prior history of tuberculosis and treatment with anti-tubercular therapy 6 months back. There was also a background of tetralogy of Fallot(TOF) with symptoms of chronic breathlessness and palpitations. Imaging evaluation with X-ray and HRCT thorax revealed a cavity in the left upper lobe with dependent soft tissue, implying a diagnosis of aspergilloma in an old tubercular cavity. TOF and right-sided aortic arch were noted. CT bronchial angiography showed dilated and tortuous left bronchial artery, as well as non-bronchial systemic collaterals from the ipsilateral internal mammary artery. Endovascular management was achieved by super-selective catheterization and embolization of the involved branch of the left bronchial artery and selective embolization of non-bronchial systemic collaterals from the ipsilateral internal mammary artery.ConclusionsBAE has a high clinical success rate and is recommended as first-line therapy in the management of massive hemoptysis. The CT pulmonary angiography, as well as the pre-embolization angiogram, is very important to detect the source of hemoptysis from the non-bronchial systemic circulation, increasing the success rate and decreasing the incidence of recurrence. BAE is effective even in presence of underlying vascular anomalies such as Fallot of Tetralogy.

Hemoptisis pada Pasien Aspergilloma Paru Kiri

Background: Aspergilloma is a fungus ball (misetoma) that occurs because there is a cavity in the parenchyma due to previous lung disease. This fungus ball can move inside the cavity but does not invate the cavity wall. The presence of fungus ball causes recurrent hemoptysis. Case: We present a 45-year-old female patient with left lung Aspergilloma. Diagnosis of Aspergilloma was based on histopathology from FNAB CT guiding of left pulmonary which showed Aspergillus. Patient was treated with left superior lobe lobectomy at the hospital. The examination result of anatomical patology obtained from lung tissue was aspergillosis, from GeneXpert examination lung tissue showed positive MTB with rifampisin sensitive. Post-operative condition of the patient was stable, surgical wound improved, took off drain patient. There were clinical improvements after the surgery. Discussion: Diagnosis of Aspergilloma was based on clinical, radiology, and microbiology. Aspergilloma with severe symptoms (hemoptysis massive with life-threatening or other complications that require more than 1 time hospitalisation) and good physical condition should undergo surgical therapy in the form of lobectomy in accordance with the extent of lung abnormalities. Patient got first category anti tuberculosis drugs for 6 months and fluconazole for 2 months. Conclusion: It is necessary to consider the suspicion of Aspergillus infection, in patient with history of previous tuberculosis accompanied by a history of recurrent hemoptysis. Patient with reccurent hemoptysis and good physical condition should undergo surgical therapy.

Surgical treatment of pulmonary aspergilloma: a single-center experience

Aspergillus fumigatus is a saprophytic fungus which colonizes in the cavitary lesions in the lungs. In our part of the world, where tuberculosis is endemic, the healed tubercular cavities form a good nidus for this fungus. The fungus forms a fungal ball or aspergilloma within the cavity which erodes the walls of the cavity and causes hemoptysis by erosion of the bronchial vessels. Hemoptysis is the main symptom for which patients seek medical attention. Antifungal agents are not useful against the fungal ball. Surgery in the form of lobectomy is the primary treatment. Surgery for aspergilloma is known to be risky because of intrapleural adhesions, obliteration of the interlobar fissures, massive hemorrhage during dissection, and poor pulmonary reserve of the patient due to the underlying disease. Clinical presentation, radiological investigations, operative techniques, postoperative outcome, and follow up of 24 cases of pulmonary aspergilloma treated surgically were studied prospectively between August 2010 and July 2013 at IPGMER & SSKM Hospital, Kolkata. There were 15 male (62.5 %) and 9 female (37.5 %) patients in this series. Mean age of the study population was 34.54 years. All the patients had complex aspergilloma. Tuberculosis was the underlying disease in 22 patients (91 %). The mean duration from first diagnosis of tuberculosis to the diagnosis of aspergilloma was 3.4 years. Hemoptysis was the main symptom in 79.16 % cases. Chest x-ray was the first investigation which gave a clue to the diagnosis. Computed tomography scan was diagnostic in all cases delineating the location of the pulmonary cavity along with the aspergilloma inside it and the characteristic air crescent sign. Right upper lobe was involved in 13 patients (54.16 %) and left upper lobe was involved in 11 patients (45.84 %). Lobectomy was done in 16 patients (66.67 %), segmentectomy in 4 patients (16.66 %), and pneumonectomy in 4 patients (16.66 %). There was one mortality, and the overall complication was 33.33 %. The average follow-up period was 21.65 months, during which there was no mortality and no recurrence of hemoptysis in these patients. Though surgery for aspergilloma is considered to be risky, excision of the cavity along with the involved lobe can be done with acceptable morbidity and mortality to provide the patient complete cure and symptom-free survival.

Retroperitoneal aspergilloma

We report a previously healthy 8-year-old boy who presented to the hospital with a palpable abdominal mass, fever and abdominal pain. CT and MRI scans confirmed a large mass that was centered in the retroperitoneum. The lesion was biopsied and the histology showed branching hyphae. Tissue cultures grew Aspergillus fumigatus and a diagnosis of aspergilloma was made. The immunological work-up did not reveal an immunodeficiency. This case is a unique presentation of aspergilloma presenting in an unusual location and in an immunocompetent patient.

Bola fúngica por Aspergillus fumigatus em cavidade pleural

To report the cases of 6 patients with fungus ball caused by Aspergillus fumigatus (aspergilloma) in the pleural cavity. Between 1980 and 2009, 391 patients were diagnosed with aspergilloma at the Santa Casa Hospital Complex in Porto Alegre, Brazil. The diagnosis of aspergilloma in the pleural cavity was made through imaging tests revealing effusion and pleural thickening with air-fluid level; direct mycological examination revealing septate hyphae, consistent with Aspergillus sp.; and positive culture for A. fumigatus in the surgical specimen from the pleural cavity. Of the 391 patients studied, 6 (2%) met the established diagnostic criteria. The mean age of those 6 patients was 48 years (range, 29-66 years), and 5 (83%) were male. The most common complaints were cough, expectoration, and hemoptysis. Four patients (67%) had a history of tuberculosis that had been clinically cured. All of the patients were submitted to surgical removal of the aspergilloma, followed by intrapleural instillation of amphotericin B, in 4; and 2 received systemic antifungal treatment p.o. There was clinical improvement in 5 patients, and 1 died after the surgery. In adult patients with a history of cavitary lung disease or pleural fistula, a careful investigation should be carried out and fungal infection, especially aspergilloma, should be taken into consideration. In such cases, laboratory testing represents the most efficient use of the resources available to elucidate the diagnosis.

Imaging diagnosis of aspergilloma

A 55-year-old man with Human Immunodeficiency Virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS), has a history of noncompliance to antiretroviral therapy with recurrent opportunistic infections due to clostridium difficile and mycobacterium avium complex. He presented to the hospital with fever, diarrhea, weight loss and generalized weakness, and was diagnosed with clostridium difficile colitis and treated as such. His absolute CD4 count was 153 cells/microliter and HIV1-RNA 2,190 copies/mL. (Published: 30 April 2012) Citation: Journal of Community Hospital Internal Medicine Perspectives 2012, 2 : 17276 - http://dx.doi.org/10.3402/jchimp.v2i1.17276

Aspergilloma in preexisting cavity – serial chest roentgenograms can help in diagnosis

A 24-year-old male presented with hemoptysis, off and on, which was gradually increasing. The patient had four chest roentgenograms, which depicts various stages of aspergilloma formation in preexisting cavity. The diagnosis of aspergilloma was made and patient underwent lobectomy.

Role of the CT in Diagnosis of Intrathoracic Aspergilloma

In this study two cases are evaluated in which the chest radiographs showed mass within cavitation and their diagnosis are confirmed by HRCT and fineneedle biopsies. The CT images of the cases are compared with those in literature and the effect of CT in diagnosis of aspergilloma is evaluated.

Identification of the 33-kDa alkaline protease of Aspergillus fumigatus in vitro and in vivo.

Aspergillus fumigatus produced a 33-kDa serine protease (ALP) in vitro and in vivo. In vitro, this alkaline protease was secreted when the fungus was cultivated in the absence of protein, if the pH of the medium remained close to neutrality. Western blotting and immunoelectronmicroscopy studies showed that ALP was localised in the wall of the fungus and was degraded after secretion in the culture medium under conditions of low pH. Although present in the lung during infection, ALP did not appear to be diagnostically useful and was different from the precipitating chymotrypsin antigen used in the diagnosis of aspergilloma.

Management of pulmonary aspergilloma in the presence of active tuberculosis.

Eleven cases of pulmonary aspergilloma complicating active cavitating pulmonary tuberculosis are reviewed. Nine of the 10 patients who had combined medical (antituberculosis drugs) and surgical treatment were cured of their disease; one patient, who had bilateral multiple aspergillomas, died from massive haemoptysis after resection of one of the affected lobes. The only medically treated patient who refused surgery had fatal haemoptysis at home. Pulmonary resection is recommended for patients who are fit for operation whenever the diagnosis of aspergilloma is made because most published reports indicate that only a few patients benefit from drug treatment alone.