Unusual forms of chronic pulmonary aspergillosis in patients with solid tumors

Ref ID: 19544

Author:

M Peghin1,7,8*, C Garcia-Vidal2,7, J Andreu3, C Cervera4,7, A Moreno4,7, C Gudiol2, 7, M Martin5,
E Felip6, J Gavaldá1,7, A Pahissa1,7,8, I Ruiz-Camps1,8

Author address:

1 Department of Infectious Diseases, Hospital Universitari de la Vall d’Hebron, Barcelona
2 Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona
3 Department of Radiology, Hospital Universitari de la Vall d’Hebron, Barce

Full conference title:

6th Advances Against Aspergillosis 2014

Abstract:

Background:
Aspergillus spp. can cause acute invasive disease in severely immunocompromised patients.
Nonetheless, there are few reported cases of solid tumors complicated with chronic pulmonary
aspergillosis (CPA).
Methods:
A retrospective observational cohort study performed in patients with primary lung cancer or
secondary lung metastasis complicated with CPA in three referral hospitals.
Results:
From 2008 to 2011, 14 episodes of CPA were diagnosed, including 11 (78.6%) probable and 3 proven
(21.4%). Nine patients (64.3%) had primary lung cancer. Thirteen patients (92.9%) had more than
one local or systemic predisposing factor for CPA. No patient had previous fungal colonization.
Aspergillus spp. was isolated in 6 specimens of bronchoalveolar lavage, 6 sputum, 2 biopsies, and
1 percutaneous lung puncture. At the time Aspergillus spp. was isolated, the most common radiologic
findings on chest computed tomography (CT) were cavitary masses, and development or expansion
of cavitation in existing masses or nodules (10/14, 71.4%). On CT follow-up, most patients (8/12,
66.7%) had new cavity formation or expansion of one or more existing cavities. All patients were
treated with azoles and two underwent surgery. Ten (71.4%) patients died after Aspergillus spp. was
detected (median time 73 days, IQR 33-243): 2 (20%) deaths were CPA-attributable and 6 (60%)
were related.
Conclusions:
Primary lung cancer and secondary lung metastasis seem to be triggering factors for Aspergillus spp.
implantation, and predispose to CPA. Once localized in the damaged lung, the mold can grow and
cause or expand cavities. In lung cancer patients, Aspergillus spp. detection is associated with a very
poor prognosis.

Abstract Number: 71

Conference Year: 2014

Link to conference website: http://www.AAA2014.org

New link: NULL

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