Pulmonary aspergillosis, which is now the most common pulmonary fungal infection, is increasing in frequency more rapidly than any other fungal disease. Aspergillus lung disease is subdivided into hypersensitivity, noninvasive infection and invasive infection, though considerable clinical overlap among them may occur. Chronic necrotizing pulmonary aspergillosis (CNPA), which is an indolent form of invasive infection, is reported to be susuccessfully treated by antifungal chemotherapy in many cases. However we have recently experienced several fatal cases. This study was undertaken to reveal the characteristics of the fatal CNPA cases. Eleven fatal cases of CNPA has been registered in our hospital for 10 years. Diagnosis of CNPA was made according to the criteria of Binder RE, et al. Patients were all advanced-aged (>60 years old) and 9 males and 2 females. Most of them had some evidence of impairment of host defenses such as low dose corticosteroid therapy (3 cases), poor nutrition (4 cases), diabetes mellitus (2 cases), chronic obstructive lung disease (3cases), lung cancer (1 case) or sarcoidosis (1 case). Most of them had been treated as pulmonary tuberculosis (3 cases), repeated pneumonia (3 cases) or interstitial pneumonia (2 cases) for months to years prior to correct diagnosis. When they were diagnosed correctly or suspected strongly of CNPA, all of their chest roentgenogram showed extensive infiltration with cavity formation. Intensive antifungal chemotherapy was started soon after that, while general condition gradually got worse in all of the cases and died of respiratory failure (4 cases), sudden hemoptysis (4 cases) or general exhaustion (3 cases). The analysis of these cases suggests that in order to improve the prognosis in the fatal CNPA patients, it is important to develop reliable diagnostic tests to diagnose CNPA in the early stage as well as to invent new powerful regimen for therapy.
Full conference title:
The American Lung Association - American Thoracic Association Conference,1998