Purpose: In our outpatients' department 315 patients affected by Chronic Pulmonary Aspergilloses (CPA) have been followed, at least 200 of these have been studied through Denning and Stevens guide lines. Diagnosis and therapy duration is often a problem. Methods: Usually the diagnosis has been demonstrated by the clinic data, the thorax cT-scan (T) with contrast medium, the positivity of Aspergillar antibodies and the cultural positivity for Aspergillus on BA/BAL. The T/PET Fusion (T/PF; contemporary cT-scan and Positron Emission Thomography) represents a diagnostic method that allows to evidence parenchymal areas endowed with metabolic activity potentially evocative for aspergillar infection; in fact the simple cT- scan with contrast medium often proves to have huge limits in distinguishing between simple fibrotic areas compared with areas with active aspergillosis . Results: In the suspected cases, by clinical history, aspergillar positive precipitins, but with negative BA/BAL, it is useful to execute a T guided thin needle aspirate so that to formulate certain aspergillar diagnosis by means of cytological and cultural examination of the obtained material. In our opinion the T/PF has a fundamental role in evidencing the metabolically active areas where biopsy has to be effected. Moreover T/PF is useful to follow the CPA evolution often requiring a 3-12 months or more treatment period - by means of a metabolic uptake of radioactive glucose attenuation; this technique proves to be optimal in order to estimate the evolution of the disease and the course of the relative pharmacological treatment. In our observational study we have examined 28 patients (aged from 37 to 80; average age 50) by subjecting them to T/PF. The results obtained have allowed to exclude in 4 patients the diagnosis of CPA: since 1 patient was affected by lung cancer and saprophytic contamination, 3 from ABPA with non concomitant CPA. Among the 24 patients remaining (14 males and 10 females) to whom CPA diagnosis has been formulated, 9 were also affected by concomitant aspergilloma. Only in 7 patients a T/PF has been practiced at the beginning and at the end of the antimycotic therapy: in all these patients both precipitins and T/PF have showed negative at the end of the treatment, with T/PF agreeing with antibody negativisation. Conclusions: T/PF permitted: 1. active CPA confirmation inside otherwise simple fibrotic areas 2. guided thin needle aspiration of aspergillar sample 3. useful in therapy recovery and confirmed eradication of aspergillosis.
Full conference title:
4th Advances Against Aspergillosis
- AAA 4th (2010)