Invasive bronchopulmonary infection with Aspergillus species is a severe complication in various diseases, especially in immunocompromised patients. The available systemic treatment regimen (Amphotericin B, 5-Flucytosine, ltraconazole) is limited by side effects and high toxicity (liver, kidney) and is frequently not effective (incomplete elimination, relapse after discontinuation). We report our experience with additive fiberoptic instillation of Amphotericin B in three patients (1 acute myeloic leukaemia, 1 chronic myeloic leukaemia, 1 chronic obstructive lung disease) and Miconazole in one patient (Non-Hodgkin's lymphoma). Two patients suffered from Aspergilloma and two from diffuse Aspergillus pneumonia. Because of insufficient regression of the pulmonary infiltrates under systemic antimycotic treatment we performed a 2-8 fold instillation of Amphotericin (5-30 mg) or Miconazole (30 mg) into the concerning segmental bronchi through a fiberbronchoscope in wedge position. Side effects of instillation were transient cough and mild bronchospasm. In one case with aspergilloma we observed an self-limited endobronchial bleeding after the second instillation. The follow up showed improvement of the clinical performance in all cases and accelerated regression of the pulmonary infiltrates with nearly complete resolution in two cases without the need for thoracic surgery. The lung tissue received from later thoracic surgery procedure (right upper lobe) of one patient showed no more vital mycotic specimens.The bronchoscopic instillation of antimycotic drugs can be an additional and tolerable option for the treatment of non-resolving Aspergillus infections of the lung, especially if surgical resection procedures are functional impossible.
Full conference title:
7th European Respiratory Society Annual Conference
- ERS 17th (2007)