Pt DT – Aspergilloma/chronic IPA

Date: 26 November 2013

This chest radiograph (AMBER film) demonstrates the typical extensive pleural thickening at the right apex, seen in patients with aspergillomas. The cavity appears not to contain an aspergilloma but on CT scan had some ‘debris’ and Aspergillus antibiotics (precipitins) were strongly positive. The differential diagnosis lies between an aspergilloma and chronic invasive pulmonary aspergillosis. The extensive pleural thickening is heavily in favour of an aspergilloma, even without a well demonstrated fungal ball in the cavity.

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  • Patients has history of ABPA complicating long standing asthma. His total IgE has fluctuated between 2,200 and 4,600 KU/L, his Aspergillus IgE between 36.3 and 65.4 kAU/L and Aspergillus IgG from 87-154 mg/L. He has been taking long term itraconazole.

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  • The chemical structure of the novel arylamidine T-2307

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  • Laryngeal aspergillosis, probably related to inhaled corticosteroids.

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  • VL-2397 (formerly known as ASP2397) is a novel antifungal drug initially developed by our partner, Astellas Pharma. This drug was isolated from a leaf litter fungus Acremonium species collected in a Malaysian national park. Astellas presented two posters at the 2014 ICAAC meeting which described the in vitro and the in vivo antifungal activities of this drug. The differentiating attributes from the preclinical data of VL-2397 include:

    • A novel mechanism of action, with a potential to be complementary or synergistic with the existing classes of antifungals.
    • Rapid fungal cell kill activity demonstrated in preclinical models, which was faster than marketed antifungals.
    • Activity against azole-resistant fungal species.
    • Low propensity for P450 drug-drug interactions.

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