Respiratory Care |

Clinical Characteristics of Chronic Cavitary Pulmonary Aspergillosis: Experiences of 2 Years in a Single Center FREE TO VIEW

Hwa Young Lee; Jeong Uk Lim; Ah Young Shin; Ju Sang Kim; Joong Hyun Ahn
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Catholic University of Korea, Seoul, Republic of Korea

Chest. 2014;146(4_MeetingAbstracts):919A. doi:10.1378/chest.1990277
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SESSION TITLE: Respiratory Infections Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Chronic cavitary pulmonary aspergillosis (CCPA) is defined as cavitary lesions with significant systemic symptoms and considered to be associated with invasiveness of pulmonary aspergillosis infection from the simple aspergilloma. Although CCPA causes chronic destruction of the lung tissues resulting significant morbidities, little is known about the optimal treatment strategies. This study investigated the clinical features at the diagnosis, focusing on the differences in patients’ baseline characteristics, radiologic and serologic profiles between CCPA and simple aspergilloma and the treatment outcomes.

METHODS: From January 2012 to August 2013, we reviewed the medical records of the patients with positive serum Aspergilus IgG or Aspergillus Ag or Aspergillus species isolated from respiratory specimens.

RESULTS: A total of 35 patients with suspected pulmonary aspergillosis were identified, which included 4 ABPA, 3 CNPA, 8 IPA, 5 simple aspergilloma and 15 CCPA. Fifteen patients were males, median age of 57 years. 63.6% (n=7) of the patients were ever smokers. Old pulmonary tuberculosis (n=15) and emphysema (n=4) were primary underlying lung conditions. Most frequent symptoms were hemoptysis, 42.9% (n=6). Comparing the asymptomatic simple aspergilloma, larger cavity size, pleural thickening, bronchiectasis, and BPF was more frequently found in chest computed tomography of CCPA. Aspergillus IgG titer was higher in CCPA. BMI, FEV1 (%), serum albumin, Aspergillus Ag titer, WBC count, ESR and CRP levels were not significantly different. Total 8 patients (57.1%) were treated with itraconazole (100%), amphotericin B deoxycholate (12.5%) and voriconazole (37.5%) for mean 134 days and 2 had curative operations. For median 206 days’ follow up period, 66.7% (n=6) had favorable responses in symptoms (44.4%) or radiologic findings (55.5%). During the treatment, serum Aspergillus IgG titer was decreased in patients with favorable responses (33.3%), whereas none with unfavorable responses or without the antifungal treatment.

CONCLUSIONS: Previous pulmonary tuberculosis infection and emphysema could be the risk factors for CCPA development. During the 6 months' follow up periods, 66.7% of the patients diagnosed as CCPA had favorable clinical outcomes.

CLINICAL IMPLICATIONS: We suggest that patients with simple aspergilloma who present progressive symptoms with radiological changes and high serum Aspergillus IgG titer should be considered to use antifungal agents, anticipating favorable clinical outcomes.

DISCLOSURE: The following authors have nothing to disclose: Hwa Young Lee, Jeong Uk Lim, Ah Young Shin, Ju Sang Kim, Joong Hyun Ahn

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