Invasive pulmonary aspergillosis

Nodular or halo-like lesions detected by high-resolution computed tomography (HRCT) scans are often the first indication of invasive pulmonary aspergillosis. 

Invasive pulmonary aspergillosis with cerebromenin-geal involvement has been described after short-term intravenous administration of methylprednisolone (SEDA-22, 449 334). Of 473 HIV-infected children, 7 (1.5%) developed invasive aspergillosis during the study period (1987-95) (SEDA-22, 449 335). Sustained neutropenia or glucocorticoid therapy as predisposing factors for invasive aspergillosis were found in only two patients. 

Monlun E, de Blay F, Berton C, Gasser B, Jaeger A, Pauli G. Invasive pulmonary aspergillosis with cerebrome-ningeal involvement after short-term intravenous corticosteroid therapy in a patient with asthma. Respir Med 1997 91(7) 435—7. 

Leav BA, Fanburg B, Hadley S. Invasive pulmonary aspergillosis associated with high-dose inhaled fluticasone. N Engl J Med 2000 343(8) 586. 

Smith JM, Tang CM, Van Noorden S, Holden DW Virulence of Aspergillus fumigatus double mutants lacking restrictocin and an alkaline protease in a low-dose model of invasive pulmonary aspergillosis. Infect Immun 1994 62 5247-5254. 

Gerson SL, Tablof GH, Hurwifz S, Strom BL, Lusk EJ, Cassileth PA Prolonged granulocytopenia The major risk factor for invasive pulmonary aspergillosis in patients with acute leukaemia. Ann Intern Med 1984 100 345-351. 

Erjavec Z, Woolthuis GM, de Vries-Hospers HG, Sluiter WJ, Daenen SM, de Pauw B, Halie MR. Tolerance and efficacy of amphotericin B inhalations for prevention of invasive pulmonary aspergillosis in haema-tological patients. Eur J Clin Microbiol Infect Dis 1997 16(5) 364-8. 

Invasive aspergillosis occurred after high-dose inhaled fluticasone (440 micrograms qds) and zafirlukast 20 mg/ day in a 44-year old man with moderately severe asthma this is the first report of invasive pulmonary aspergillosis associated with an inhaled glucocorticoid (123). 

There have been other reports of histoplasmosis (59), invasive pulmonary aspergillosis (60), and extensive pulmonary coccidioidomycosis (61). 

Warris A, Bjorneklett A, Gaustad P. Invasive pulmonary aspergillosis associated with infliximab therapy. N Engl J Med 2001 344(14) 1099-100. 

CaiUot D, Bassaris H, McGeer A, Arthur C, Prentice HG, Seifert W, De Beule K. Intravenous itraconazole followed by oral itraconazole in the treatment of invasive pulmonary aspergillosis in patients with hematologic mahgnancies, chronic granulomatous disease, or AIDS. Qin Infect Dis 2001 33(8) e83-90. 

Mehrad B, Stricter RM, Moore TA Tsai WC Lira SA, Standiford TJ CXC chemokine receptor-2 ligands are necessaiy components of neutrophil-mediated host de fense in invasive pulmonary aspergillosis J Immunol 1999, 163 6086-6094... 

Mehrad B, Moore TA, Standiford TJ. Macrophage inflammatory protein-1 alpha is a critical mediator of host defense against invasive pulmonary aspergillosis in neutropenic hosts. J Immunol 2000 165 962-968. 

Dc Rosa FG, Shaz D, Campagna AC et al. Invasive pulmonary aspergillosis soon after therapy with infliximab, a tumor necrosis factor-alpha-neutralizing antibody a possible healthcare-associated case Infect Control Hosp Epidemiol 2003 24(7) 477-482. 

Meeker, D.P., Gephardt, G.N., Cordasco, E.M. and Wiedemann, H.P. (1991). Hypersensitivity pneumonitis versus invasive pulmonary aspergillosis Two cases with unusual pathologic findings and review of the literature, American Review of Respiratory Disease, 143, 431 36. 

Seaton, A. (1991). Invasive pulmonary aspergillosis in non-immunocompromised patients, British Medical Journal, 302, 906. 

Tzankov A, Ludescher C, Duba HC, Steinlechner M, Knapp R, Schmid T, Grunewald K, Gastl G, Stauder R (2001) Spontaneous remission in a secondary acute myelogenous leukaemia following invasive pulmonary aspergillosis. Ann Hematol 80 423 425... 

Kim MJ, Lee KS, Kim J, Jung KJ, Lee HG, Kim TS (2001) Crescent sign in invasive pulmonary aspergillosis frequency and related CT and clinical factors. J Comput Assist To-mogr 25 305-310... 

Infection risk A 56-year-old woman with underlying COPD, a past cigarette smoker and current cannabis smoker, had multiple pulmonary nodules seen in a routine chest X-ray [19 ]. Biopsy of the nodules showed cavitary lesions and invasive pulmonary aspergillosis. Aspergillus can be found in samples of marijuana and chronic cannabis use probably predisposed her, perhaps owing to impairment in mucociliary activity and alveolar macrophages function. While prior reports of invasive pulmonary aspergillosis have been documented in immunocompromised individuals who use cannabis, she was not immunocompromised. 

A 63-year-old woman with septic shock received voriconazole to treat invasive pulmonary aspergillosis (IPA). She had prolonged neutropenia due to chemotherapy Jbr a diffuse large-cell lymphoma. Multiple episodes spontaneous bradycardia (20-40 beats/min) ensued. The heart rate was normalised ffter voriconazole was changed to caspofungin. 

Because of the significant mortality rate associated with invasive pulmonary aspergillosis, it is tempting to use combination therapy with itraconazole and amphotericin B, but this approach has not been scrutinized in clinical trials. 

In the treatment of invasive pulmonary aspergillosis, there is no set duration of therapy as eradication of this organism is dependent on the host immune response. For example, those patients treated for invasive disease during the neutropenic phase of induction chemotherapy for acute leukemia who, after recovery from myelosuppression, has a normal chest X-ray, should have antifungal therapy reinstituted when that patient undergoes consolidation therapy if neutropenia is anticipated. 

In Aspergillus bronchopneumonia, also known as airway-invasive aspergillosis, which occurs in up to 10% of patients developing invasive pulmonary aspergillosis, CT scans show centrilobular nodules... 

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