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Pulmonary Aspergillus Overlap Syndromes

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Abstract

Background

Broadly, there are three main categories in pulmonary aspergillosis: chronic forms of aspergillosis; allergic bronchopulmonary aspergillosis; and invasive aspergillosis (IPA). IPA has been further subdivided into angioinvasive and airway-invasive aspergillosis. Aspergillus overlap syndromes is defined as the occurrence of more than one form aspergillus disease in a single individual.

Objectives

To help clinicians correctly deal with AOS.

Methods

Retrospectively study the clinical findings of nine patients presenting with AOS.

Results

Four cases were diagnosed as angioinvasive aspergillosis complicated with ABPA, three cases as IPA overlap aspergilloma, and two cases as ABPA with AWIA. All the patients presented with cough and expectoration. In three patients with IPA overlap aspergilloma, two had hemoptysis, two had wheezing and fever. All of patients with IPA overlap ABPA had wheezing, dyspnea, and fever, three had sputum plugs, two had hemoptysis, and five patients had mucopurulent discharge and rhonchi in auscultation. Their total IgE ranged from 129 to 2124 IU/ml (676.5 ± 557.33 IU/ml). Fungal culture in sputum showed A. Fumigatus in three patients. All the six patients with IPA overlap ABPA applied steroid therapy and antifungal therapy. Three of them received two or more antifungal drugs successively, and three received combinational therapy. All the patients improved except one diagnosed ABPA overlap IPA.

Conclusions

Clinical manifestation of AOS is not typical. Poor first-line therapeutic effects and complicated diagnosis criteria require clinicians to be aware of AOS when facing patients with aspergillosis.

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References

  1. Patterson TF, Thompson GR, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the infectious diseases society of America. Clin Infect Dis. 2016;63(4):e1–60.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Chabi ML, Goracci A, Roche N, et al. Pulmonary aspergillosis. Diagn Interv Imaging. 2015;96(5):435–42.

    Article  CAS  PubMed  Google Scholar 

  3. Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J. 2015;47(1):45–68.

    Article  Google Scholar 

  4. Agarwal R, Sehgal IS, Dhooria S, et al. Developments in the diagnosis and treatment of allergic bronchopulmonary aspergillosis. Expert Rev Respir Med. 2016;10(12):1317–34.

    Article  CAS  PubMed  Google Scholar 

  5. De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European organization for research and treatment of cancer/invasive fungal infections cooperative group and the national institute of allergy and infectious diseases mycoses study group (EORTC/MSG) consensus group. Clin Infect Dis. 2008;46(12):1813–21.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Osborne D, Vock P, Godwin JD, et al. CT identification of bronchopulmonary segments: 50 normal subjects. AJR Am J Roentgenol. 1984;142(1):47–52.

    Article  CAS  PubMed  Google Scholar 

  7. Frija J, Schmit P, Katz M, et al. Computed tomography of the pulmonary fissures: normal anatomy. J Comput Assist Tomogr. 1982;6(6):1069–74.

    Article  CAS  PubMed  Google Scholar 

  8. Reiff DB, Wells AU, Carr DH, et al. CT findings in bronchiectasis: limited value in distinguishing between idiopathic and specific types. AJR Am J Roentgenol. 1995;165(2):261–7.

    Article  CAS  PubMed  Google Scholar 

  9. Hansell DM, Strickland B. High-resolution computed tomography in pulmonary cystic fibrosis. Br J Radiol. 1989;62(733):1–5.

    Article  CAS  PubMed  Google Scholar 

  10. Agarwal R, Aggarwal AN, Gupta D. High-attenuation mucus in allergic bronchopulmonary aspergillosis: another cause of diffuse high-attenuation pulmonary abnormality. AJR Am J Roentgenol. 2006;186(3):904.

    Article  PubMed  Google Scholar 

  11. Maturu VN, Agarwal R. Acute invasive pulmonary aspergillosis complicating allergic bronchopulmonary aspergillosis: case report and systematic review. Mycopathologia. 2015;180(3–4):209–15.

    Article  PubMed  Google Scholar 

  12. Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: a clinical review. Eur Respir Rev. 2011;20(121):156–74.

    Article  CAS  PubMed  Google Scholar 

  13. Askew DS, Kontoyiannis DP, Clemons KV. Advances against aspergillosis: biology, host response, diagnosis and treatment. Mycopathologia. 2014;178(5–6):321–4.

    Article  PubMed  Google Scholar 

  14. Shah A, Panjabi C. Allergic bronchopulmonary aspergillosis: a perplexing clinical entity. Allergy Asthma Immunol Res. 2016;8(4):282.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Agarwal R, Aggarwal AN, Garg M, et al. Allergic bronchopulmonary aspergillosis with aspergilloma: an immunologically severe disease with poor outcome. Mycopathologia. 2012;174(3):193–201.

    Article  PubMed  Google Scholar 

  16. Montani D, Zendah I, Achouh L, et al. Association of pulmonary aspergilloma and allergic bronchopulmonary aspergillosis. Eur Respir Rev. 2010;19:349.

    Article  CAS  PubMed  Google Scholar 

  17. Zmeili OS, Soubani AO. Pulmonary aspergillosis: a clinical update. QJM. 2007;100(6):317–34.

    Article  CAS  PubMed  Google Scholar 

  18. Buckingham S, Hansell D. Aspergillus in the lung: diverse and coincident forms. Eur Radiol. 2003;13(8):1786–800.

    Article  PubMed  Google Scholar 

  19. Brad H, Tbompson WSJR. Varied radiologic appearances of pulmonary aspergillosis. RadioGraphics. 1995;15:1273–84.

    Article  Google Scholar 

  20. Garnacho-Montero J, Olaechea P, Alvarez-Lerma F, et al. Epidemiology, diagnosis and treatment of fungal respiratory infections in the critically ill patient. Rev Esp Quimioter. 2013;26(2):173–88.

    PubMed  Google Scholar 

  21. Agarwal R, Chakrabarti A, Shah A, et al. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy. 2013;43(8):850–73.

    Article  CAS  PubMed  Google Scholar 

  22. Ganassini A, Cazzadori A. Invasive pulmonary aspergillosis complicating allergic bronchopulmonary aspergillosis. Respir Med. 1995;89:143.

    Article  CAS  PubMed  Google Scholar 

  23. Panackal AA. Combination antifungal therapy for invasive aspergillosis revisited. Med Mycol Open Access. 2016;2(2):16.

    Article  Google Scholar 

  24. Marr KA, Schlamm HT, Herbrecht R, et al. Combination antifungal therapy for invasive aspergillosis: a randomized trial. Ann Intern Med. 2015;162(2):81–9.

    Article  PubMed  Google Scholar 

  25. Raad II, Zakhem AE, Helou GE, et al. Clinical experience of the use of voriconazole, caspofungin or the combination in primary and salvage therapy of invasive aspergillosis in haematological malignancies. Int J Antimicrob Agents. 2015;45(3):283–8.

    Article  CAS  PubMed  Google Scholar 

  26. Panackal AA, Parisini E, Proschan M. Salvage combination antifungal therapy for acute invasive aspergillosis may improve outcomes: a systematic review and meta-analysis. Int J Infect Dis. 2014;28:80–94.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Frange P, Bougnoux ME, Lanternier F, et al. An update on pediatric invasive aspergillosis. Médecine et Maladies Infectieuses. 2015;45(6):189–98.

    Article  CAS  PubMed  Google Scholar 

  28. Mu X, Yu J, Nie L, et al. Mixed types of pulmonary aspergillosis. Zhonghua Jie He He Hu Xi Za Zhi. 2014;37(9):677–81.

    PubMed  Google Scholar 

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Acknowledgements

The work was supported by Natural Science Foundation of Shanghai (13ZR1406600).

Funding

The study was supported by Natural Science Foundation of Shanghai (13ZR1406600).

Authors’ Contribution

SC designed the study, LY collected and analyzed the data, LY and JZ wrote the paper, and JZ and SC contributed to the review of the manuscript.

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Authors and Affiliations

  1. Department of Pulmonary Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Liyang Li, Zhilong Jiang & Changzhou Shao

Authors
  1. Liyang Li
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  2. Zhilong Jiang
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  3. Changzhou Shao
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Corresponding author

Correspondence to Changzhou Shao.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study, formal consent is not required.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Li, L., Jiang, Z. & Shao, C. Pulmonary Aspergillus Overlap Syndromes. Mycopathologia 183, 431–438 (2018). https://doi.org/10.1007/s11046-017-0212-y

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  • DOI: https://doi.org/10.1007/s11046-017-0212-y

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