Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management.
Identifieur interne : 002227 ( Main/Exploration ); précédent : 002226; suivant : 002228Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management.
Auteurs : David W. Denning [Royaume-Uni] ; Jacques Cadranel [France] ; Catherine Beigelman-Aubry [Suisse] ; Florence Ader [France] ; Arunaloke Chakrabarti [Inde] ; Stijn Blot [Australie] ; Andrew J. Ullmann [Allemagne] ; George Dimopoulos [Grèce] ; Christoph LangeSource :
- The European respiratory journal [ 1399-3003 ] ; 2016.
Descripteurs français
- KwdFr :
- Acide tranéxamique (usage thérapeutique), Antifibrinolytiques (usage thérapeutique), Antifongiques (usage thérapeutique), Artères bronchiques, Aspergillose bronchopulmonaire allergique (), Aspergillose bronchopulmonaire allergique (diagnostic), Aspergillose bronchopulmonaire allergique (immunologie), Aspergillose pulmonaire (), Aspergillose pulmonaire (diagnostic), Aspergillose pulmonaire (immunologie), Aspergillose pulmonaire invasive (), Aspergillose pulmonaire invasive (diagnostic), Aspergillose pulmonaire invasive (immunologie), Bronchoscopie, Chirurgie thoracique vidéoassistée, Embolisation thérapeutique (), Humains, Hémoptysie (), Hémoptysie (étiologie), Immunocompétence, Maladie chronique, Mycétome (), Mycétome (diagnostic), Mycétome (immunologie), Poumon (), Poumon (imagerie diagnostique), Prise en charge de la maladie, Sujet immunodéprimé, Tomodensitométrie.
- MESH :
- diagnostic : Aspergillose bronchopulmonaire allergique, Aspergillose pulmonaire, Aspergillose pulmonaire invasive, Mycétome.
- imagerie diagnostique : Poumon.
- immunologie : Aspergillose bronchopulmonaire allergique, Aspergillose pulmonaire, Aspergillose pulmonaire invasive, Mycétome.
- usage thérapeutique : Acide tranéxamique, Antifibrinolytiques, Antifongiques.
- étiologie : Hémoptysie.
- Artères bronchiques, Aspergillose bronchopulmonaire allergique, Aspergillose pulmonaire, Aspergillose pulmonaire invasive, Bronchoscopie, Chirurgie thoracique vidéoassistée, Embolisation thérapeutique, Humains, Hémoptysie, Immunocompétence, Maladie chronique, Mycétome, Poumon, Prise en charge de la maladie, Sujet immunodéprimé, Tomodensitométrie.
English descriptors
- KwdEn :
- Antifibrinolytic Agents (therapeutic use), Antifungal Agents (therapeutic use), Aspergillosis, Allergic Bronchopulmonary (complications), Aspergillosis, Allergic Bronchopulmonary (diagnosis), Aspergillosis, Allergic Bronchopulmonary (immunology), Aspergillosis, Allergic Bronchopulmonary (therapy), Bronchial Arteries, Bronchoscopy, Chronic Disease, Disease Management, Embolization, Therapeutic (methods), Hemoptysis (etiology), Hemoptysis (therapy), Humans, Immunocompetence, Immunocompromised Host, Invasive Pulmonary Aspergillosis (complications), Invasive Pulmonary Aspergillosis (diagnosis), Invasive Pulmonary Aspergillosis (immunology), Invasive Pulmonary Aspergillosis (therapy), Lung (diagnostic imaging), Lung (surgery), Mycetoma (complications), Mycetoma (diagnosis), Mycetoma (immunology), Mycetoma (therapy), Pulmonary Aspergillosis (complications), Pulmonary Aspergillosis (diagnosis), Pulmonary Aspergillosis (immunology), Pulmonary Aspergillosis (therapy), Thoracic Surgery, Video-Assisted, Tomography, X-Ray Computed, Tranexamic Acid (therapeutic use).
- MESH :
- chemical , therapeutic use : Antifibrinolytic Agents, Antifungal Agents, Tranexamic Acid.
- complications : Aspergillosis, Allergic Bronchopulmonary, Invasive Pulmonary Aspergillosis, Mycetoma, Pulmonary Aspergillosis.
- diagnosis : Aspergillosis, Allergic Bronchopulmonary, Invasive Pulmonary Aspergillosis, Mycetoma, Pulmonary Aspergillosis.
- diagnostic imaging : Lung.
- etiology : Hemoptysis.
- immunology : Aspergillosis, Allergic Bronchopulmonary, Invasive Pulmonary Aspergillosis, Mycetoma, Pulmonary Aspergillosis.
- methods : Embolization, Therapeutic.
- surgery : Lung.
- therapy : Aspergillosis, Allergic Bronchopulmonary, Hemoptysis, Invasive Pulmonary Aspergillosis, Mycetoma, Pulmonary Aspergillosis.
- Bronchial Arteries, Bronchoscopy, Chronic Disease, Disease Management, Humans, Immunocompetence, Immunocompromised Host, Thoracic Surgery, Video-Assisted, Tomography, X-Ray Computed.
Abstract
Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ~240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferably via video-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with single Aspergillus nodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up.
DOI: 10.1183/13993003.00583-2015
PubMed: 26699723
Affiliations:
- Allemagne, Australie, France, Grèce, Inde, Royaume-Uni, Suisse
- Angleterre, Attique (région), Auvergne-Rhône-Alpes, Bavière, Canton de Vaud, District de Basse-Franconie, Grand Manchester, Province de Flandre-Orientale, Rhône-Alpes, Région flamande, Île-de-France
- Athènes, Gand, Lausanne, Lyon, Manchester, Paris, Wurtzbourg
- Université de Gand
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Le document en format XML
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<term>Aspergillosis, Allergic Bronchopulmonary (diagnosis)</term>
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<term>Chronic Disease</term>
<term>Disease Management</term>
<term>Embolization, Therapeutic (methods)</term>
<term>Hemoptysis (etiology)</term>
<term>Hemoptysis (therapy)</term>
<term>Humans</term>
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<term>Invasive Pulmonary Aspergillosis (diagnosis)</term>
<term>Invasive Pulmonary Aspergillosis (immunology)</term>
<term>Invasive Pulmonary Aspergillosis (therapy)</term>
<term>Lung (diagnostic imaging)</term>
<term>Lung (surgery)</term>
<term>Mycetoma (complications)</term>
<term>Mycetoma (diagnosis)</term>
<term>Mycetoma (immunology)</term>
<term>Mycetoma (therapy)</term>
<term>Pulmonary Aspergillosis (complications)</term>
<term>Pulmonary Aspergillosis (diagnosis)</term>
<term>Pulmonary Aspergillosis (immunology)</term>
<term>Pulmonary Aspergillosis (therapy)</term>
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<term>Antifibrinolytiques (usage thérapeutique)</term>
<term>Antifongiques (usage thérapeutique)</term>
<term>Artères bronchiques</term>
<term>Aspergillose bronchopulmonaire allergique ()</term>
<term>Aspergillose bronchopulmonaire allergique (diagnostic)</term>
<term>Aspergillose bronchopulmonaire allergique (immunologie)</term>
<term>Aspergillose pulmonaire ()</term>
<term>Aspergillose pulmonaire (diagnostic)</term>
<term>Aspergillose pulmonaire (immunologie)</term>
<term>Aspergillose pulmonaire invasive ()</term>
<term>Aspergillose pulmonaire invasive (diagnostic)</term>
<term>Aspergillose pulmonaire invasive (immunologie)</term>
<term>Bronchoscopie</term>
<term>Chirurgie thoracique vidéoassistée</term>
<term>Embolisation thérapeutique ()</term>
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<term>Hémoptysie ()</term>
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<term>Maladie chronique</term>
<term>Mycétome ()</term>
<term>Mycétome (diagnostic)</term>
<term>Mycétome (immunologie)</term>
<term>Poumon ()</term>
<term>Poumon (imagerie diagnostique)</term>
<term>Prise en charge de la maladie</term>
<term>Sujet immunodéprimé</term>
<term>Tomodensitométrie</term>
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<term>Antifungal Agents</term>
<term>Tranexamic Acid</term>
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<keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Aspergillosis, Allergic Bronchopulmonary</term>
<term>Invasive Pulmonary Aspergillosis</term>
<term>Mycetoma</term>
<term>Pulmonary Aspergillosis</term>
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<term>Invasive Pulmonary Aspergillosis</term>
<term>Mycetoma</term>
<term>Pulmonary Aspergillosis</term>
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<term>Aspergillose pulmonaire</term>
<term>Aspergillose pulmonaire invasive</term>
<term>Mycétome</term>
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<keywords scheme="MESH" qualifier="immunologie" xml:lang="fr"><term>Aspergillose bronchopulmonaire allergique</term>
<term>Aspergillose pulmonaire</term>
<term>Aspergillose pulmonaire invasive</term>
<term>Mycétome</term>
</keywords>
<keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>Aspergillosis, Allergic Bronchopulmonary</term>
<term>Invasive Pulmonary Aspergillosis</term>
<term>Mycetoma</term>
<term>Pulmonary Aspergillosis</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Embolization, Therapeutic</term>
</keywords>
<keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Lung</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Aspergillosis, Allergic Bronchopulmonary</term>
<term>Hemoptysis</term>
<term>Invasive Pulmonary Aspergillosis</term>
<term>Mycetoma</term>
<term>Pulmonary Aspergillosis</term>
</keywords>
<keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Acide tranéxamique</term>
<term>Antifibrinolytiques</term>
<term>Antifongiques</term>
</keywords>
<keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Hémoptysie</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Bronchial Arteries</term>
<term>Bronchoscopy</term>
<term>Chronic Disease</term>
<term>Disease Management</term>
<term>Humans</term>
<term>Immunocompetence</term>
<term>Immunocompromised Host</term>
<term>Thoracic Surgery, Video-Assisted</term>
<term>Tomography, X-Ray Computed</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Artères bronchiques</term>
<term>Aspergillose bronchopulmonaire allergique</term>
<term>Aspergillose pulmonaire</term>
<term>Aspergillose pulmonaire invasive</term>
<term>Bronchoscopie</term>
<term>Chirurgie thoracique vidéoassistée</term>
<term>Embolisation thérapeutique</term>
<term>Humains</term>
<term>Hémoptysie</term>
<term>Immunocompétence</term>
<term>Maladie chronique</term>
<term>Mycétome</term>
<term>Poumon</term>
<term>Prise en charge de la maladie</term>
<term>Sujet immunodéprimé</term>
<term>Tomodensitométrie</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en">Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ~240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferably via video-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with single Aspergillus nodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up.</div>
</front>
</TEI>
<affiliations><list><country><li>Allemagne</li>
<li>Australie</li>
<li>France</li>
<li>Grèce</li>
<li>Inde</li>
<li>Royaume-Uni</li>
<li>Suisse</li>
</country>
<region><li>Angleterre</li>
<li>Attique (région)</li>
<li>Auvergne-Rhône-Alpes</li>
<li>Bavière</li>
<li>Canton de Vaud</li>
<li>District de Basse-Franconie</li>
<li>Grand Manchester</li>
<li>Province de Flandre-Orientale</li>
<li>Rhône-Alpes</li>
<li>Région flamande</li>
<li>Île-de-France</li>
</region>
<settlement><li>Athènes</li>
<li>Gand</li>
<li>Lausanne</li>
<li>Lyon</li>
<li>Manchester</li>
<li>Paris</li>
<li>Wurtzbourg</li>
</settlement>
<orgName><li>Université de Gand</li>
</orgName>
</list>
<tree><noCountry><name sortKey="Lange, Christoph" sort="Lange, Christoph" uniqKey="Lange C" first="Christoph" last="Lange">Christoph Lange</name>
</noCountry>
<country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Denning, David W" sort="Denning, David W" uniqKey="Denning D" first="David W" last="Denning">David W. Denning</name>
</region>
</country>
<country name="France"><region name="Île-de-France"><name sortKey="Cadranel, Jacques" sort="Cadranel, Jacques" uniqKey="Cadranel J" first="Jacques" last="Cadranel">Jacques Cadranel</name>
</region>
<name sortKey="Ader, Florence" sort="Ader, Florence" uniqKey="Ader F" first="Florence" last="Ader">Florence Ader</name>
</country>
<country name="Suisse"><region name="Canton de Vaud"><name sortKey="Beigelman Aubry, Catherine" sort="Beigelman Aubry, Catherine" uniqKey="Beigelman Aubry C" first="Catherine" last="Beigelman-Aubry">Catherine Beigelman-Aubry</name>
</region>
</country>
<country name="Inde"><noRegion><name sortKey="Chakrabarti, Arunaloke" sort="Chakrabarti, Arunaloke" uniqKey="Chakrabarti A" first="Arunaloke" last="Chakrabarti">Arunaloke Chakrabarti</name>
</noRegion>
</country>
<country name="Australie"><region name="Région flamande"><name sortKey="Blot, Stijn" sort="Blot, Stijn" uniqKey="Blot S" first="Stijn" last="Blot">Stijn Blot</name>
</region>
</country>
<country name="Allemagne"><region name="Bavière"><name sortKey="Ullmann, Andrew J" sort="Ullmann, Andrew J" uniqKey="Ullmann A" first="Andrew J" last="Ullmann">Andrew J. Ullmann</name>
</region>
</country>
<country name="Grèce"><region name="Attique (région)"><name sortKey="Dimopoulos, George" sort="Dimopoulos, George" uniqKey="Dimopoulos G" first="George" last="Dimopoulos">George Dimopoulos</name>
</region>
</country>
</tree>
</affiliations>
</record>
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