Treatment of Chronic Pulmonary Aspergillosis: Current Standards and Future Perspectives.
Identifieur interne : 000432 ( Main/Exploration ); précédent : 000431; suivant : 000433Treatment of Chronic Pulmonary Aspergillosis: Current Standards and Future Perspectives.
Auteurs : Ana Alastruey-Izquierdo [Espagne] ; Jacques Cadranel [France] ; Holger Flick [Autriche] ; Cendrine Godet [France] ; Christophe Hennequin [France] ; Martin Hoenigl [États-Unis, Autriche] ; Chris Kosmidis [Royaume-Uni] ; Christoph Lange [Allemagne, Suède] ; Oxana Munteanu ; Iain Page [Royaume-Uni] ; Helmut J F. Salzer [Allemagne]Source :
- Respiration; international review of thoracic diseases [ 1423-0356 ]
Descripteurs français
- KwdFr :
- Antifongiques (usage thérapeutique), Aspergillose pulmonaire (chirurgie), Aspergillose pulmonaire (imagerie diagnostique), Aspergillose pulmonaire (traitement médicamenteux), Guides de bonnes pratiques cliniques comme sujet (MeSH), Humains (MeSH), Poumon (anatomopathologie), Poumon (chirurgie), Poumon (imagerie diagnostique).
- MESH :
- anatomopathologie : Poumon.
- chirurgie : Aspergillose pulmonaire, Poumon.
- imagerie diagnostique : Aspergillose pulmonaire, Poumon.
- traitement médicamenteux : Aspergillose pulmonaire.
- usage thérapeutique : Antifongiques.
- Guides de bonnes pratiques cliniques comme sujet, Humains.
English descriptors
- KwdEn :
- MESH :
- chemical , therapeutic use : Antifungal Agents.
- diagnostic imaging : Lung, Pulmonary Aspergillosis.
- drug therapy : Pulmonary Aspergillosis.
- pathology : Lung.
- surgery : Lung, Pulmonary Aspergillosis.
- Humans, Practice Guidelines as Topic.
Abstract
Chronic pulmonary aspergillosis (CPA) complicates conditions including tuberculosis, chronic obstructive pulmonary disease and sarcoidosis, and is associated with high morbidity and mortality. Surgical cure should be considered where feasible; however, many patients are unsuitable for surgery due to extensive disease or poor respiratory function. Azoles are the only oral drug with anti-Aspergillus activity and itraconazole and voriconazole are considered as first-line drugs. A randomized controlled trial demonstrated improvement or stability in three-quarters of patients given 6 months of itraconazole, but a quarter relapsed on stopping therapy. Long-term treatment may therefore be required in some cases. Itraconazole, voriconazole and posaconazole require therapeutic drug monitoring. No published data are yet available for isavuconazole. Adverse drug effects of azoles are common, including peripheral neuropathy, heart failure, elevated liver enzymes, QTc prolongation and sun sensitivity. Many serious drug-drug interactions occur, including major interactions with rifamycins, simvastatin, warfarin, clopidogrel, immunosuppressant drugs like sirolimus. Furthermore, drug resistance occurs, including cross-resistance to all azoles, but the true prevalence is not yet determined. Intravenous therapy is possible with echinocandins or amphotericin B, but long-term use is challenging. Hemoptysis complicates CPA and can be fatal. Tranexamic acid should be given acutely to reduce bleeding. Bronchial artery embolization can stop acute bleeds. In some circumstances, emergency surgery may be necessary to resect the source of the bleed. Current CPA treatments can be beneficial but have many drawbacks. New oral anti-Aspergillus agents are needed, along with optimization of currently available treatments.
DOI: 10.1159/000489474
PubMed: 29982245
Affiliations:
- Allemagne, Autriche, Espagne, France, Royaume-Uni, Suède, États-Unis
- Angleterre, Californie, Communauté de Madrid, Grand Manchester, Nouvelle-Aquitaine, Poitou-Charentes, Svealand, Île-de-France
- Madrid, Manchester, Paris, Poitiers, Stockholm
Links toward previous steps (curation, corpus...)
Le document en format XML
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type="country">Angleterre</region><region type="région" nuts="1">Grand Manchester</region></placeName></affiliation></author><author><name sortKey="Lange, Christoph" sort="Lange, Christoph" uniqKey="Lange C" first="Christoph" last="Lange">Christoph Lange</name><affiliation wicri:level="1"><nlm:affiliation>Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel</wicri:regionArea><wicri:noRegion>Borstel</wicri:noRegion><wicri:noRegion>Borstel</wicri:noRegion><wicri:noRegion>Borstel</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>German Center for Infection Research, Clinical 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nuts="2">Svealand</region></placeName></affiliation></author><author><name sortKey="Munteanu, Oxana" sort="Munteanu, Oxana" uniqKey="Munteanu O" first="Oxana" last="Munteanu">Oxana Munteanu</name><affiliation><nlm:affiliation>Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, Chisinau, Moldova.</nlm:affiliation><wicri:noCountry code="subField">Moldova</wicri:noCountry></affiliation></author><author><name sortKey="Page, Iain" sort="Page, Iain" uniqKey="Page I" first="Iain" last="Page">Iain Page</name><affiliation wicri:level="3"><nlm:affiliation>National Aspergillosis Center, Manchester University Foundation Trust, UK, and Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>National Aspergillosis Center, Manchester University Foundation Trust, UK, and Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester</wicri:regionArea><placeName><settlement type="city">Manchester</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Manchester</region></placeName></affiliation></author><author><name sortKey="Salzer, Helmut J F" sort="Salzer, Helmut J F" uniqKey="Salzer H" first="Helmut J F" last="Salzer">Helmut J F. Salzer</name><affiliation wicri:level="1"><nlm:affiliation>Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel</wicri:regionArea><wicri:noRegion>Borstel</wicri:noRegion><wicri:noRegion>Borstel</wicri:noRegion><wicri:noRegion>Borstel</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>German Center for Infection Research, Clinical Tuberculosis Center, Borstel</wicri:regionArea><wicri:noRegion>Borstel</wicri:noRegion><wicri:noRegion>Borstel</wicri:noRegion><wicri:noRegion>Borstel</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2018">2018</date><idno type="RBID">pubmed:29982245</idno><idno type="pmid">29982245</idno><idno type="doi">10.1159/000489474</idno><idno type="wicri:Area/Main/Corpus">000508</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000508</idno><idno type="wicri:Area/Main/Curation">000508</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000508</idno><idno type="wicri:Area/Main/Exploration">000508</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Treatment of Chronic Pulmonary Aspergillosis: Current Standards and Future Perspectives.</title><author><name sortKey="Alastruey Izquierdo, Ana" sort="Alastruey Izquierdo, Ana" uniqKey="Alastruey Izquierdo A" first="Ana" last="Alastruey-Izquierdo">Ana Alastruey-Izquierdo</name><affiliation wicri:level="3"><nlm:affiliation>Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Cadranel, Jacques" sort="Cadranel, Jacques" uniqKey="Cadranel J" first="Jacques" last="Cadranel">Jacques Cadranel</name><affiliation wicri:level="3"><nlm:affiliation>Service de Pneumologie, AP-HP, Hôpital Tenon, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Service de Pneumologie, AP-HP, Hôpital Tenon, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Sorbonne Université, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Sorbonne Université, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Flick, Holger" sort="Flick, Holger" uniqKey="Flick H" first="Holger" last="Flick">Holger Flick</name><affiliation wicri:level="1"><nlm:affiliation>Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.</nlm:affiliation><country xml:lang="fr">Autriche</country><wicri:regionArea>Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz</wicri:regionArea><wicri:noRegion>Graz</wicri:noRegion></affiliation></author><author><name sortKey="Godet, Cendrine" sort="Godet, Cendrine" uniqKey="Godet C" first="Cendrine" last="Godet">Cendrine Godet</name><affiliation wicri:level="3"><nlm:affiliation>Service des Maladies Infectieuses et Tropicales, CHU de Poitiers, Poitiers, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Service des Maladies Infectieuses et Tropicales, CHU de Poitiers, Poitiers</wicri:regionArea><placeName><region type="region">Nouvelle-Aquitaine</region><region type="old region">Poitou-Charentes</region><settlement type="city">Poitiers</settlement></placeName></affiliation></author><author><name sortKey="Hennequin, Christophe" sort="Hennequin, Christophe" uniqKey="Hennequin C" first="Christophe" last="Hennequin">Christophe Hennequin</name><affiliation wicri:level="3"><nlm:affiliation>Sorbonne Universités, UPMC Univ Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Sorbonne Universités, UPMC Univ Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Service de Parasitologie-Mycologie, AP-HP, Hôpital Saint-Antoine, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Service de Parasitologie-Mycologie, AP-HP, Hôpital Saint-Antoine, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Hoenigl, Martin" sort="Hoenigl, Martin" uniqKey="Hoenigl M" first="Martin" last="Hoenigl">Martin Hoenigl</name><affiliation wicri:level="2"><nlm:affiliation>Division of Infectious Diseases, University of California, San Diego, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Diseases, University of California, San Diego, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation><affiliation wicri:level="1"><nlm:affiliation>Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria.</nlm:affiliation><country xml:lang="fr">Autriche</country><wicri:regionArea>Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz</wicri:regionArea><wicri:noRegion>Graz</wicri:noRegion></affiliation></author><author><name sortKey="Kosmidis, Chris" sort="Kosmidis, Chris" uniqKey="Kosmidis C" first="Chris" last="Kosmidis">Chris Kosmidis</name><affiliation wicri:level="3"><nlm:affiliation>National Aspergillosis Center, Manchester University Foundation Trust, UK, and Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>National Aspergillosis Center, Manchester University Foundation Trust, UK, and Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester</wicri:regionArea><placeName><settlement type="city">Manchester</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Manchester</region></placeName></affiliation></author><author><name sortKey="Lange, Christoph" sort="Lange, Christoph" uniqKey="Lange C" first="Christoph" last="Lange">Christoph Lange</name><affiliation wicri:level="1"><nlm:affiliation>Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel</wicri:regionArea><wicri:noRegion>Borstel</wicri:noRegion><wicri:noRegion>Borstel</wicri:noRegion><wicri:noRegion>Borstel</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>German Center for Infection Research, Clinical Tuberculosis Center, Borstel</wicri:regionArea><wicri:noRegion>Borstel</wicri:noRegion><wicri:noRegion>Borstel</wicri:noRegion><wicri:noRegion>Borstel</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>International Health/Infectious Diseases, University of Lübeck, Lübeck</wicri:regionArea><wicri:noRegion>Lübeck</wicri:noRegion><wicri:noRegion>Lübeck</wicri:noRegion><wicri:noRegion>Lübeck</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:affiliation>Department of Medicine, Karolinska Institutet, Stockholm, Sweden.</nlm:affiliation><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Medicine, Karolinska Institutet, Stockholm</wicri:regionArea><placeName><settlement type="city">Stockholm</settlement><region nuts="2">Svealand</region></placeName></affiliation></author><author><name sortKey="Munteanu, Oxana" sort="Munteanu, Oxana" uniqKey="Munteanu O" first="Oxana" last="Munteanu">Oxana Munteanu</name><affiliation><nlm:affiliation>Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, Chisinau, Moldova.</nlm:affiliation><wicri:noCountry code="subField">Moldova</wicri:noCountry></affiliation></author><author><name sortKey="Page, Iain" sort="Page, Iain" uniqKey="Page I" first="Iain" last="Page">Iain Page</name><affiliation wicri:level="3"><nlm:affiliation>National Aspergillosis Center, Manchester University Foundation Trust, UK, and Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>National Aspergillosis Center, Manchester University Foundation Trust, UK, and Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester</wicri:regionArea><placeName><settlement type="city">Manchester</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Manchester</region></placeName></affiliation></author><author><name sortKey="Salzer, Helmut J F" sort="Salzer, Helmut J F" uniqKey="Salzer H" first="Helmut J F" last="Salzer">Helmut J F. Salzer</name><affiliation wicri:level="1"><nlm:affiliation>Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel</wicri:regionArea><wicri:noRegion>Borstel</wicri:noRegion><wicri:noRegion>Borstel</wicri:noRegion><wicri:noRegion>Borstel</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>German Center for Infection Research, Clinical Tuberculosis Center, Borstel</wicri:regionArea><wicri:noRegion>Borstel</wicri:noRegion><wicri:noRegion>Borstel</wicri:noRegion><wicri:noRegion>Borstel</wicri:noRegion></affiliation></author></analytic><series><title level="j">Respiration; international review of thoracic diseases</title><idno type="eISSN">1423-0356</idno></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antifungal Agents (therapeutic use)</term><term>Humans (MeSH)</term><term>Lung (diagnostic imaging)</term><term>Lung (pathology)</term><term>Lung (surgery)</term><term>Practice Guidelines as Topic (MeSH)</term><term>Pulmonary Aspergillosis (diagnostic imaging)</term><term>Pulmonary Aspergillosis (drug therapy)</term><term>Pulmonary Aspergillosis (surgery)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Antifongiques (usage thérapeutique)</term><term>Aspergillose pulmonaire (chirurgie)</term><term>Aspergillose pulmonaire (imagerie diagnostique)</term><term>Aspergillose pulmonaire (traitement médicamenteux)</term><term>Guides de bonnes pratiques cliniques comme sujet (MeSH)</term><term>Humains (MeSH)</term><term>Poumon (anatomopathologie)</term><term>Poumon (chirurgie)</term><term>Poumon (imagerie diagnostique)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antifungal Agents</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Poumon</term></keywords><keywords scheme="MESH" qualifier="chirurgie" xml:lang="fr"><term>Aspergillose pulmonaire</term><term>Poumon</term></keywords><keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Lung</term><term>Pulmonary Aspergillosis</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Pulmonary Aspergillosis</term></keywords><keywords scheme="MESH" qualifier="imagerie diagnostique" xml:lang="fr"><term>Aspergillose pulmonaire</term><term>Poumon</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Lung</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Lung</term><term>Pulmonary Aspergillosis</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Aspergillose pulmonaire</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antifongiques</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Humans</term><term>Practice Guidelines as Topic</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Guides de bonnes pratiques cliniques comme sujet</term><term>Humains</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Chronic pulmonary aspergillosis (CPA) complicates conditions including tuberculosis, chronic obstructive pulmonary disease and sarcoidosis, and is associated with high morbidity and mortality. Surgical cure should be considered where feasible; however, many patients are unsuitable for surgery due to extensive disease or poor respiratory function. Azoles are the only oral drug with anti-Aspergillus activity and itraconazole and voriconazole are considered as first-line drugs. A randomized controlled trial demonstrated improvement or stability in three-quarters of patients given 6 months of itraconazole, but a quarter relapsed on stopping therapy. Long-term treatment may therefore be required in some cases. Itraconazole, voriconazole and posaconazole require therapeutic drug monitoring. No published data are yet available for isavuconazole. Adverse drug effects of azoles are common, including peripheral neuropathy, heart failure, elevated liver enzymes, QTc prolongation and sun sensitivity. Many serious drug-drug interactions occur, including major interactions with rifamycins, simvastatin, warfarin, clopidogrel, immunosuppressant drugs like sirolimus. Furthermore, drug resistance occurs, including cross-resistance to all azoles, but the true prevalence is not yet determined. Intravenous therapy is possible with echinocandins or amphotericin B, but long-term use is challenging. Hemoptysis complicates CPA and can be fatal. Tranexamic acid should be given acutely to reduce bleeding. Bronchial artery embolization can stop acute bleeds. In some circumstances, emergency surgery may be necessary to resect the source of the bleed. Current CPA treatments can be beneficial but have many drawbacks. New oral anti-Aspergillus agents are needed, along with optimization of currently available treatments.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">29982245</PMID><DateCompleted><Year>2018</Year><Month>12</Month><Day>21</Day></DateCompleted><DateRevised><Year>2018</Year><Month>12</Month><Day>21</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1423-0356</ISSN><JournalIssue CitedMedium="Internet"><Volume>96</Volume><Issue>2</Issue><PubDate><MedlineDate>2018</MedlineDate></PubDate></JournalIssue><Title>Respiration; international review of thoracic diseases</Title><ISOAbbreviation>Respiration</ISOAbbreviation></Journal><ArticleTitle>Treatment of Chronic Pulmonary Aspergillosis: Current Standards and Future Perspectives.</ArticleTitle><Pagination><MedlinePgn>159-170</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1159/000489474</ELocationID><Abstract><AbstractText>Chronic pulmonary aspergillosis (CPA) complicates conditions including tuberculosis, chronic obstructive pulmonary disease and sarcoidosis, and is associated with high morbidity and mortality. Surgical cure should be considered where feasible; however, many patients are unsuitable for surgery due to extensive disease or poor respiratory function. Azoles are the only oral drug with anti-Aspergillus activity and itraconazole and voriconazole are considered as first-line drugs. A randomized controlled trial demonstrated improvement or stability in three-quarters of patients given 6 months of itraconazole, but a quarter relapsed on stopping therapy. Long-term treatment may therefore be required in some cases. Itraconazole, voriconazole and posaconazole require therapeutic drug monitoring. No published data are yet available for isavuconazole. Adverse drug effects of azoles are common, including peripheral neuropathy, heart failure, elevated liver enzymes, QTc prolongation and sun sensitivity. Many serious drug-drug interactions occur, including major interactions with rifamycins, simvastatin, warfarin, clopidogrel, immunosuppressant drugs like sirolimus. Furthermore, drug resistance occurs, including cross-resistance to all azoles, but the true prevalence is not yet determined. Intravenous therapy is possible with echinocandins or amphotericin B, but long-term use is challenging. Hemoptysis complicates CPA and can be fatal. Tranexamic acid should be given acutely to reduce bleeding. Bronchial artery embolization can stop acute bleeds. In some circumstances, emergency surgery may be necessary to resect the source of the bleed. Current CPA treatments can be beneficial but have many drawbacks. New oral anti-Aspergillus agents are needed, along with optimization of currently available treatments.</AbstractText><CopyrightInformation>© 2018 S. Karger AG, Basel.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Alastruey-Izquierdo</LastName><ForeName>Ana</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cadranel</LastName><ForeName>Jacques</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Service de Pneumologie, AP-HP, Hôpital Tenon, Paris, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Sorbonne Université, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Flick</LastName><ForeName>Holger</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Godet</LastName><ForeName>Cendrine</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Service des Maladies Infectieuses et Tropicales, CHU de Poitiers, Poitiers, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hennequin</LastName><ForeName>Christophe</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Sorbonne Universités, UPMC Univ Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Service de Parasitologie-Mycologie, AP-HP, Hôpital Saint-Antoine, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hoenigl</LastName><ForeName>Martin</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Division of Infectious Diseases, University of California, San Diego, California, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kosmidis</LastName><ForeName>Chris</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>National Aspergillosis Center, Manchester University Foundation Trust, UK, and Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lange</LastName><ForeName>Christoph</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Medicine, Karolinska Institutet, Stockholm, Sweden.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Munteanu</LastName><ForeName>Oxana</ForeName><Initials>O</Initials><AffiliationInfo><Affiliation>Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, Chisinau, Moldova.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Page</LastName><ForeName>Iain</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>National Aspergillosis Center, Manchester University Foundation Trust, UK, and Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Salzer</LastName><ForeName>Helmut J F</ForeName><Initials>HJF</Initials><AffiliationInfo><Affiliation>Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><CollectiveName>on behalf of CPAnet</CollectiveName></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2018</Year><Month>07</Month><Day>06</Day></ArticleDate></Article><MedlineJournalInfo><Country>Switzerland</Country><MedlineTA>Respiration</MedlineTA><NlmUniqueID>0137356</NlmUniqueID><ISSNLinking>0025-7931</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000935">Antifungal Agents</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000935" MajorTopicYN="N">Antifungal Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008168" MajorTopicYN="N">Lung</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017410" MajorTopicYN="N">Practice Guidelines as Topic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D055732" MajorTopicYN="N">Pulmonary Aspergillosis</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Antifungal treatment</Keyword><Keyword MajorTopicYN="N">Aspergillus</Keyword><Keyword MajorTopicYN="N">Chronic pulmonary aspergillosis</Keyword><Keyword MajorTopicYN="N">Management</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2018</Year><Month>04</Month><Day>18</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2018</Year><Month>04</Month><Day>18</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2018</Year><Month>7</Month><Day>10</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2018</Year><Month>12</Month><Day>24</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2018</Year><Month>7</Month><Day>9</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">29982245</ArticleId><ArticleId IdType="pii">000489474</ArticleId><ArticleId IdType="doi">10.1159/000489474</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Allemagne</li><li>Autriche</li><li>Espagne</li><li>France</li><li>Royaume-Uni</li><li>Suède</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Californie</li><li>Communauté de Madrid</li><li>Grand Manchester</li><li>Nouvelle-Aquitaine</li><li>Poitou-Charentes</li><li>Svealand</li><li>Île-de-France</li></region><settlement><li>Madrid</li><li>Manchester</li><li>Paris</li><li>Poitiers</li><li>Stockholm</li></settlement></list><tree><noCountry><name sortKey="Munteanu, Oxana" sort="Munteanu, Oxana" uniqKey="Munteanu O" first="Oxana" last="Munteanu">Oxana Munteanu</name></noCountry><country name="Espagne"><region name="Communauté de Madrid"><name sortKey="Alastruey Izquierdo, Ana" sort="Alastruey Izquierdo, Ana" uniqKey="Alastruey Izquierdo A" first="Ana" last="Alastruey-Izquierdo">Ana Alastruey-Izquierdo</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="Cadranel, Jacques" sort="Cadranel, Jacques" uniqKey="Cadranel J" first="Jacques" last="Cadranel">Jacques Cadranel</name><name sortKey="Godet, Cendrine" sort="Godet, Cendrine" uniqKey="Godet C" first="Cendrine" last="Godet">Cendrine Godet</name><name sortKey="Hennequin, Christophe" sort="Hennequin, Christophe" uniqKey="Hennequin C" first="Christophe" last="Hennequin">Christophe Hennequin</name><name sortKey="Hennequin, Christophe" sort="Hennequin, Christophe" uniqKey="Hennequin C" first="Christophe" last="Hennequin">Christophe Hennequin</name></country><country name="Autriche"><noRegion><name sortKey="Flick, Holger" sort="Flick, Holger" uniqKey="Flick H" first="Holger" last="Flick">Holger Flick</name></noRegion><name sortKey="Hoenigl, Martin" sort="Hoenigl, Martin" uniqKey="Hoenigl M" first="Martin" last="Hoenigl">Martin Hoenigl</name></country><country name="États-Unis"><region name="Californie"><name sortKey="Hoenigl, Martin" sort="Hoenigl, Martin" uniqKey="Hoenigl M" first="Martin" last="Hoenigl">Martin Hoenigl</name></region></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Kosmidis, Chris" sort="Kosmidis, Chris" uniqKey="Kosmidis C" first="Chris" last="Kosmidis">Chris Kosmidis</name></region><name sortKey="Page, Iain" sort="Page, Iain" uniqKey="Page I" first="Iain" last="Page">Iain Page</name></country><country name="Allemagne"><noRegion><name sortKey="Lange, Christoph" sort="Lange, Christoph" uniqKey="Lange C" first="Christoph" last="Lange">Christoph Lange</name></noRegion><name sortKey="Lange, Christoph" sort="Lange, Christoph" uniqKey="Lange C" first="Christoph" last="Lange">Christoph Lange</name><name sortKey="Lange, Christoph" sort="Lange, Christoph" uniqKey="Lange C" first="Christoph" last="Lange">Christoph Lange</name><name sortKey="Salzer, Helmut J F" sort="Salzer, Helmut J F" uniqKey="Salzer H" first="Helmut J F" last="Salzer">Helmut J F. Salzer</name><name sortKey="Salzer, Helmut J F" sort="Salzer, Helmut J F" uniqKey="Salzer H" first="Helmut J F" last="Salzer">Helmut J F. Salzer</name></country><country name="Suède"><region name="Svealand"><name sortKey="Lange, Christoph" sort="Lange, Christoph" uniqKey="Lange C" first="Christoph" last="Lange">Christoph Lange</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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