Abstract
Aspergillus is a mould widespread in the environment and is responsible for a wide spectrum of clinical syndromes. Chronic necrotizing aspergillosis (CNA) is locally invasive and is seen mainly in patients with mild immunodeficiency or with chronic lung disease.
Our purpose was to characterize a population of patients followed in a tertiary hospital with the diagnosis of CNA.
The authors performed a 5 year retrospective analysis of patients with positive cultures or histopathological evidence of Aspergillus (a total of 45 patients).
Diagnosis criteria for CNA were present in 12 patients. All performed a thoracic CT scan and fibroscopy. 10 Patients were males, median age was 65.5 (38-83 years), with an average age adjusted Charlson index score of 4.8. The most frequent risk factores were severe sctructural lung disease (n=10), past history of pulmonary tuberculosis (n=6), severe COPD (n=4), prolonged corticotherapy (n=4) and lung cancer (n=2).
5 Patients had previously identified Aspergilloma. This subgroup of patients had an average of 2.275 known risk factores for CNA (vs 4.0 in patients without Aspergilloma).
Voriconazol was the treatment of choice and prescribed to 9 patients (75%).
The 6 overall 6 months mortality was 33.3% (non-survivors had an average age adjusted Charlson index score of 8).
Our results provide data on clinical characteristics and outcomes of CNA in patients with pre-existing chronic respiratory conditions. A significant 6 months mortality was observed in patients with high Charlson index score.
We concluded that CNA is an uncommon diagnosis but represents a relevant comorbidity in patients with severe pulmonary chronic disease.
- Copyright ©ERS 2015