Invasive pulmonary aspergillosis: effects of early resection in a neutropenic rat model
J M Habicht1, M Preiss, J Passweg
1Division of Cardio-Thoracic Surgery, University Hospital, Basel, Switzerland. jmhabicht@intergga.ch
Objective:
Invasive pulmonary aspergillosis is frequent in neutropenic patients. Usually localized in the beginning, the disease spreads and mortality is high despite antifungal treatment. The role of early adjuvant surgery is not clear. Surgery may help to confirm fungal disease, may control fungal disease locally and may prevent systemic spreading. This study examines effects of early resection on survival and dissemination in a rat model of localized invasive pulmonary aspergillosis.
Methods:
Forty persistently neutropenic male albino rats were challenged with standardized conidial aspergillus inoculum injected into peripheral lung tissue of the right upper lobe under direct vision. Animals were divided into four groups. Twenty animals were treated with amphotericin B at 1 mg/kg per day beginning 48 h after inoculation, 20 animals were left untreated. In each group half the animals underwent early resection of localized invasive aspergillosis by lobectomy. Animals were checked daily and mortality was recorded up to 28 days after which surviving animals were sacrificed.
Results:
Significantly higher survival was observed in resected animals in the non-Am B groups (survival: 10 +/- 19% without early resection and 50 +/- 32% with early resection; P = 0.044). However, early resection did not lead to improved survival in animals treated with amphotericin B (survival 70 +/- 29% without early resection and 50 +/- 32% with early resection; P = 0.316).
Conclusions:
In this rat model of localized invasive pulmonary aspergillosis effects of early resection on survival could be demonstrated only in animals not receiving amphotericin B treatment.
Insights
Early surgical resection improved survival in rats with invasive pulmonary aspergillosis but only when not treated with amphotericin B, suggesting surgery may be beneficial in specific cases.
Area of Science:
- Mycology and Infectious Diseases
- Surgical Oncology
- Pulmonology
Background:
- Invasive pulmonary aspergillosis is a serious complication in neutropenic patients, often leading to high mortality despite antifungal therapy.
- The potential benefit of early surgical intervention in managing localized invasive pulmonary aspergillosis remains unclear.
- Surgery could potentially aid in diagnosis, local disease control, and prevention of systemic spread.
Purpose of the Study:
- To investigate the impact of early surgical resection on survival rates in a rat model of localized invasive pulmonary aspergillosis.
- To assess the effect of early resection on the dissemination of fungal disease.
- To evaluate the combined effect of early resection and amphotericin B treatment.
Main Methods:
- Forty neutropenic rats were inoculated with Aspergillus in the right upper lobe lung tissue.
- Animals were divided into four groups: treated with amphotericin B (Am B) or untreated, with or without early lobectomy.
- Survival was monitored for 28 days post-inoculation.
Main Results:
- Early resection significantly improved survival in rats not treated with amphotericin B (50% vs. 10%).
- In contrast, early resection did not significantly improve survival in rats treated with amphotericin B (50% vs. 70%).
- The study demonstrated a survival benefit of early resection only in the absence of amphotericin B treatment.
Conclusions:
- Early surgical resection can improve survival in localized invasive pulmonary aspergillosis in a rat model.
- This survival benefit was observed exclusively in animals not receiving amphotericin B.
- The findings suggest that adjuvant surgery may be a valuable strategy for invasive pulmonary aspergillosis in specific clinical scenarios, particularly when antifungal therapy alone is insufficient or not administered.
