Related Experiment Video
Updated: Dec 19, 2025
Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis
Published on: March 9, 2018
Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist
Felix Bongomin1, Lucy Grace Asio1, Joseph Baruch Baluku2
1Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu P.o.Box 166, Uganda.
Abstract:
Chronic pulmonary aspergillosis (CPA) is a spectrum of several progressive disease manifestations caused by Aspergillus species in patients with underlying structural lung diseases. Duration of symptoms longer than three months distinguishes CPA from acute and subacute invasive pulmonary aspergillosis. CPA affects over 3 million individuals worldwide. Its diagnostic approach requires a thorough Clinical, Radiological, Immunological and Mycological (CRIM) assessment. The diagnosis of CPA requires (1) demonstration of one or more cavities with or without a fungal ball present or nodules on chest imaging, (2) direct evidence of Aspergillus infection or an immunological response to Aspergillus species and (3) exclusion of alternative diagnoses, although CPA and mycobacterial disease can be synchronous. Aspergillus antibody is elevated in over 90% of patients and is the cornerstone for CPA diagnosis. Long-term oral antifungal therapy improves quality of life, arrests haemoptysis and prevents disease progression. Itraconazole and voriconazole are alternative first-line agents; voriconazole is preferred for patients with contra-indications to itraconazole and in those with severe disease (including large aspergilloma). In patients co-infected with tuberculosis (TB), it is not possible to treat TB with rifampicin and concurrently administer azoles, because of profound drug interactions. In those with pan-azole resistance or intolerance or progressive disease while on oral triazoles, short-term courses of intravenous liposomal amphotericin B or micafungin is used. Surgery benefits patients with well-circumscribed simple aspergillomas and should be offered earlier in low-resource settings.
Insights
Chronic pulmonary aspergillosis (CPA), a progressive lung disease affecting millions, is diagnosed via clinical, radiological, immunological, and mycological assessment. Long-term antifungal therapy is key for managing CPA symptoms and disease progression.
Area of Science:
- Pulmonology
- Infectious Diseases
- Mycology
Background:
- Chronic pulmonary aspergillosis (CPA) encompasses progressive lung diseases caused by Aspergillus species in individuals with pre-existing lung conditions.
- Symptoms lasting over three months differentiate CPA from acute or subacute invasive forms.
- CPA impacts over 3 million people globally, necessitating effective diagnostic and management strategies.
Purpose of the Study:
- To outline the diagnostic criteria for CPA, emphasizing the Clinical, Radiological, Immunological, and Mycological (CRIM) assessment.
- To discuss the role of Aspergillus antibody detection as a cornerstone in CPA diagnosis.
- To review current and alternative therapeutic approaches for CPA, including antifungal agents and surgical options.
Main Methods:
- Diagnosis relies on chest imaging (cavities, fungal balls, nodules), evidence of Aspergillus infection or immune response, and exclusion of other conditions.
- Aspergillus antibody levels, elevated in over 90% of patients, are crucial for diagnosis.
- Treatment strategies involve long-term oral antifungals (itraconazole, voriconazole), with considerations for drug interactions (e.g., with tuberculosis treatment) and resistance.
Main Results:
- Elevated Aspergillus antibody levels are observed in over 90% of CPA patients.
- Long-term oral antifungal therapy demonstrates efficacy in improving quality of life, reducing hemoptysis, and preventing disease progression.
- Surgical intervention is beneficial for well-defined aspergillomas, particularly in resource-limited settings.
Conclusions:
- CPA diagnosis requires a comprehensive CRIM assessment, with Aspergillus antibody testing being a key component.
- Long-term oral antifungal therapy is the mainstay of CPA management, improving patient outcomes.
- Treatment decisions must account for potential drug interactions, patient tolerance, disease severity, and the availability of surgical options.
More Related Videos
08:01Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology
Published on: March 22, 2012
15:01Confocal Laser Scanning Microscopy-Based Quantitative Analysis of Aspergillus fumigatus Conidia Distribution in Whole-Mount Optically Cleared Mouse Lung
Published on: September 18, 2021
Related Concept Videos
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
01:31Pulmonary Tuberculosis III
The first classification is based on the development of the disease, and it includes the following categories:
01:28Pulmonary Tuberculosis II
Here is a detailed explanation of its pathophysiology:
Transmission: The process begins when a person inhales droplet nuclei containing M. tuberculosis. These are typically released into the air when an individual with pulmonary or...
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:28Fungal Phylum Ascomycota
01:29Chronic Obstructive Pulmonary Disease-V: Management
Smoking Cessation