[Usefulness of percutaneous instillation of antifungal agents for pulmonary aspergilloma]
Related Experiment Videos
T Shirai1, M Taniguchi, S Imokawa
1Department of Respiratory Medicine, Fujieda Municipal Shida General Hospital, Shizuoka, Japan.
Abstract:
We studied the usefulness of percutaneous instillation of antifungal agents for treatment of pulmonary aspergilloma. The subjects were six patients, four males and two females, with a mean age of 69 years (range, 45 to 90 years). In all cases, radiography revealed a fungus ball or thickened cavity wall in residual tuberculous cavities. The patients had clinical symptoms including hemoptysis, fever, cough and sputum, and most of them showed severe emaciation, anemia, hypoalbuminemia and hypoxia. Miconazole or fluconazole was instilled through an indwelling catheter inserted percutaneously into the cavity from the anterior chest wall or parascapular region under fluoroscopic observation. After treatment with a total dose of 610 to 2070 mg over a period of 6 to 18 weeks, clinical symptoms were diminished in all patients and radiographic findings were improved in five. Furthermore, Aspergillus fumigatus, which had been isolated from sputum samples of three patients, was eradicated. According to evaluation of the overall therapeutic effects, this therapy was considered to be effective in five patients, giving an efficacy rate of 83%. No recurrence has been detected in six patients during a mean follow-up of 13 months after treatment. Since percutaneous instillation involves less pain and stress than other kinds of
Insights
Percutaneous antifungal instillation effectively treated pulmonary aspergilloma in six patients, improving symptoms and radiographic findings. This minimally invasive approach demonstrated an 83% efficacy rate with no recurrence observed during follow-up.
Area of Science:
- Pulmonology
- Mycology
- Interventional Radiology
Background:
- Pulmonary aspergilloma often occurs in patients with pre-existing lung conditions, such as tuberculous cavities.
- Patients frequently present with severe symptoms like hemoptysis, fever, and respiratory distress, alongside systemic complications.
- Conventional treatments may be invasive or less effective for localized fungal infections within lung cavities.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous instillation of antifungal agents for treating pulmonary aspergilloma.
- To assess the impact of this minimally invasive technique on clinical symptoms and radiographic findings.
- To determine the eradication rate of Aspergillus fumigatus and long-term recurrence rates.
Main Methods:
- Six patients with pulmonary aspergilloma in tuberculous cavities underwent percutaneous antifungal instillation.
- Antifungal agents (miconazole or fluconazole) were administered via an indwelling catheter inserted under fluoroscopic guidance.
- Treatment duration ranged from 6 to 18 weeks, with total doses between 610 and 2070 mg.
Main Results:
- All six patients experienced diminished clinical symptoms, including hemoptysis and fever.
- Radiographic findings improved in five patients, with successful eradication of Aspergillus fumigatus in three.
- An overall efficacy rate of 83% was observed, with no recurrence noted during a mean 13-month follow-up.
Conclusions:
- Percutaneous instillation of antifungal agents is an effective and minimally invasive treatment for pulmonary aspergilloma.
- The procedure offers significant clinical and radiological improvement with a low recurrence rate.
- This therapeutic approach provides a less painful and stressful alternative for managing complex pulmonary fungal infections.