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[Chronic necrotizing pulmonary aspergillosis: infrequent form of aspergillosis]
M Navarro1, C Domingo, M Gallego
1Servicio de Neumología, Hospital del Parc Taulí, Sabadell, Barcelona.
Background:
Chronic necrotizing pulmonary aspergillosis (CNPA) is a chronic pulmonary infection caused by the genus Aspergillus, which usually involves moderately immunosuppressed patients.
Method:
We describe 3 patients with a toxic syndrome that had lasted several weeks or months, with lung infiltrates in the chest X-ray and the CT scan. Mycobacterium tuberculosis could not be isolated from different respiratory smears (sputum, bronchoaspiration, Barlett catheter and pulmonary punction in the third case). Moreover, there was no response to anaerobic treatment.
Results:
All 3 patients were moderately immunosuppressed (2 men were COPD and the woman was an asthmatic patient). One of the men was being treated for a nocardiosis. In all three cases, A. fumigatus was isolated from de different respiratory smears.
Conclusions:
To diagnose a CPNA, a high degree of clinical suspicion is needed. The differential diagnose should be done with pulmonary tuberculosis and anaerobic infections. The presence of a member of the genus Aspergillus in the tracheobronchial secretions of a patient should not be systematically considered a saprofit, specially when other microorganisms can not be isolated.
Insights
Chronic necrotizing pulmonary aspergillosis (CNPA) is a fungal infection in moderately immunocompromised patients. Aspergillus fumigatus was identified in patients with prolonged toxic syndromes, highlighting the need for clinical suspicion in diagnosis.
Area of Science:
- Pulmonology
- Infectious Diseases
- Mycology
Background:
- Chronic necrotizing pulmonary aspergillosis (CNPA) is a serious fungal infection.
- It primarily affects individuals with moderate immunosuppression.
Observation:
- Three patients presented with prolonged toxic syndromes and lung infiltrates on imaging.
- Standard bacterial and anaerobic cultures were negative.
- Mycobacterium tuberculosis was not isolated.
Findings:
- All three patients were moderately immunosuppressed (COPD, asthma).
- Aspergillus fumigatus was consistently isolated from respiratory samples.
- One patient was undergoing treatment for nocardiosis.
Implications:
- CNPA diagnosis requires high clinical suspicion.
- Differential diagnosis must include pulmonary tuberculosis and anaerobic infections.
- Aspergillus in respiratory secretions may indicate active infection, not just colonization.