Overview
Chronic pulmonary aspergillosis (CPA) is a spectrum of fungal infections caused by Aspergillus species, characterized by varying degrees of lung involvement, ranging from indolent to aggressive forms, often complicating underlying lung diseases or immunosuppression 2.Diagnosis
Clinical Presentation: Chronic cough, fever, weight loss, and radiological findings such as nodules, cavities, or infiltrates 2.
Imaging: High-resolution CT scans often reveal characteristic findings like nodules, cavitation, or mosaic attenuation 2.
Microbiological Confirmation: Sputum cultures or bronchoscopy with bronchoalveolar lavage (BAL) for Aspergillus species 2.
Serological Tests: Galactomannan antigen testing in serum or BAL fluid can be useful, though not always specific 2.
Histopathology: Biopsy or BAL cytology showing Aspergillus hyphae or galactomannan 2.Management
First-Line Antifungal Therapy: Voriconazole is typically recommended as first-line treatment 2.
Adjunctive Treatments: Surgical intervention may be necessary for localized disease or complications like large cavities 2.
Immunomodulatory Therapy: Corticosteroids may be used in conjunction with antifungals for severe inflammatory responses 2.Special Populations
Comorbidities: Management in patients with chronic pulmonary thromboembolism (CPTE) should consider overlapping cardiac complications, monitoring RV function via E/Ea ratio and BNP levels 1.Key Recommendations
Utilize high-resolution CT imaging for accurate diagnosis of chronic pulmonary aspergillosis 2.
Initiate voriconazole as the primary antifungal therapy for chronic pulmonary aspergillosis 2 (Evidence: Strong).
Monitor cardiac function, particularly RV function, using E/Ea ratio and BNP levels in patients with coexisting chronic pulmonary thromboembolism 1 (Evidence: Moderate).References
1 Shiina Y, Funabashi N, Lee K, Daimon M, Sekine T, Kawakubo M et al.. Doppler imaging predicts cardiac events in chronic pulmonary thromboembolism. International journal of cardiology 2009. link
2 Lough J, Shuster J. Constipated plasma cells associated with monomeric macroglobulinemia. Human pathology 1975. link80178-x)