[Antimycotic treatment of pulmonary aspergilloma in patients without neutropenia].
OBJECTIVE
Pulmonary aspergillomas are associated with a high morbidity and mortality. There are only very few data about non-surgical treatment in immunocompetent patients.


METHODS
We evaluated 30 patients (19 male/11 female; mean age: 54 years) with pulmonary aspergillosis, their symptoms, treatment and outcome during a time period of 9 years. All patients had either definitive (18/60 %) or probable (12/40 %) aspergillosis with a cultural confirmation.


RESULTS
Underlying diseases were tuberculosis (16/53 %), malignancy (8/30 %), COPD (15/50 %), pneumonia (3/10 %). Only five patients were immunocompromised (steroid medication: n = 4, chronic lymphatic leukemia: n = 1) All patients had a contraindication against surgery, 26 received antifungal treatment (mostly with voriconazole or itraconazole). The overall response was 61 %, there was an improvement of radiological signs in seven (23 %). Especially hemoptysis and dyspnea resolved. 12 patients died during the 9 years (40 %), nine from their underlying disease, three from the pulmonary aspergilloses (hemoptysis: n = 2, secondary invasive aspergillosis: n = 1).


CONCLUSIONS
Pulmonary aspergilloma in its chronic form is a disease of patients with pulmonary disease but who are immunocompetent. Antifungal treatment seems to be a therapeutic option, if surgery is not possible.
Grysczyk
H
H
Abteilung für Pneumologie und Infektiologie, Lungenklinik Heckeshorn, Zentralklinik Emil von Behrin, Germany. haloheck@zedat.fu-berlin.de
De Roux
A
A
Grassot
A
A
Mauch
H
H
Lode
H
H
D000935:Antifungal Agents / Q000627:therapeutic use*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009503:Neutropenia; D011743:Pyrimidines / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; D065819:Voriconazole