[Acute invasive pulmonary aspergillosis in chronic lung disease--a review].
BACKGROUND
Apart from malignancies and solid organ transplant, chronic lung disease, in particular chronic obstructive pulmonary disease (COPD), is a third important predisposing factor for acute invasive pulmonary aspergillosis.


BACKGROUND
COPD is present in 2% of patients dying from invasive aspergillosis. This opportunistic infection occurs because of an immunodeficiency linked both to altered local immunity and to systemic factors such as long term steroid treatment and malnutrition. In patients whose sputum and/or endotracheal aspirate specimens contain hyphal forms of filamentous Aspergillus, half will have a clinically significant aspergillus infection. Diagnostic tests include serum galactomannan antigen test, serum antibody titre, thoracic CT scan and bronchoalveolar lavage (BAL). The identification of fungal hyphae in BAL fluid by microscopy and/or on culture is critical for a positive diagnosis. The mortality rate for acute invasive pulmonary aspergillosis in chronic lung diseases reaches almost 100%. Antifungal monotherapy is still recommended as a first line treatment. Combined treatment can be used in refractory aspergillosis as a salvage therapy. The question of maintaining, decreasing or interrupting steroid treatment must be considered.


CONCLUSIONS
Prospective studies are needed to evaluate a standardised diagnostic strategy such as exists for patients with haematological disease. Whether this will improve prognosis remains to be seen.


CONCLUSIONS
Acute invasive pulmonary aspergillosis complicating chronic lung disease is not rare. Improved diagnosis procedures and recent therapeutic advances may have a positive impact on patient prognosis.
Ader
F
F
Service de Réanimation Médicale et Maladies Infectieuses, CH Gustave Dron, Tourcoing, France. florader@yahoo.fr
Nseir
S
S
Guery
B
B
Tillie-Leblond
I
I
D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000209:etiology*; D002423:Cause of Death; D006801:Humans; D016867:Immunocompromised Host; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000209:etiology*; D009894:Opportunistic Infections / Q000209:etiology; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012307:Risk Factors
D000935:Antifungal Agents