[Treatment of non-invasive pulmonary aspergillosis with new anti-fungal drugs].
Pulmonary aspergilloma is characterized radiographically by the presence of a fungal ball. However, this disease proscess begins from a considerably earlier date. X-ray findings can detect the early stages of this disease better than any other inspective methods. From the treatment perspective, it is too late to start anti-fungal drugs after a fungus ball has already appeared. Therefore, image analysis of this disease process is important for early diagnosis. We examined 48 lesions in 41 cases where images were traceable before the recovery of precedent lung diseases. We could divide the development of pulmonary aspergillosis into the following 10 steps, through analysis of all films including CT findings. Step 0: Basic state Step 1: Initial consolidation Step 2: Cavity wall thickening Step 3: Further thickening Step 4: Irregular inner layer Step 5: Desquamation Step 6: Fungus ball formation Step 7: Enlargement downward Step 8: Spreading to other lung field Step 9: Extra pulmonary extension The sequential line could be indicated as the development of pulmonary aspergillosis through plotting the points of each steps and elapsed days from step 0. The longest observation days are about 8200 days. We learned the followings from this analysis. 1. The courses of progression revealed that pulmonary aspergillosis is not worsening linearly, while with ups and downs. 2. General tendencies are divided into two groups as a rapid development group and as a chronic development group. 3. Fungus ball is configured on average one month later after the irregular inner layer appeared. 4. Initial consolidation appears on average at 783 days after the image of the precedent disease improved it most, and fungus ball is configured afterwards at 1588 days. 5. Pulmonary aspergillosis is not a static disease that has dynamic process. 6. Spontaneous limited remissions were observed in 14%, but the usage of anti-fungal drugs (mainly with ITCZ) shortened the interval period to remission significantly. 7. In the same analysis of another 21 cases with MCFG treatment, the interval period to remission was 66.4 days, and 17 cases with VRCZ treatment , that was 58.5 days. Consequently, pulmonary aspergilloma originates from minor changes without fungus ball, and terminates with fatal extensive destructive lesions. This disease is configured with each different sequential stage. The clinical terms of "Pulmonary aspergilloma" or "Semi Invasive Pulmonary Aspergillosis" describes only a limited phase of this chronic and prolonged disease. We consider that the term of "Chronic Necrotizing Pulmonary Aspergillosis" is more suitable expression for this disease entity, if the original definition could be re-defined.
Kurashima
Atsuyuki
A
Division of Clinical Research, National Hospital Organization Tokyo National Hospital, 3-1-1, Takeoka, Kiyose-shi, Tokyo 204-8585, Japan. krsm@tokyo.hosp.go.jp
D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy*; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy*
D000935:Antifungal Agents