title: Recurrence of chronic pulmonary aspergillosis after discontinuation of maintenance treatment by antifungal triazoles.
abstract: OBJECTIVE
  To assess the prevalence and risk factors of recurrence of chronic pulmonary aspergillosis (CPA) after discontinuation of antifungal triazoles.
  
  
  METHODS
  We reviewed the medical records of CPA patients who achieved resolution of clinical and radiographic manifestations and stopped taking antifungal triazoles between June 2006 and June 2012 at Tokyo National Hospital. We evaluated whether there was CPA recurrence within 1 year after treatment cessation and investigated risk factors for relapse. The association of anti-Aspergillus antibody conversion with CPA recurrence was also reviewed.
  
  
  RESULTS
  A total of 39 patients were included in this study and there was CPA recurrence in 14 patients. Compared with the Non-recurrence group, the Recurrence group exhibited 1) younger age (p = 0.017), 2) more than one lung lobe affected by CPA more frequently (p = 0.008), 3) longer duration needed to remit manifestations of chest radiograph (p = 0.031), 4) longer antifungal treatment duration (p = 0.042). The present study did not reveal an association between negative conversion of serum anti-Aspergillus antibody and recurrence risk. Multivariate logistic regression analysis revealed that patients with CPA with affected area of more than one lung lobe had increased risk (odds ratio, 10.20; 95% confidence interval, 1.49-69.77; p = 0.018).
  
  
  CONCLUSIONS
  CPA recurrence can be seen in about one-third of cases after discontinuing azole treatment. We should make decisions about treatment duration and follow up depending on the severity of each case, particularly on the expansion of CPA-affected area.
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan. Electronic address: d.er.leier@hotmail.co.jp.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Koyama
authors.affiliation: Asthma and Allergy Center, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Nobuharu
authors.initials: N
authors.lastname: Ohshima
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Suzuki
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kawashima
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ando
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Sato
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nagai
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan; Asthma and Allergy Center, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Ohta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D055732:Pulmonary Aspergillosis / Q000188:drug therapy* / Q000382:microbiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000382:microbiology*; D014230:Triazoles / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000935:Antifungal Agents; D014230:Triazoles
keywords: Anti-Aspergillus antibody; Chronic pulmonary aspergillosis; Maintenance treatment; Recurrence; Treatment duration; Triazole