Document Detail


Clinical characteristics and treatment outcomes of chronic necrotizing pulmonary aspergillosis: a review of 43 cases.
MedLine Citation:
PMID:  19910234     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Chronic necrotizing pulmonary aspergillosis (CNPA) is uncommon, and the optimal therapeutic regimen has not been established. In a retrospective cohort study, we investigated the clinical characteristics and treatment outcomes of patients with CNPA. METHODS: We reviewed the medical records of all patients who had been diagnosed with CNPA at our institution over the last 10 years. RESULTS: Forty-three patients were identified. Their median age was 60 years (interquartile range (IQR) 45-65 years), and 34 (79%) of the patients were men. The most common underlying lung disease was pulmonary tuberculosis (n=40, 93%). After CNPA was diagnosed, all patients were treated with antifungal drugs, including oral itraconazole (n=39, 91%) or intravenous amphotericin B (n=4, 9%). Seventeen (40%) patients discontinued therapy early (<3 months), 14 patients due to death and three to loss of follow-up. Twenty-six (60%) patients received oral itraconazole at a daily dose of 200-400mg for more than 3 months. The median treatment duration was 6 months (IQR 6-12 months). In these 26 patients, clinical improvement was observed in 15 (58%) and radiological improvement was observed in 11 (42%). Ten (38%) patients showed no improvement. Twenty-two (51%) patients died, including 18 (42%) CNPA-related deaths, during a median follow-up of 15 months (IQR 2.5-32 months). The median survival time was 62 months. CONCLUSIONS: CNPA is difficult to treat and often has a poor outcome. Further studies with more patients are needed to identify the optimal therapy for patients with CNPA.
Authors:
Hae-Seong Nam; Kyeongman Jeon; Sang-Won Um; Gee Young Suh; Man Pyo Chung; Hojoong Kim; O Jung Kwon; Won-Jung Koh
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-11-11
Journal Detail:
Title:  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases     Volume:  14     ISSN:  1878-3511     ISO Abbreviation:  Int. J. Infect. Dis.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-20     Completed Date:  2010-09-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9610933     Medline TA:  Int J Infect Dis     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  e479-82     Citation Subset:  IM    
Copyright Information:
Copyright 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Affiliation:
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Adult
Aged
Amphotericin B / administration & dosage,  therapeutic use*
Antifungal Agents / administration & dosage,  therapeutic use*
Cohort Studies
Drug Administration Schedule
Female
Humans
Injections, Intravenous
Invasive Pulmonary Aspergillosis / drug therapy*
Itraconazole / administration & dosage,  therapeutic use*
Male
Medical Records
Middle Aged
Republic of Korea
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antifungal Agents; 1397-89-3/Amphotericin B; 84625-61-6/Itraconazole

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