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Chronic pulmonary aspergillosis

Authors

  • K. E. Schweer,

    Corresponding author
    1. 1st Department of Internal Medicine, Center for Clinical Studies II in Infectious Diseases, University Hospital Cologne, Cologne, Germany
    • Correspondence: K. Schweer, 1st Department of Internal Medicine, University Hospital Cologne, Studienzentrum Infektiologie 2, Herder Strasse 52-54, Cologne 50931, Germany.

      Tel.: +49 221 478 6494. Fax: +49 221 478 3611.

      E-mail: katharina.schweer@ctuc.de

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  • C. Bangard,

    1. Department of Radiology, University Hospital Cologne, Cologne, Germany
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  • K. Hekmat,

    1. Department of Thoracic Surgery, University Hospital Cologne, Cologne, Germany
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  • O. A. Cornely

    1. 1st Department of Internal Medicine, Center for Clinical Studies II in Infectious Diseases, University Hospital Cologne, Cologne, Germany
    2. Clinical Trials Centre Cologne, University Hospital Cologne, Cologne, Germany
    3. Center for Integrated Oncology CIO KölnBonn, University Hospital Cologne, Cologne, Germany
    4. Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University Hospital Cologne, Cologne, Germany
    5. German Centre for Infection Research (DZIF), University Hospital Cologne, Cologne, Germany
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Summary

Chronic pulmonary aspergillosis (CPA) is a group of consuming diseases usually presenting with prolonged and relapsing cough, dyspnoea and weight loss. Acute symptoms such as haemoptysis and bronchial or pulmonary haemorrhage may occasionally occur. CPA affects patients with underlying pulmonary conditions, for example, chronic obstructive pulmonary disease or mycobacteriosis or common immunosuppressive conditions such as diabetes. Precise epidemiology is unknown, and while prevalence is considered low the chronic and relapsing nature of the disease challenges the treating physician. Diagnostics largely rely on serologic Aspergillus precipitins and findings on thoracic computed tomography. The latter are manifold comprising cavity formation, pleural involvement and sometimes aspergilloma. Other markers for aspergillosis are less helpful, in part due to the non- or semi-invasive nature of these forms of Aspergillus infection. Various antifungals were shown to be effective in CPA treatment. Azoles are the most frequently applied antifungals in the outpatient setting, but are now compromised by findings of Aspergillus resistance. Long-term prognosis is not fully elucidated and may be driven by the underlying morbidities. Prospective registry-type studies may be suitable to systematically broaden our CPA knowledge base. This article gives an overview of the available literature and proposes a clinical working algorithm for CPA management.

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