Abstract
Aspergillus, küf türlerinden oluşan ve çevrede yaygın olarak bulunan bir mantar türüdür. Akciğer hastalıkları spektrumuna invaziv aspergilloz (İA), kronik pulmoner aspergilloz (KPA) ve alerjik bronkopulmoner aspergilloz (ABPA) gibi hastalıklar dahildir.
Nefes darlığı, genel halsizlik ve rahatsızlık yakınmaları ile başvuran 65 yaşındaki bir hastada Aspergillus fumigatus'un neden olduğu invaziv aspergilloz vakasını sunuyoruz. Mikrobiyolojik ve radyolojik araştırmalara dayanarak “olası” aspergilloz tanısı konuldu. Mikrobiyolojik incelemede A.fumigatus kültürel ve morfolojik özelliklerine göre tanımlandı. Tıbbi tedaviye rağmen hastanın durumu daha da kötüleşti. Hasta mekanik ventilasyon cihazını reddetti.
Muhtemelen, kronik obstrüktif akciğer hastalığında (KOAH) geç tanı ve uygun tedavinin olmaması İA gelişimine ve letal sonluğa neden olmuştur. KPA, akciğerlerde kavite oluşumu ile sonuçlanan tüberküloz veya diğer hastalıklara maruz kalan immünokompetan hastalarda gelişir. Bu olgu, hastalara yeterli tedaviyi sağlamak için aspergilloz tanısının güvenilir ve zamanında konulmasının önemini göstermektedir.
Histopatolojik inceleme için biyopsi alınmasının zorluğu ve radyolojik bulguların bulunmaması göz önünde bulundurularak, doktorlar yeterli tedaviyi uygulamak ve ölümcül sonuçların sayısını azaltmak için kronik hastalığı olan hastalarda aspergilloz olasılığına daha fazla dikkat etmelidir.
Keywords
References
- Betancourt, B. Y., Garofoli, A. C., Sandhu, J. S., Boma, N., and Sy, A. M. (2015). Pulmonary aspergillosis presenting with recurrent haemoptysis. BMJ Case Rep, 2015. doi:10.1136/bcr-2015-211249
- De Pauw, B., Walsh, T. J., Donnelly, J. P., Stevens, D. A., Edwards, J. E., Calandra, T., Pappas, P. G., Maertens, J., Lortholary, O., Kauffman, C. A., Denning, D. W., Patterson, T. F., Maschmeyer, G., Bille, J., Dismukes, W. E., Herbrecht, R., Hope, W. W., Kibbler, C. C, Jan Kullberg, B., Marr, K. A., Muñoz, P., Odds, F. C., Perfect, J. R., Restrepo, A., Ruhnke, M., Segal, B. H., Sobel, J. D., Sorrell, T. C., Viscoli, C., Wingard, J. R., Zaoutis, T. and Bennett, J. E. (2008). Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis, 46(12), 1813-1821. doi:10.1086/588660
- Denning, D. W., Pleuvry, A., and Cole, D. C. (2011). Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ, 89(12), 864-872. doi:10.2471/blt.11.089441
- Kosmidis, C., and Denning, D. W. (2015). The clinical spectrum of pulmonary aspergillosis. Thorax, 70(3), 270-277. doi:10.1136/thoraxjnl-2014-206291
- Maghrabi, F., and Denning, D. W. (2017). The Management of Chronic Pulmonary Aspergillosis: The UK National Aspergillosis Centre Approach. Curr Fungal Infect Rep, 11(4), 242-251. doi:10.1007/s12281-017-0304-7
- Naaraayan, A., Kavian, R., Lederman, J., Basak, P., and Jesmajian, S. (2015). Invasive pulmonary aspergillosis - case report and review of literature. J Community Hosp Intern Med Perspect, 5(1), 26322. doi:10.3402/jchimp.v5.26322
- Steinbach, W. J., Marr, K. A., Anaissie, E. J., Azie, N., Quan, S. P., Meier-Kriesche, H. U., Apewokin, S., and Horn, D. L. (2012). Clinical epidemiology of 960 patients with invasive aspergillosis from the PATH Alliance registry. J Infect, 65(5), 453-464. doi:10.1016/j.jinf.2012.08.003
- Thompson, G. R., 3rd, and Patterson, T. F. (2011). Pulmonary aspergillosis: recent advances. Semin Respir Crit Care Med, 32(6), 673-681. doi:10.1055/s-0031-1295715
- Walsh, T. J., Anaissie, E. J., Denning, D. W., Herbrecht, R., Kontoyiannis, D. P., Marr, K. A., Morrison V. A., Segal B. H., Steinbach W. J., Stevens D. A., van Burik J. A., Wingard J. R. and Patterson, T. F. (2008). Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis, 46(3), 327-360. doi:10.1086/525258
Abstract
Aspergillus – a genus consisting of mold species widely distributed in the environment. The spectrum of pulmonary diseases includes invasive aspergillosis (IA), chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA).
We report a case of invasive aspergillosis caused by Aspergillus fumigatus in a 65-year-old patient admitted with complaints of shortness of breath, general weakness, and malaise. Diagnosis of “probable” aspergillosis was established based on microbiological and radiological investigations. During microbiological analysis A.fumigatus was isolated an identified based on cultural and morphological characteristics. Despite the medical treatment, the patient’s complaints worsened. He refused artificial lung ventilation apparatus.
Probably, chronic obstructive pulmonary disease (COPD) together with late diagnosis and absence of appropriate treatment resulted in the development of IA and lethal outcome. CPA develops in immunocompetent patients, suffering from tuberculosis or other diseases accompanied by the formation of cavities in lungs. This case demonstrates the importance of reliable and timely diagnosis of aspergillosis in order to provide patients with adequate treatment.
Taking into account difficulty of obtaining of punctate for histopathological examination and absence of radiological signs physicians should give more attention to the probability of aspergillosis in patients with chronic disease in order to apply adequate therapy and reduce the number of lethal outcomes.
References
- Betancourt, B. Y., Garofoli, A. C., Sandhu, J. S., Boma, N., and Sy, A. M. (2015). Pulmonary aspergillosis presenting with recurrent haemoptysis. BMJ Case Rep, 2015. doi:10.1136/bcr-2015-211249
- De Pauw, B., Walsh, T. J., Donnelly, J. P., Stevens, D. A., Edwards, J. E., Calandra, T., Pappas, P. G., Maertens, J., Lortholary, O., Kauffman, C. A., Denning, D. W., Patterson, T. F., Maschmeyer, G., Bille, J., Dismukes, W. E., Herbrecht, R., Hope, W. W., Kibbler, C. C, Jan Kullberg, B., Marr, K. A., Muñoz, P., Odds, F. C., Perfect, J. R., Restrepo, A., Ruhnke, M., Segal, B. H., Sobel, J. D., Sorrell, T. C., Viscoli, C., Wingard, J. R., Zaoutis, T. and Bennett, J. E. (2008). Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis, 46(12), 1813-1821. doi:10.1086/588660
- Denning, D. W., Pleuvry, A., and Cole, D. C. (2011). Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ, 89(12), 864-872. doi:10.2471/blt.11.089441
- Kosmidis, C., and Denning, D. W. (2015). The clinical spectrum of pulmonary aspergillosis. Thorax, 70(3), 270-277. doi:10.1136/thoraxjnl-2014-206291
- Maghrabi, F., and Denning, D. W. (2017). The Management of Chronic Pulmonary Aspergillosis: The UK National Aspergillosis Centre Approach. Curr Fungal Infect Rep, 11(4), 242-251. doi:10.1007/s12281-017-0304-7
- Naaraayan, A., Kavian, R., Lederman, J., Basak, P., and Jesmajian, S. (2015). Invasive pulmonary aspergillosis - case report and review of literature. J Community Hosp Intern Med Perspect, 5(1), 26322. doi:10.3402/jchimp.v5.26322
- Steinbach, W. J., Marr, K. A., Anaissie, E. J., Azie, N., Quan, S. P., Meier-Kriesche, H. U., Apewokin, S., and Horn, D. L. (2012). Clinical epidemiology of 960 patients with invasive aspergillosis from the PATH Alliance registry. J Infect, 65(5), 453-464. doi:10.1016/j.jinf.2012.08.003
- Thompson, G. R., 3rd, and Patterson, T. F. (2011). Pulmonary aspergillosis: recent advances. Semin Respir Crit Care Med, 32(6), 673-681. doi:10.1055/s-0031-1295715
- Walsh, T. J., Anaissie, E. J., Denning, D. W., Herbrecht, R., Kontoyiannis, D. P., Marr, K. A., Morrison V. A., Segal B. H., Steinbach W. J., Stevens D. A., van Burik J. A., Wingard J. R. and Patterson, T. F. (2008). Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis, 46(3), 327-360. doi:10.1086/525258
Details
| Primary Language | English |
|---|---|
| Journal Section | RESEARCH ARTICLE |
| Authors | |
| Publication Date | October 28, 2020 |
| Published in Issue | Year 2020 Volume: 11 Issue: 2 |
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