Progress in the Diagnosis and Treatment of Pulmonary Aspergillosis

Xiaobo      Feng; Zhirong      Yao; Wanqing      Liao

Abstract

Aspergillus is the most common fungal pathogen of the respiratory mycosis. The respiratory diseases caused by Aspergillus are mainly classified into four clinical types, namely allergic bronchopulmonary aspergillosis, invasive aspergillosis, aspergilloma, and chronic pulmonary aspergillosis. Among the four clinical types of pulmonary aspergillosis, invasive aspergillosis is the most dangerous and difficult to treat disease. The diagnosis of invasive aspergillosis is established initially on clinical aspects and confirmed by the finding of pathogen in culture and histopathology. A number of methods can be conducted to obtain tissue samples from patients with invasive aspergillosis, chronic pulmonary aspergillosis or aspergilloma. Besides BAL detection and transbronchial biopsy, a fine-needle biopsy can be performed and guided by CT to diagnose these diseases. Antifungal agents including those with activity against Aspergillus have been developed. Several agents such as voriconazole, amphotericin B lipid complex, caspofungin, micafungin and anidulafungin are promising in the treatment of the pulmonary aspergillosis in the future. Moreover, under certain condition, surgical intervention is needed to combine with antifungal therapy to deal with aspergilloma or chronic pulmonary aspergillosis, and the use of glucocorticoids to control the inflammatory response is also very important in therapy of allergic bronchopulmonary aspergillosis besides antifungal agents.

Keywords: Allergic bronchopulmonary aspergillosis, aspergilloma, chronic pulmonary aspergillosis, invasive aspergillosis.

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