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1/177. Fatal invasive aspergillosis in an adolescent with cystic fibrosis.

    We report on a 13-year-old girl with cystic fibrosis (CF) who developed refractory airflow obstruction despite high-dose steroids. She developed invasive aspergillosis and died despite oral and intravenous antifungal therapy. We speculate that the increasing use of immunosuppressive strategies and aggressive antipseudomonal therapy in CF may lead to an increase in aspergillus lung disease, including invasive aspergillosis in the future. ( info)

2/177. Spinal aspergillus abscess in a patient with bronchocentric granulomatosis.

    aspergillus fumigatus hyphae is often found in the lung tissue of patients with bronchocentric granulomatosis (BCG). This organism is believed to be one agent responsible for inciting the hypersensitivity response and subsequent development of the characteristic pathology that defines BCG. The definitive etiology of this disease, however, remains conjectural. Corticosteroids represent the mainstay of therapy. The fungi recovered from patients with BCG are considered noninvasive; thus, the risk of fungal invasion secondary to steroid-induced immunosuppression is believed to be negligible. However, we report a case of spinal aspergillus abscess that developed in a patient with BCG subsequent to steroid therapy. This case also highlights the necessity for aggressive medical and neurosurgical intervention to avert the development of neurological sequelae. ( info)

3/177. Allergic bronchopulmonary aspergillosis caused by aspergillus ochraceus.

    A case with the characteristics of allergic bronchopulmonary aspergillosis is described. The species of Aspergillus involved, A. ochraceus, has not previously been found in this disorder. The organism had antigenic properties distinct from five other species of Aspergillus most commonly associated with allergic bronchopulmonary aspergillosis. The patient had immediate skin test, immunodiffusion, and radioallergosorbent reactivity to the species. Four per cent of 112 serum samples from others suspected of having allergic bronchopulmonary aspergillosis had precipitins to A. ochraceus only. It may be necessary in some cases to prepare and test extracts of the patient's Aspergillus isolate in order to confirm the diagnosis. ( info)

4/177. Hilar adenopathy in allergic bronchopulmonary aspergillosis.

    BACKGROUND: A 20-year-old male student developed allergic bronchopulmonary aspergillosis (ABPA). Computed tomography (CT) of the thorax done to detect central bronchiectasis (CB) for confirmation of diagnosis revealed, in addition, right hilar lymphadenopathy. Hilar adenopathy is thought to be rare in ABPA and has been documented only once before. Because of the finding of hilar adenopathy, the earlier reported patient had to undergo an invasive surgical procedure. OBJECTIVE: To report a case of true hilar adenopathy in ABPA. methods: This is a single case report. Contrast enhanced CT of the thorax was done. serum precipitating antibodies against aspergillus fumigatus were tested using gel diffusion technique, and intradermal testing with antigens of Aspergillus species was performed. Specific IgG antibodies against A. fumigatus and total IgE levels were measured by ELISA. RESULTS: A review of serial chest radiographs over a period of 3 years demonstrated transient pulmonary infiltrates and right hilar prominence. Computed tomography of the thorax revealed right hilar lymphadenopathy along with bilateral central bronchiectasis and patchy infiltrates. Strong bands of precipitins were detected against A. fumigatus. Intradermal testing with antigens of Aspergillus species elicited strong type I (immediate) and type III (Arthus-type) hypersensitivity reactions to A. fumigatus and A. niger. Specific IgG antibodies against A. fumigatus was positive and total IgE level was significantly elevated. Peripheral blood eosinophilia was also detected. CONCLUSIONS: Although extremely rare, ABPA should be considered in the differential diagnosis of hilar adenopathy. ( info)

5/177. Allergic bronchopulmonary aspergillosis due to aspergillus niger without bronchial asthma.

    A 65-year-old woman was admitted to our hospital with a dry cough and pulmonary infiltrates. Chest radiograph and CT revealed mucoid impaction and consolidations. Peripheral blood eosinophilia and elevated serum IgE were observed. aspergillus niger was cultured repeatedly from her sputum, but A. fumigatus was not detected. Immediate skin test and specific IgE (RAST) to Aspergillus antigen were positive. Precipitating antibodies were confirmed against A. niger antigen, but not against A. fumigatus antigen. She had no asthmatic symptoms, and showed no bronchial hyperreactivity to methacholine. Thus, this case was diagnosed as allergic bronchopulmonary aspergillosis (ABPA) without bronchial asthma due to A. niger, an organism rarely found in ABPA. The administration of prednisone improved the symptoms and corrected the abnormal laboratory findings. ( info)

6/177. ARDS after double extrinsic exposure hypersensitivity pneumonitis.

    hypersensitivity pneumonitis or extrinsic allergic alveolitis is a lung disease due to T cell and macrophage activation with IgA, IgG or IgE immunocomplex tissue lesions following extrinsic exposure to organic or inorganic agents. We report a case of hypersensitivity pneumonitis (pigeon protein sensitized) with a second nosocomial exposure to aspergillus fumigatus proteins from a contaminated oxygen water humidifier: the second extrinsic exposure induced significant acute respiratory failure with ARDS. A pre-existing COPD syndrome requiring prolonged oxygen therapy (7 days) involved lung disease with delayed clinical diagnosis and therapy. Microbiological and mycological analysis of oxygen water humidifiers should be considered, especially for hypersensitivity pneumonitis patients, when a new inexplicable clinical impairment occurs. ( info)

7/177. Bronchocentric granulomatosis as a first clinical manifestation in an adult patient with p67phox deficiency.

    We report on a case of adult chronic granulomatous disease which first manifested as a pulmonary mass, and was histologically diagnosed as bronchocentric granulomatosis associated with aspergillosis in a patient with a deficiency of p67phox and a low oxidative response. Antifungal treatment was required for clinical resolution. copyright copyright 1999 S. Karger AG, Basel ( info)

8/177. Severe allergic bronchopulmonary aspergillosis in an infant with cystic fibrosis and her asthmatic father.

    An infant with cystic fibrosis and her asthmatic father were diagnosed as suffering from allergic bronchopulmonary aspergillosis (ABPA). cystic fibrosis was diagnosed in the infant at 6 weeks of age, and gene mutations were W1282X/G542X. She was diagnosed definitively as suffering from ABPA at age 3.5 years, but had suggestive symptoms from age 11 months. This may be the youngest age described to date for ABPA. The child responded well to systemic steroid therapy, but remained steroid-dependent over the next 4 years. Treatment with itraconazole enabled a marked reduction in steroid dosage. The father was an asthmatic, and a heterozygote for the cystic fibrosis transmembrane regulator (CFTR) mutation W1282X. He had a normal sweat test, atopy, and moderate reversible airway obstruction. There was no proven exposure to Aspergillus in the home environment. The importance of considering the diagnosis of ABPA even in infancy, the therapeutic dilemmas, and the possible role of abnormal CFTR function in the development of ABPA are discussed. ( info)

9/177. Two year follow-up of a garbage collector with allergic bronchopulmonary aspergillosis (ABPA).

    BACKGROUND: Separate collection of biodegradable garbage and recyclable waste is expected to become mandatory in some western countries. A growing number of persons engaged in garbage collection and separation might become endangered by high loads of bacteria and fungi. Case history and examination A 29 year old garbage collector involved in emptying so-called biological garbage complained of dyspnea, fever, and flu-like symptoms during work beginning in the summer of 1992. Chest x-ray showed streaky shadows near both hili reaching into the upper regions. IgE- and IgG-antibodies (CAP, Pharmacia, sweden) were strongly positive for aspergillus fumigatus with 90.5 kU/L and 186%, respectively. Total-IgE was also strongly elevated with 5430 kU/L. Bronchial challenge testing with commercially available aspergillus fumigatus extract resulted in an immediate-type asthmatic reaction. Two years later he was still symptomatic and antibodies persisted at lower levels. CONCLUSIONS: Our diagnosis was allergic bronchopulmonary aspergillosis (ABPA) including asthmatic responses as well as hypersensitivity pneumonitis (extrinsic allergic alveolitis) due to exposure to moldy household waste. A growing number of persons engaged in garbage collection and handling are exposed and at risk to develop sensitization to fungi due to exposure to dust of biodegradable waste. Further studies are necessary to show if separate collection of biodegradable waste increases the health risks due to exposure to bacteria and fungi in comparison to waste collection without separation. ( info)

10/177. Allergic bronchopulmonary aspergillosis in two patients with cystic fibrosis.

    Allergic bronchopulmonary aspergillosis (ABPA) is hypersensitivity to aspergillus fumigatus which manifests as episodic wheezing, usually refractory to bronchodilator therapy, with fixed and transient pulmonary infiltrates, central bronchiectasis, blood eosinophilia, elevated serum IgE level, immediate skin reactivity to an A. fumigatus antigen and precipitating antibodies to A. fumigatus. It is an unusual complication of asthma and cystic fibrosis (CF). We present two cystic fibrosis patients with ABPA treated successfully with prednisone and, in Case 1 also with itraconazole. The physician should be alert to the possibility of ABPA whenever CF patients present with the new infiltrates, high serum total IgE and other positive parameters of A. fumigatus sensitization. Treatment with systemic steroids should be started in order to prevent irreversible lung damage. ( info)
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