[Respiratory features of Aspergillus infection in eight years of pulmonology practice].

Aim: To evaluate clinical manifestations of Aspergillus infections in our pulmonology practice.

Methods: Between 2002-2009, we assessed retrospectively and prospectively, Aspergillus related diseases in patients admitted in Clinical Hospital of Pneumology from Cluj-Napoca, Romania. Positive diagnosis was based on identification of Aspergillus speciae (A spp) on Sabouraud medium, pathological, or immunological proves.

Results: 83 patients were included. A spp was isolated in 73 patients from: sputum 46, bronchial lavages (BL) 17, both sputum and BL 4, sputum and nasal secretion 1, or from surgical samples 5 cases. In those 10 cases without A spp positive cultures, diagnosis was confirmed by pathologic examination on surgical or bronchoscopical samples in 6 and 2 cases respectively. 76 patients had previous chronic respiratory diseases and 7 had nonrespiratory chronic diseases. We identified the following clinical forms: chronic cavitary aspergillosis 46 cases, aspergillus tracheobronchitis 19 cases, allergic aspergillosis 15 cases, invasive aspergillosis 3 cases. We observed a poor definition on nosological forms, diagnosis like "pulmonary aspergillosis" or "aspergilloma" were the most common. In 12 cases no clinical significance was attributed for detection A spp in bronchial smears. 60 patients supported specific management: antifungal therapy in 38 cases, surgical procedures in 14 cases and both methods in 8 cases, with many differences in treatment and follow-up.

Conclusions: Chronic cavitary aspergillosis was the most frequent clinical form observed in our pulmonology practice. Using the clinical guidelines for fungal respiratory infections we can avoid the wrong diagnosis and then include a correct antifungal treatment in the complex management of our chronic pulmonary patients.