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[Three autopsy cases of chronic necrotizing pulmonary aspergillosis]. | LitMetric

AI Article Synopsis

  • - Chronic necrotizing pulmonary aspergillosis (CNPA) is a slow-moving lung infection caused by Aspergillus species, first identified in the 1980s, and is diagnosed through a combination of clinical, radiological, and laboratory assessments due to the challenges of obtaining histopathological evidence.
  • - The study reports three autopsy cases of middle-aged men with a history of pulmonary mycobacterial infection, presenting with upper lobe cavitary infiltrates and diagnosed based on Japanese guidelines, but they succumbed to respiratory failure despite receiving antifungal treatment.
  • - Autopsy results revealed cavities filled with the fungus without invading viable lung tissue, indicating that CNPA is associated with considerable health complications and high mortality rates

Article Abstract

Chronic necrotizing pulmonary aspergillosis (CNPA), also called semi-invasive pulmonary aspergillosis, was first described in the early 1980s as a distinct type of pulmonary aspergillosis. CNPA was an indolent, cavitary, infectious process of the lung parenchyma secondary to local invasion by Aspergillus species. Diagnosis is confirmed by pathological evidence of lung tissue invasion by the fungus. Clinical diagnosis by combined clinical, radiological and laboratory findings is needed because histopathological confirmation cannot always be obtained in the clinical setting. CNPA is recognized as a clinical syndrome in Japan, and has been poorly defined histologically. We report three autopsy cases of CNPA evaluated histopathologically. Subjects were middle-aged to older men with a medical history of pulmonary mycobacterial infection who presented with pulmonary or systemic symptoms. Radiologically, progressive upper lobe cavitary infiltrates were seen with mycetomas and infiltration in lower lung fields. Clinically, CNPA was diagnosed based on 2007 Japanese guidelines for the diagnosis and treatment of deep fungal infection. Subjects died of respiratory failure within one month to three years of diagnosis despite antifungal therapy including micafungin, voriconazole, or itraconazole combined with broad spectrum antibiotics. Autopsy findings showed cavities containing the fungus but no fungal invasion of viable lung tissue. The area of progressive infiltration revealed bacterial pneumonia, organizing pneumonia or organizing diffuse alveolar damage without Aspergillus. In conclusion, CNPA is a chronic progressive clinical form of pulmonary aspergillosis with significant morbidity and mortality.

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Source
http://dx.doi.org/10.11150/kansenshogakuzasshi.86.597DOI Listing

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