Challenges, Characteristics, and Outcomes of Chronic Pulmonary Aspergillosis: A 11-Year Experience in A Middle-Income Country.

OBJECTIVES: Chronic pulmonary aspergillosis (CPA) is a research priority in fungal diseases with a need for new studies to reduce misdiagnosis with more common diseases, discuss improvement in diagnostic methods and better characterize gaps in antifungal and surgical treatments to improve clinical outcomes. METHODS: In this retrospective study, we reviewed medical records of patients diagnosed with CPA from January 2010 to June 2021 at University of São Paulo, São Paulo, Brazil. We evaluated clinical characteristics, radiological findings, serology, treatment, and outcomes. RESULTS: The study included 91 participants, with 43 (47.3%) patients who underwent surgery and 69 (75.8%) received antifungal therapy. We found a predominance of middle-aged adults (median 51 years), males (n = 58, 64%) with lower BMI (median 21.3 kg/m2). The most common underlying lung disease was pulmonary tuberculosis (n = 70, 76.9%). The commonest symptoms were cough (n = 67, 74%), haemoptysis, and dyspnea (n = 63, 70%). The most common chest computerized tomography abnormalities were cavity (n = 86, 94.5%), with a predominance of mycetomas (n = 78, 91%). The serology was positive in 81% (61/75). The one-year mortality was low (3.3%). Clinical improvement and stability occurred in 89% of participants for constitucional symptoms and 86% for pulmonary symptoms. While serological improvement and stability occurred in 71%. Radiological improvement and stability occurred in 75%. CONCLUSION: We observed a good outcome after 1-year follow-up, in which the majority had improvement or stability of pulmonary and constitutional symptoms, decrease in CIE titers and low mortality.

Prevalencia del síndrome del edificio enfermo en trabajadores de la industria manufacturera / Prevalence of sick building syndrome in manufacturing industry workers

El síndrome del edificio enfermo, se refiere a un conjunto de síntomas generales en mucosa (ocular y/o respiratoria) y piel que presentan los ocupantes de edificaciones con calidad ambiental deficientes, exponiendo a sus ocupantes a factores de riesgos físicos, mecánicos, químicos, biológicos y psicosociales, que puede afectar negativamente la salud y productividad de las personas. Con el propósito de determinar la frecuencia de los síntomas de los ocupantes de una industria manufacturera del Perú, se realizó estudio transversal aplicándose a 237 trabajadores, estratificados por áreas laborales, el cuestionario sugerido por el Instituto Nacional de Higiene y Seguridad en el Trabajo, además de evaluar la condición ambiental mediante la determinación de bioaerosoles cultivables y contables. Los resultados mostraron prevalencia superior al 20% en síntomas como: sequedad en ojos y garganta, picor en garganta congestión nasal, dolor de cabeza y debilidad general. Se tomaron, cuantificaron y caracterizaron 164 muestras de bioaerosoles, los microrganismos encontrados con mayor porcentaje fueron, Aspergillus sp. 54,68% (68) en el área administrativa, mientras que en las áreas de producción y almacén predomino Penicillium sp. con 87,10% (108) y 62,21% (77) respectivamente. Otros géneros encontrados en mayor porcentajes, en las tres áreas fueron: Trichoderma, Acremonium, Monilia, Cladosporium, entre otros. Los hallazgos se correlacionan con lo reportado en diversas investigaciones, la presencia de mencionados hongos, sugiere que existe una inadecuada calidad ambiental y aunada a la prevalencia obtenida en cuanto a sintomatología, se puede clasificar la edificación objeto de estudio con el Síndrome del edificio enfermo(AU)

Sick building syndrome refers to a set of general mucosal (ocular and/or respiratory) and skin symptoms presented by occupants of buildings with poor environmental quality, exposing their occupants to physical, mechanical, chemical, biological and psychosocial, which can negatively affect the health and productivity of people. In order to determine the frequency of the symptoms of the occupants of a manufacturing industry in Peru, a cross-sectional study was carried out, applying to 237 workers, stratified by work areas, the questionnaire suggested by the National Institute of Hygiene and Safety at Work, in addition to to evaluate the environmental condition by determining cultivable and countable bioaerosols. The results showed a prevalence greater than 20% in symptoms such as: dry eyes and throat, itchy throat, nasal congestion, headache and general weakness. 164 samples of bioaerosols were taken, quantified and characterized, the microorganisms found with the highest percentage were Aspergillus sp. 54.68% (68) in the administrative area, while in the production and storage areas, Penicillium sp. with 87.10% (108) and 62.21% (77) respectively. Other genera found in higher percentages in the three areas were: Trichoderma, Acremonium, Monilia, Cladosporium, among others. The findings correlate with what has been reported in various investigations, the presence of these fungi suggests that there is an inadequate environmental quality and, together with the prevalence obtained in terms of symptoms, the building under study can be classified with the Sick Building Syndrome(AU)

Prevalence of chronic pulmonary aspergillosis regarding time of tuberculosis diagnosis in Brazil.

BACKGROUND: Data on the prevalence of chronic pulmonary aspergillosis (CPA) in patients with active or cured tuberculosis (TB) are scarce, mainly due to diagnostic difficulties. The diagnosis of CPA is based on pulmonary symptoms and chest computed tomography (CT) scans and is considered confirmed when there is microbiological or serological evidence of Aspergillus spp. OBJECTIVES: To estimate the prevalence of CPA in patients treated or undergoing treatment for PTB, seen in two referral hospitals in Mato Grosso do Sul, Brazil. PATIENTS AND METHODS: A total of 193 consecutive patients who were treated or previously treated for pulmonary tuberculosis underwent prospective evaluation: (a) clinical evaluation; (b) chest CT scan; (c) sputum examination-culture for fungi and smears for direct mycology; (d) detection of anti-Aspergillus fumigatus antibodies using an enzyme-linked immunosorbent assay Platelia® test; and (e) anti-Aspergillus spp. antibodies were assessed via a DID test. RESULTS: The global prevalence of CPA was 10.9% (95% confidence interval, 7.2%-16.1%), but it increased with the time of TB diagnosis. The variables independently associated with CPA were previous pulmonary tuberculosis over 4 years ago and haemoptysis. Cavities, pleural thickening and the presence of a fungal ball were the most frequent tomographic findings in patients with CPA. CONCLUSIONS: The high prevalence observed and its increase over time suggest the need for continuous surveillance of CPA in patients with active or previous pulmonary tuberculosis and throughout life, with clinical, tomographic and serological evaluations (ELISA) for a timely diagnosis and a better prognosis.

Pulmonary aspergilloma in immunocompromised patients in a Respiratory Care Unit.

INTRODUCTION: Pulmonary aspergilloma is commonly associated with comorbidities that cause immunodeficiency such as diabetes mellitus, tuberculosis, human immunodeficiency virus/acquired immunodeficiency syndrome and/or a pre-existing parenchymal lung disease such as chronic obstructive pulmonary disease. Predisposing factors can further increase the risk of acquiring this mycosis. Our objective was to determine the frequency, clinical and microbiological characteristics of pulmonary aspergilloma in immunocompromised patients. METHODOLOGY: Retrospective case series of patients diagnosed with pulmonary aspergilloma in a respiratory care unit in Mexico City from 2000 to 2019 was studied. Bronchoalveolar lavage cultures on Sabouraud-dextrose agar and serum galactomannan determination were performed on each patient. RESULTS: We identified twenty-four patients with pulmonary aspergilloma (sixteen male and eight female), thirteen had a history of tuberculosis (54%), seven of diabetes mellitus (29%), three of human immunodeficiency virus/acquired immunodeficiency syndrome (13%) and one of chronic obstructive pulmonary disease (4%). The most commonly reported symptoms were hemoptysis in eighteen patients (75%), dyspnea in sixteen patients (67%) and chest pain in thirteen patients (54%). Aspergillus fumigatus was identified in all cultures and galactomannan was positive in 21 serum samples (87%). CONCLUSIONS: Coexistence of diseases that could suppress the immune system predispose to pulmonary aspergilloma; clinical presentation is often confused with other systemic diseases. A high degree of clinical suspicion is important for early detection.

COVID-19-Associated Pulmonary Aspergillosis in a Series of Complete Autopsies from the Brazilian Amazon.

Between April and July 2020, and, therefore, prior to the broad recommendation of corticosteroids for severe COVID-19, a total of 50 full autopsies were performed in Manaus. We confirmed two invasive cases of aspergillosis through histopathology and gene sequencing (4%) in our autopsy series. The confirmed invasive aspergillosis incidence seems much lower than expected based on the "probable and possible" definitions, and an individualized approach should be considered for each country scenario. Interestingly, a prolonged length of stay in the intensive care unit was not observed in any of the cases. Timely diagnosis and treatment of fungal infection can reduce mortality rates.

Aspergillosis pulmonar / Pulmonary aspergillosis

RESUMEN Se presenta a una paciente de 50 años de edad, atendida durante 2 años por Consulta de Neumología, en la ciudad de Matanzas. Presentaba bronquitis crónica con tratamiento para la misma, hace 3 meses ingresa por Servicio de Medicina Interna por una neumonía de lenta resolución, asociada un síndrome general. Durante el ingreso se manejan varias posibilidades diagnósticas como: posible tuberculosis pulmonar, neoplasia de pulmón o neumonía a gérmenes atípicos. Se confirmó diagnóstico de aspergilosis pulmonar mediante lavado bronquial por broncoscopio. Se aplicó tratamiento con antifúngicos sistémicos y se logró mejoría clínica y radiológica. En esta paciente no existían evidencias de inmunosupresión (AU).

ABSTRACT We present a female patient aged 50 years, attended for two years in the Pulmonology consultation, in the city of Matanzas. She suffered chronic bronchitis with treatment; three months ago she was admitted in the Internal Medicine Service due to a low resolution pneumonia associated to a general syndrome. During her staying in the hospital several diagnostic possibilities were managed: possible pulmonary tuberculosis, lung neoplasia or pneumonia to atypical germs. The diagnosis of pulmonary aspergillosis was confirmed through bronchial lavage `per bronchoscope. no existían evidencias de inmunosupresión. The pronosis is Lung Aspergilosis due to a bronchial washing for bronchoscopy and the treatment begins with systemic antifúngicos, achieving clinical and radiological improvement. There is no evidence of inmunosupression in the patient (AU).

Burden of serious fungal infections in Mexico.

Serious fungal infections (SFIs) could be more frequent than are recognised. Estimates of the incidence and prevalence of SFIs are essential in order to identify public health problems. We estimated the rates of SFIs in Mexico, following a methodology similar to that used in prior studies. We obtained information about the general population and populations at risk. A systematic literature search was undertaken to identify epidemiological reports of SFIs in Mexico. When Mexican reports were unavailable, we based our estimates on international literature. The most prevalent SFIs in Mexico are recurrent vulvovaginal candidiasis (5999 per 100,000) followed by allergic bronchopulmonary aspergillosis (60 per 100,000), chronic pulmonary aspergillosis (15.9 per 100,000), fungal keratitis (10.4 per 100,000), invasive candidiasis (8.6 per 100,000) and SFIs in HIV (8.2 per 100,000); coccidioidomycosis (7.6 per 100,000), IA (4.56 per 100,000). These correspond to 2,749,159 people affected in any year (2.45% of the population), probably >10,000 deaths and 7000 blind eyes. SFIs affect immunocompromised and healthy populations. Most are associated with high morbidity and mortality rates. Validation of these estimates with epidemiological studies is required. The burdens indicate that an urgent need to improve medical skills, surveillance, diagnosis, and management of SFIs exists.

[Genotyping of clinical isolates of Aspergillus flavus and its relationship with environmental isolates of an oncohematological center]. / Genotipificación de aislamientos clínicos de Aspergillus flavus y su relación con aislamientos ambientales de un centro oncohematológico.

BACKGROUND: During 4 months, and while conducting an environmental sampling of air, 2 cases of aspergillosis by Aspergillus flavus (A. flavus) were diagnosed at an oncohematological center in Buenos Aires, Argentina. AIMS: The aim of this study was to know the variability and the genetic relationship between the clinical and environmental isolates, obtained in the oncohematological center. METHODS: Two genotyping techniques of different discriminatory power (RAPD and AFLP) were used. A genetic similarity matrix was calculated using Jaccard method and was the basis for the construction of a dendrogram by UPGMA. The level of genetic variability was assessed by measuring the percentage of polymorphic loci, number of effective allele, expected heterocygozity and association index test (I(A)). RESULTS: The dendrogram reveals that the A. flavus isolates recovered from the patients were not genetically related to those gotten from the rooms occupied by the patients. The environmental isolates had higher values of genetic diversity than the clinical isolates. The I(A) estimated for all the isolates suggest that recombination events occurred. CONCLUSIONS: Patients 1 and 2 were not infected with isolates from the nosocomial environment. Clinical and environmental isolates of A. flavus showed high genetic variability among them.

[Frequency of pulmonary mycoses determined by analyzing lung secretion samples]. / Micosis pulmonares en pacientes de la Quinta Región: Período 2007-2010.

BACKGROUND: The frequency of pulmonary mycoses has increased in the past few years specially in immunocompromised patients. AIM: To determine the frequency of invasive fungal diseases by analyzing lung secretion samples. MATERIAL AND METHODS: Samples of bronchoalveolar lavage (BAL) tracheal aspiration (TA) and induced sputum (IS) were obtained from patients of five hospitals in the Valparaíso Region for the diagnosis of invasive or non-invasive fungal disease, and pneumocystis (PCP), in the period 2007-2010. Clinical data of patients was obtained reviewing medical records or interviewing attending physicians. The diagnosis considered the clinical condition of the patient (immunocompromised or prior lung damage), computed tomography imaging, direct microscopy and cultures. European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria was used for the diagnosis of invasive fungal diseases. RESULTS: Ninety respiratory samples were received and 39 fungal infections were diagnosed. Eleven were probably invasive, seven were non-invasive and 21 were PCP. All patients with probable invasive disease had neutropenia. Most patients with non-invasive infections had bronchiectasis. Aspergillus fumigatus was the main causing agent in both invasive and non-invasive fungal diseases. Patients with PCP were mostly adults with AIDS and children with leukemia. The total mortality rate of patients with invasive fungal disease was of 73%. No deaths were recorded among patients with non-invasive disease. Among patients with PCP, three of 11 HIV and six of 10 non HIV subjects died. CONCLUSIONS: Aspergillus fumigatus predominates both in invasive and non-invasive pulmonary mycoses. The former has a high mortality. PCP occurred mainly in adult patients with HIV-AIDS.

Micosis pulmonares en pacientes de la Quinta Región: Período 2007-2010 / Frequency of pulmonary mycoses determined by analyzing lung secretion samples

Background: The frequency of pulmonary mycoses has increased in the past few years specially in immunocompromised patients. Aim: To determine the frequency of invasive fungal diseases by analyzing lung secretion samples. Material and Methods: Samples of bronchoalveolar lavage (BAL) tracheal aspiration (TA) and induced sputum (IS) were obtained from patients of five hospitals in the Valparaíso Region for the diagnosis of invasive or non-invasive fungal disease, and pneumocystis (PCP), in the period 2007-2010. Clinical data of patients was obtained reviewing medical records or interviewing attending physicians. The diagnosis considered the clinical condition of the patient (immunocompromised or prior lung damage), computed tomography imaging, direct microscopy and cultures. European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria was used for the diagnosis of invasive fungal diseases. Results: Ninety respiratory samples were received and 39 fungal infections were diagnosed. Eleven were probably invasive, seven were non-invasive and 21 were PCP. All patients with probable invasive disease had neutropenia. Most patients with non-invasive infections had bronchiectasis. Aspergillus fumigatus was the main causing agent in both invasive and non-invasive fungal diseases. Patients with PCP were mostly adults with AIDS and children with leukemia. The total mortality rate of patients with invasive fungal disease was of 73%. No deaths were recorded among patients with non-invasive disease. Among patients with PCP, three of 11 HIV and six of 10 non HIV subjects died. Conclusions: Aspergillus fumigatus predominates both in invasive and non-invasive pulmonary mycoses. The former has a high mortality. PCP occurred mainly in adult patients with HIV-AIDS.

Aspergilose Pulmonar

Os autores apresentam,neste trabalho de revisão bibliográfica sobre aspergilose pulmonar,os principais aspectos da doença,de valor no diagnóstico,prognóstico e tratamento,chamando a atenção para estudos mais recentes dos componentes imunológicos