Download PDF
Pneumologie 2010; 64(3): 171-183
DOI: 10.1055/s-0029-1215306
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Bronchiale Aspergillosen[1]

Bronchial AspergillosisI.  Dobbertin1 , G.  Friedel1 , R.  Jaki1 , M.  Michl1 , M.  Kimmich1 , A.  Hofmann1 , H.-P.  Eulenbruch1 , J.  Weber1 , W.  Spengler1 , G.  Ott1 , M.  Kohlhäufl1
  • 1Klinik Schillerhöhe, Zentrum für Pneumologie und Thoraxchirurgie der Robert-Bosch-Krankenhaus GmbH, Stuttgart (Leiter der Abteilung für Pneumologie: PD Dr. M. Kohlhäufl)
Further Information

Publication History

eingereicht 12. 7. 2009

akzeptiert nach Revision 12. 10. 2009

Publication Date:
12 January 2010 (online)

Also available at
   Permissions and Reprints

Zusammenfassung

Bronchopulmonale Aspergillosen nehmen an Häufigkeit zu, sind oft schwierig zu diagnostizieren und können heute mit modernen Antimykotika besser behandelt werden als früher. Sie sind daher von aktuellem Interesse. Dies betrifft auch die bronchialen Aspergillosen, die Thema der vorliegenden Arbeit sind und seltener sind als die pulmonalen. Insgesamt werden 39 Patienten mit bronchialen Aspergillosen vorgestellt: 1.) 4 Fälle mit endobronchialen Aspergillomen, zwei davon bronchoskopisch sichtbar, 2.) ein Fall mit chronischer nekrotisierender pulmonaler Aspergillose (CNPA), bei dem ein Bronchus nekrotisierte, 3.) eine invasive Aspergillose im Bereich einer bronchialen Anastomose, 4.) 7 Fälle mit einer Aspergillusinvasion von endobronchialem Tumorgewebe und 5.) 26 Fälle mit allergischer bronchopulmonaler Aspergillose (ABPA). Schwerpunkt der Arbeit sind bronchoskopische und radiologische Befunde. 37 der 39 Fälle sind Teil einer retrospektiven Single Center-Studie mit insgesamt 116 konsekutiven bronchopulmonalen Aspergillosen, die über 7 Jahre gesammelt wurden.

Abstract

Bronchopulmonary aspergillosis is becoming more frequent, is often hard to diagnose and with todays antimycotics better to treat than before. It is therefore of current interest. This also concerns bronchial aspergillosis which is less common than pulmonary aspergillosis and the topic of this paper. A total of 39 patients with bronchial aspergillosis are presented: 1) 4 cases with endobronchial aspergilla, two which are visual bronchoscopically, 2) one case with chronic necrotising pulmonary aspergillosis (CNPA), where a bronchus has necrotised, 3) an invasive aspergillosis in the region of a bronchial anastomosis, 4) 7 cases with an Aspergillus invasion from endobronchial tumour tissue and 5) 26 cases with allergic bronchopulmonary aspergillosis (ABPA). 37 of the 39 cases are part of a single centre study with a total of 116 bronchopulmonary aspergilloses, which were collected over seven years. The focus of attention in this paper is on the bronchoscopic and radiological results.

1 Herrn Prof. Dr. Rainer Dierkesmann, dem langjährigen klinischen Direktor der Klinik Schillerhöhe nachträglich zum 65. Geburtstag

Literatur

  • 1 Denning D W. Aspergillosis. Schering-Plough Corporation 2006: 1-76
    PubMedGoogle Scholar
  • 2 Regnard J-F, Icard P, Nicolosi M. et al . Aspergilloma: a series of 89 surgical cases.  Ann Thorac Surg. 2000;  69 898-903
    CrossrefPubMedGoogle Scholar
  • 3 Soubani A O, Chandrasekar P H. The clinical spectrum of pulmonary aspergillosis.  Chest. 2002;  121 1988-1999
    CrossrefPubMedGoogle Scholar
  • 4 Akbari J G, Varma P K, Neema P K. et al . Clinical profile and surgical outcome for pulmonary aspergilloma: a single center experience.  Ann Thorac Surg. 2005;  80 1067-1072
    CrossrefPubMedGoogle Scholar
  • 5 Babatasi G, Massetti M, Chapelier A, Fadel E. et al . Surgical treatment of pulmonary aspergilloma: current outcome.  J Thorac Cardiovasc Surg. 2000;  119 906-912
    CrossrefPubMedGoogle Scholar
  • 6 Tomlinson J R, Sahn S A. Aspergilloma in sarcoid and tuberculosis.  Chest. 1987;  92 505-508
    CrossrefPubMedGoogle Scholar
  • 7 Franquet T, Müller N L, Gimenez A. et al . Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings.  RadioGraphics. 2001;  21 825-837
    CrossrefPubMedGoogle Scholar
  • 8 Rau W S. Aspergillus infections of the lung: Radiographical signs.  Mycoses. 1997;  2 (suppl 2) 25-32
    PubMedGoogle Scholar
  • 9 Sorresso D, Glisson J, Mehta J. Invasive bronchopulmonary aspergillosis presenting as an ulcerative tracheobronchitis and endobronchial aspergilloma.  J Bronchology. 1995;  2 308-311
    PubMedGoogle Scholar
  • 10 De S, Desikan P. Unusual cause of chronic cough in an immunocompetent host.  J Bronchology. 2009;  16 61-62
    PubMedGoogle Scholar
  • 11 Agca M, Arinc S, Yilmaz A. et al . A case of endobronchial aspergilloma.  Mikrobiyol Bul. 2008;  42 157-161
    PubMedGoogle Scholar
  • 12 Kim J S, Rhee Y, Kang S M. et al . A case of endobronchial aspergilloma.  Yonsei Med J. 2000;  41 422-425
    PubMedGoogle Scholar
  • 13 Tamaki S, Danbara T, Natori H. et al . A resected case of endobronchial aspergilloma due to aspergillus restrictus.  Nihon Kyobu Shikkan Gakkai Zasshi. 1980;  18 464-469
    PubMedGoogle Scholar
  • 14 Saito H, Shimokata K. Bronchoscopic observation of pulmonary aspergilloma treated with itraconazole.  Journal of Broncholgy. 1996;  3 40-42
    PubMedGoogle Scholar
  • 15 Verea-Hernando H, Martin-Egana M. et al . Bronchoscopic aspect of pulmonary aspergilloma.  Chest. 1989;  95 708-709
    PubMedGoogle Scholar
  • 16 Smith R L, Morelli M J, Aranda C P. Pulmonary aspergilloma diagnosed by fiberoptic bronchoscopy.  Chest. 1987;  92 948-949
    CrossrefPubMedGoogle Scholar
  • 17 Dar K A, Shah N N, Bhargava R. et al . Endobronchial aspergilloma in a 30-year-old man.  J Bronchology. 2007;  14 207-209
    PubMedGoogle Scholar
  • 18 Dobbertin I, Dierkesmann R, Kohlhäufl M. Lehrbuch und Atlas der Bronchoskopie. Geschichte, Techniken, Krankheitsbilder; 2. Auflage. Bern; Verlag Hans Huber 2008
    PubMedGoogle Scholar
  • 19 Mito K, Kashima K, Daa T. et al . Localized peribronchial adenomatous hyperplasia arising from an ectatic bronchus with aspergilloma.  APMIA. 2004;  112 218-221
    PubMedGoogle Scholar
  • 20 Gefter W B, Weingrad T R, Epstein D M. et al . „Semi-invasive” pulmonary aspergillosis. A new look at the spectrum of aspergillus infections of the lung.  Radiology. 1981;  140 313-321
    PubMedGoogle Scholar
  • 21 Hebisawa A, Kurashima A, Nagai H. et al . Pathology of bronchopulmonary aspergillosis.  Kekkaku. 1997;  72 109-118
    PubMedGoogle Scholar
  • 22 British Tuberculosis Association . Aspergillus in persistent lung cavities after tuberculosis. A report from the Research Committee of the British Tuberculosis Association.  Tubercle. 1968;  49 1-11
    CrossrefPubMedGoogle Scholar
  • 23 Kobashi Y, Fukuda M. et al . Chronic necrotizing pulmonary aspergillosis as a complication of pulmonary MYCOBACTERIUM AVIUM COMLEX DISEASE.  Respirology. 2006;  11 809-813
    CrossrefPubMedGoogle Scholar
  • 24 Hafeez I, Muers M F. et al . Non-tuberculous mycobacterial lung infection complicated by chronic necrotizing pulmonary aspergillosis.  Thorax. 2000;  55 717-719
    CrossrefPubMedGoogle Scholar
  • 25 Saraceno J L, Phelps D T, Futerfas R, Schwartz D B. Chronic necrotizing pulmonary aspergillosis. Approach to management.  Chest. 1997;  112 541-548
    CrossrefPubMedGoogle Scholar
  • 26 Fujiuchi S, Sakunami M, Yamamoto Y. et al . Analysis of chronic necrotizing pulmonary aspergillosis (CNPA) cases complicated with non-tuberculous mycobacteriosis (NTM).  Kekkaku. 2008;  83 573-575
    PubMedGoogle Scholar
  • 27 Miller W T. Aspergillosis: A disease with many faces.  Semin Roentgenol. 1996;  31 52-66
    CrossrefPubMedGoogle Scholar
  • 28 Lachkar S, Dominique S, Thiberville L, Nouvet G, Genevois A. Aspergillosis and sarcoidosis.  Rev Mal Respir. 2007;  24 943-953
    PubMedGoogle Scholar
  • 29 Denning D W, Riniotis K, Dobrashian R, Sambatakou H. Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review.  Clin Infect Dis. 2003;  37 S265-S280
    CrossrefPubMedGoogle Scholar
  • 30 Binder R E, Faling L J, Pugatch R D. et al . Chronic necrotizing pulmonary aspergillosis: A discrete clinical entity.  Medicine. 1982;  61 109-124
    CrossrefPubMedGoogle Scholar
  • 31 Kato T, Usami I, Morita H. et al . Chronic necrotizing pulmonary aspergillosis in pneumoconiosis.  Chest. 2003;  121 118-127
    CrossrefPubMedGoogle Scholar
  • 32 Franquet T, Müller N L, Gimenez A. et al . Semiinvasive pulmonary aspergillosis in chronic obstructive pulmonary disease.  AJR. 2000;  174 51-56
    PubMedGoogle Scholar
  • 33 Kemper C A, Hostetler J S, Follansbee S E. et al . Ulcerative and plaque-like tracheobronchitis due to infection with aspergillus in patients with AIDS.  Clin Infect Dis. 1993;  17 344-352
    CrossrefPubMedGoogle Scholar
  • 34 Young R C, Bennett J E, Vogel C L, Carbone P P, DeVita V T. Aspergillosis. The Spectrum of the disease in 98 patients.  Medicine. 1970;  49 147-173
    PubMedGoogle Scholar
  • 35 Pervez N K, Kleinerman J, Kattan M. et al . Pseudomembranous necrotizing bronchial aspergillosis. A variant of invasive aspergillosis in a patient with hemophilia and aquired immune deficience syndrome.  Am Rev Resp Dis. 1985;  131 961-963
    PubMedGoogle Scholar
  • 36 Logan P M, Primack S L, Miller R R, Müller N L. Invasive aspergillosis of the airways: radiographic, CT, and pathologic findings.  Radiology. 1994;  193 383-388
    PubMedGoogle Scholar
  • 37 Garofano S A, Stover D E, Freeberg G W, Klimstra D S. Necrotizing aspergillus tracheobronchitis: a case associated with fatal hemorrhage following endobronchial biopsy.  Journal of bronchology. 1994;  1 299-303
    CrossrefPubMedGoogle Scholar
  • 38 Oh H-J, Kim H-R, Hwang K-E. et al . Case of pseudomembanous necrotizing tracheobronchial aspergillosis in an immunocompetent host.  The Korean Journal of Internal Medicine. 2006;  21 279-282
    PubMedGoogle Scholar
  • 39 Franco J, Munoz C, Vila B, Marin J. Pseudomembranous invasive tracheobronchial aspergillosis.  Thorax. 2004;  59 452
    CrossrefPubMedGoogle Scholar
  • 40 Denning D W, Follansbee S E, Scolaro M. et al . Pulmonary aspergillosis in the aquired immunodeficience syndrome.  N Engl J Med. 1991;  324 654-652
    CrossrefPubMedGoogle Scholar
  • 41 Amhtor M J, Bontikous S, Pasterkamp G, Schaberg T. Als Tumor imonierende primäre pulmonale Kryp-tokokkose bei einer immunkompetenten Patientin. Ein Beitrag zur Differenzialdiagnose.  Pneumologie. 2000;  54 58-60
    Article in Thieme ConnectPubMedGoogle Scholar
  • 42 Husari A W, Jensen W A, Kirsch C M. et al . Pulmonary Mucormycosis presenting as an endobronchial lesion.  Chest. 1994;  106 1889-1891
    CrossrefPubMedGoogle Scholar
  • 43 Broderick L S, Conces Jr D J, Tarver R D. et al . Pulmonary aspergillosis: A spectrum of disease.  Crit Rev Diagn Imaging. 1996;  37 491-531
    PubMedGoogle Scholar
  • 44 Kimmerling E A, Fedrick J A, Tenholder M K. Invasive aspergillus niger with fatal pulmonary oxalosis in chronic pulmonary disease.  Chest. 1992;  101 870-872
    CrossrefPubMedGoogle Scholar
  • 45 Aquino S L, Kee S T, Warnock M L, Gamsu G. Pulmonary aspergillosis: imaging findings with pathologyic correlation.  AJR. 1994;  163 811-815
    PubMedGoogle Scholar
  • 46 Sawasaki H, Horie K, Yamada M. et al . Bronchial stump aspergillosis. Experimental and clinical study.  J Thorac Cardiovasc Surg. 1969;  58 198-208
    PubMedGoogle Scholar
  • 47 Mehrad B, Paciocco G, Martinez F J. et al . Spectrum of aspergillus infection in lung transplant recipients.  Chest. 2001;  119 169-175
    CrossrefPubMedGoogle Scholar
  • 48 Agarwal R. Allergic bronchopulmonary aspergillosis.  Chest. 2009;  135 805-826
    CrossrefPubMedGoogle Scholar
  • 49 Agarwal R, Gupta D, Aggarwal A, Saxena A, Chakrabarti A, Jindal S. Clinical significance of hyperattenuating mucoid impaction in allergic bronchopulmonary aspergillosis. An analysis of 155 patients.  Chest. 2007;  132 1183-1190
    CrossrefPubMedGoogle Scholar
  • 50 Ward S, Heyneman L, Lee M J, Leung A N, Hansell D M, Müller N L. Accuracy of CT in the diagnosis of allergic bronchopulmonary aspergillosis.  AJR. 199;  173 937-942
    PubMedGoogle Scholar
  • 51 Hutcheson P S, Knutsen A P, Rejent A J, Slavin R G. A 12-Year longitudinal study of aspergillus sensitivity in patients with cystic fibrosis.  Chest. 1996;  110 363-366
    CrossrefPubMedGoogle Scholar
  • 52 Geller D E, Kaplowitz H, Light M J. et al . Allergic bronchopulmonary aspergillosis in cystic fibrosis.  Chest. 1999;  116 639-646
    CrossrefPubMedGoogle Scholar
  • 53 Becker J W, Burke W, McDonald G. et al . Prevalence of allergic bronchopulmonary aspergillosis and atopy in adult patients with cystic fibrosis.  Chest. 1996;  109 1536-1540
    CrossrefPubMedGoogle Scholar
  • 54 Bosken C H, Myers J L, Greenberger P A, Katzenstein A L. Pathologic features of allergic bronchopulmonary aspergillosis.  Am J Surg Pathol. 1988;  12 216-22
    CrossrefPubMedGoogle Scholar
  • 55 Johkoh T, Müller N L, Akira M. et al . Eosinophilic lung diseases: diagnostic accuracy of thin-section CT in 111 patients.  Radiology. 2000;  216 773-780
    PubMedGoogle Scholar
  • 56 Berkin K E, Vernon D RH, Kerr J W. Lung collapse caused by allergic bronchopulmonary aspergillosis in non-asthmatic patients.  British Medical Journal. 1982;  285 552-553
    CrossrefPubMedGoogle Scholar
  • 57 Klech H, Pohl W, Koehn H, Kummer F. Indications for the therapeutic bronchial lavage in refractory status asthmaticus with mucus plugging.  Atemw.-Lungenkrkh. 1990;  16 17-19
    PubMedGoogle Scholar
  • 58 Borbely R B, D’Alonzo E. „Plastic bronchitis” as a cause of nonresolving pneumococcal pneumonia.  Journal of Bronchology. 1997;  4 304-306
    CrossrefPubMedGoogle Scholar
  • 59 Heilmeyer L. Lehrbuch der Inneren Medizin; 2 Auflage. Berlin, Göttingen, Heidelberg; Springer Verlag 1961
    PubMedGoogle Scholar
  • 60 Park J Y, Elshami A A, Kang D S, Jung T H. Plastic bronchitis.  Eur Respir J. 1996;  9 612-614
    CrossrefPubMedGoogle Scholar
  • 61 Jelihovsky T. The structure of bronchial plugs in mucoid impaction, bronchocentric granulomatosis and asthma.  Histopathology. 1983;  7 153-167
    CrossrefPubMedGoogle Scholar
  • 62 Nagata K, Iwasaki Y, Yamada T. et al . Severe asthma complicated with large mucoid impaction: successful removal with balloon catheter.  Nihon Kokyuki Gakkai Zasshi. 2004;  42 914-918
    PubMedGoogle Scholar
  • 63 Liu D B, Zeng Q Y, Luo R Z. et al . Clinical features and surgery in children with plastic bronchitis.  Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2006;  41 683-686
    PubMedGoogle Scholar
  • 64 Eberlein M H, Drummond M B, Haponik E F. Plastic bronchitis: a management challenge.  Am J Med Sci. 2008;  335 163-9
    CrossrefPubMedGoogle Scholar
  • 65 Aubry M C, Fraser R. The role of bronchial biopsy and washing in the diagnosis of allergic bronchopulmonary aspergillosis.  Mod Pathol. 1998;  11 607-611
    PubMedGoogle Scholar
  • 66 Siedziewska J, Zaleska J, Wiatr E. et al . Plastic bronchitis and mucoid impaction-uncommon disease syndromes with expectoration mucus plugs.  Pneumonol Allergol Pol. 2001;  69 50-61
    PubMedGoogle Scholar
  • 67 Kradin R L, Mark E J. The pathology of pulmonary disorders due to aspergillus spp.  Arch Pathol Lab Med. 2008;  132 606-614
    PubMedGoogle Scholar
  • 68 Brauer E, Thompson G. Tracheobronchial aspergillosis.  Journal of Bronchology. 1994;  1 133-134
    CrossrefPubMedGoogle Scholar
  • 69 Klein D L, Gamsu G. Thoracic manifestations of aspergillosis.  AJR. 1980;  134 543-552
    PubMedGoogle Scholar
  • 70 Shah A, Panjabi C. Contemporaneous occurence of allergic bronchopulmonary aspergillosis, allergic Aspergillus sinusitis, and aspergilloma.  Ann Allergy Asthma Immunol. 2006;  96 874-878
    CrossrefPubMedGoogle Scholar
  • 71 Rosenberg I L, Greenberger P A. Allergic bronchopulmonary aspergillosis and aspergilloma. Long-term follow-up without enlargement of a large multiloculated cavity.  Chest. 1984;  85 123-125
    CrossrefPubMedGoogle Scholar
  • 72 Kumar R. Allergic bronchopulmonary aspergillosis with aspergilloma mimicking pulmonary tuberculosis.  Ind J Tub. 2000;  47 103-105
    PubMedGoogle Scholar

1 Herrn Prof. Dr. Rainer Dierkesmann, dem langjährigen klinischen Direktor der Klinik Schillerhöhe nachträglich zum 65. Geburtstag

Dr. med. Ingrid Dobbertin

Klinik Schillerhöhe
Abteilung für Pneumologie

Solitudestr. 18
70839 Gerlingen

Email: ingriddobbertin@gmx.de

Email: Kohlhaeufl.Martin@klinik-schillerhoehe.de

      >