Chronische pulmonale Aspergillose

Zusammenfassung

Chronische Verlaufsformen pulmonaler Aspergillosen (CPA) treten bei Patienten unterschiedlicher Disziplinen als seltene Komplikation leichter bis mittelschwerer Immunsuppression oder chronischer Lungenparenchymveränderung auf. Durch unspezifische klinische Ausprägung und protrahierten Verlauf stellen sie für den behandelnden Arzt eine diagnostische und therapeutische Herausforderung dar. Die Diagnosestellung stützt sich im Wesentlichen auf CT-radiologische Kennzeichen und den serologischen Nachweis von Präzipitinen. Therapeutisch sind in variabler Frequenz und Dauer antimykotische Therapien notwendig. Eine Resektion wird lediglich für das simple Aspergillom empfohlen. In den ersten Jahren nach Diagnosestellung ist ein gutes Ansprechen auf antimykotische Therapie beschrieben. Die Langzeitprognose ist ungewiss.

Wir geben einen Überblick über Epidemiologie, Diagnose und Management der CPA. Die Diversität dieses Krankheitsbildes wird durch vier Fallbeispiele illustriert.

Abstract

Chronic pulmonary aspergillosis (CPA) is a rare complication in patients with either mild immunosuppression or various pulmonary diseases. Diagnosis and therapy are challenging because of unspecific symptoms like productive cough, weight loss, fever and haemoptysis. Differential diagnoses are manifold, and CPA is characterized by findings in chest CT and serologic proof of precipitins. Surgery is only recommended for simple aspergillomas. Recurrent prolonged courses of antifungal treatment yield satisfactory short-term outcome, but long-term prognosis is uncertain.

We provide an overview of the literature and present four cases to illustrate disease diversity.

Schlüsselwörter

Chronische pulmonale Aspergillose - chronische nekrotisierende pulmonale Aspergillose - chronische fibrosierende pulmonale Aspergillose - chronische kavitäre pulmonale Aspergillose - kompliziertes Aspergillom - semi-invasive Aspergillose - subakute Aspergillose

Keywords

Chronic cavitary pulmonary aspergillosis - chronic necrotising pulmonary aspergillosis - chronic fibrosing pulmonary aspergillosis - complex aspergilloma - semi-invasive aspergillosis - subacute aspergillosis

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