Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1991 Jan;46(1):15–20. doi: 10.1136/thx.46.1.15

Corticosteroid treatment as a risk factor for invasive aspergillosis in patients with lung disease.

L B Palmer 1, H E Greenberg 1, M J Schiff 1
PMCID: PMC1020907  PMID: 1871691

Abstract

Invasive pulmonary aspergillosis usually occurs in severely immunocompromised or neutropenic patients. Six patients with invasive aspergillosis are described whose only defence impairment was underlying lung disease and corticosteroid treatment. Cough, fever, and sputum production were the usual reasons for presentation and four patients developed the sepsis syndrome. Radiographic findings included de novo cavitation in three patients and rapid radiographic progression in four. Aspergillus species were isolated from respiratory secretions of all patients early in the course of the disease. Treatment was effective in only two patients and the subsequent progress of the others was consistent with a chronic necrotising process. Invasive pulmonary aspergillosis is uncommon in patients with respiratory diseases receiving corticosteroids, but should be considered when pneumonia and cavitary infiltrates occur.

Full text

PDF
15

Images in this article

16Image
on p.16
17Image
on p.17
18Image
on p.18

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Binder R. E., Faling L. J., Pugatch R. D., Mahasaen C., Snider G. L. Chronic necrotizing pulmonary aspergillosis: a discrete clinical entity. Medicine (Baltimore) 1982 Mar;61(2):109–124. doi: 10.1097/00005792-198203000-00005. [DOI] [PubMed] [Google Scholar]
  2. Blum J., Reed J. C., Pizzo S. V., Thompson W. M. Miliary aspergillosis associated with alcoholism. AJR Am J Roentgenol. 1978 Oct;131(4):707–709. doi: 10.2214/ajr.131.4.707. [DOI] [PubMed] [Google Scholar]
  3. Brown E., Freedman S., Arbeit R., Come S. Invasive pulmonary aspergillosis in an apparently nonimmunocompromised host. Am J Med. 1980 Oct;69(4):624–627. doi: 10.1016/0002-9343(80)90478-7. [DOI] [PubMed] [Google Scholar]
  4. Burke P. S., Coltman C. A., Jr Multiple pulmonary aspergillomas in acute leukemia. Cancer. 1971 Nov;28(5):1289–1292. doi: 10.1002/1097-0142(1971)28:5<1289::aid-cncr2820280530>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  5. Comstock G. W., Palmer C. E., Stone R. W., Goodman N. L. Fungi in the sputum of normal men. Mycopathol Mycol Appl. 1974 Oct 15;54(1):55–62. doi: 10.1007/BF02055973. [DOI] [PubMed] [Google Scholar]
  6. Cooper J. A., Weinbaum D. L., Aldrich T. K., Mandell G. L. Invasive aspergillosis of the lung and pericardium in a nonimmunocompromised 33 year old man. Am J Med. 1981 Nov;71(5):903–907. doi: 10.1016/0002-9343(81)90396-x. [DOI] [PubMed] [Google Scholar]
  7. Fauci A. S., Dale D. C., Balow J. E. Glucocorticosteroid therapy: mechanisms of action and clinical considerations. Ann Intern Med. 1976 Mar;84(3):304–315. doi: 10.7326/0003-4819-84-3-304. [DOI] [PubMed] [Google Scholar]
  8. Fischer J. J., Walker D. H. Invasive pulmonary aspergillosis associated with influenza. JAMA. 1979 Apr 6;241(14):1493–1494. [PubMed] [Google Scholar]
  9. Herbert P. A., Bayer A. S. Fungal pneumonia (Part 4): invasive pulmonary aspergillosis. Chest. 1981 Aug;80(2):220–225. doi: 10.1378/chest.80.2.220. [DOI] [PubMed] [Google Scholar]
  10. Kallenbach J., Dusheiko J., Block C. S., Bethlehem B., Koornhof H. J., Zwi S. Aspergillus pneumonia--a cluster of four cases in an intensive care unit. S Afr Med J. 1977 Nov 26;52(23):919–923. [PubMed] [Google Scholar]
  11. Karam G. H., Griffin F. M., Jr Invasive pulmonary aspergillosis in nonimmunocompromised, nonneutropenic hosts. Rev Infect Dis. 1986 May-Jun;8(3):357–363. doi: 10.1093/clinids/8.3.357. [DOI] [PubMed] [Google Scholar]
  12. Karas A., Hankins J. R., Attar S., Miller J. E., McLaughlin J. S. Pulmonary aspergillosis: an analysis of 41 patients. Ann Thorac Surg. 1976 Jul;22(1):1–7. doi: 10.1016/s0003-4975(10)63943-4. [DOI] [PubMed] [Google Scholar]
  13. Lake K. B., Browne P. M., Van Dyke J. J., Ayers L. Fatal disseminated aspergillosis in an asthmatic patient treated with corticosteroids. Chest. 1983 Jan;83(1):138–139. doi: 10.1378/chest.83.1.138. [DOI] [PubMed] [Google Scholar]
  14. Meyer R. D., Young L. S., Armstrong D., Yu B. Aspergillosis complicating neoplastic disease. Am J Med. 1973 Jan;54(1):6–15. doi: 10.1016/0002-9343(73)90077-6. [DOI] [PubMed] [Google Scholar]
  15. O'Brien A. A., Moore D. P., Keogh J. A. Pulmonary berylliosis on corticosteroid therapy, with cavitating lung lesions and aspergillomata--report on a fatal case. Postgrad Med J. 1987 Sep;63(743):797–799. doi: 10.1136/pgmj.63.743.797. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Ordronneau J., de Lajartre A. Y., Chollet S., Germaud P., Moinard D., Chailleux E. Aspergillose invasive disséminée associée à une infection à Mycoplasma pneumoniae. Rev Mal Respir. 1987;4(5):273–275. [PubMed] [Google Scholar]
  17. PEPYS J., RIDDELL R. W., CITRON K. M., CLAYTON Y. M., SHORT E. I. Clinical and immunologic significance of Aspergillus fumigatus in the sputum. Am Rev Respir Dis. 1959 Aug;80:167–180. doi: 10.1164/arrd.1959.80.2.167. [DOI] [PubMed] [Google Scholar]
  18. Palmer L. B., Schiff M. J. Rapidly progressive pneumonia in a patient with chronic obstructive pulmonary disease. Chest. 1989 Jan;95(1):179–180. doi: 10.1378/chest.95.1.179. [DOI] [PubMed] [Google Scholar]
  19. Pelczar M. E., Glas-Greenwalt P., Astrup T. Primary pulmonary aspergillosis with high fibrinolytic activity in the aortic intima. Chest. 1972 Apr;61(4):394–396. doi: 10.1378/chest.61.4.394. [DOI] [PubMed] [Google Scholar]
  20. Rinehart J. J., Balcerzak S. P., Sagone A. L., LoBuglio A. F. Effects of corticosteroids on human monocyte function. J Clin Invest. 1974 Dec;54(6):1337–1343. doi: 10.1172/JCI107880. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Rinehart J. J., Sagone A. L., Balcerzak S. P., Ackerman G. A., LoBuglio A. F. Effects of corticosteroid therapy on human monocyte function. N Engl J Med. 1975 Jan 30;292(5):236–241. doi: 10.1056/NEJM197501302920504. [DOI] [PubMed] [Google Scholar]
  22. Rodenhuis S., Beaumont F., Kauffman H. F., Sluiter H. J. Invasive pulmonary aspergillosis in a non-immunosuppressed patient: successful management with systemic amphotericin and flucytosine and inhaled amphotericin. Thorax. 1984 Jan;39(1):78–79. doi: 10.1136/thx.39.1.78. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Roselle G. A., Kauffman C. A. Case report: invasive pulmonary aspergillosis in a nonimmunosuppressed patient. Am J Med Sci. 1978 Nov-Dec;276(3):357–361. doi: 10.1097/00000441-197811000-00014. [DOI] [PubMed] [Google Scholar]
  24. Sawkar L. A., Dickerman J. M., Easom H. F. Primary pulmonary aspergillosis. A case report. N C Med J. 1972 Sep;33(9):776–778. [PubMed] [Google Scholar]
  25. Schaffner A., Douglas H., Braude A. Selective protection against conidia by mononuclear and against mycelia by polymorphonuclear phagocytes in resistance to Aspergillus. Observations on these two lines of defense in vivo and in vitro with human and mouse phagocytes. J Clin Invest. 1982 Mar;69(3):617–631. doi: 10.1172/JCI110489. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Schaffner A. Therapeutic concentrations of glucocorticoids suppress the antimicrobial activity of human macrophages without impairing their responsiveness to gamma interferon. J Clin Invest. 1985 Nov;76(5):1755–1764. doi: 10.1172/JCI112166. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Schrijver G., Verwers H. R., Meinders A. E. A non-immunosuppressed patient with presumably invasive pulmonary aspergillosis and a favourable outcome. Neth J Med. 1983;26(4):112–119. [PubMed] [Google Scholar]
  28. Stover D. E., Zaman M. B., Hajdu S. I., Lange M., Gold J., Armstrong D. Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Ann Intern Med. 1984 Jul;101(1):1–7. doi: 10.7326/0003-4819-101-1-1. [DOI] [PubMed] [Google Scholar]
  29. Strelling M. K., Rhaney K., Simmons D. A., Thomson J. Fatal acute pulmonary aspergillosis in two children of one family. Arch Dis Child. 1966 Feb;41(215):34–43. doi: 10.1136/adc.41.215.34. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Tankanow L., Eichenhorn M. S. Disseminated Strongyloides stercoralis and Aspergillus fumigatus presenting as diffuse interstitial pneumonitis in a steroid-dependent chronic obstructive pulmonary disease patient. Henry Ford Hosp Med J. 1988;36(1):41–43. [PubMed] [Google Scholar]
  31. Wajszczuk C. P., Dummer J. S., Ho M., Van Thiel D. H., Starzl T. E., Iwatsuki S., Shaw B., Jr Fungal infections in liver transplant recipients. Transplantation. 1985 Oct;40(4):347–353. doi: 10.1097/00007890-198510000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Waldhorn R. E., Tsou E., Kerwin D. M. Invasive pulmonary aspergillosis associated with aspergilloma in sarcoidosis. South Med J. 1983 Feb;76(2):251–253. doi: 10.1097/00007611-198302000-00029. [DOI] [PubMed] [Google Scholar]
  33. Waldorf A. R., Levitz S. M., Diamond R. D. In vivo bronchoalveolar macrophage defense against Rhizopus oryzae and Aspergillus fumigatus. J Infect Dis. 1984 Nov;150(5):752–760. doi: 10.1093/infdis/150.5.752. [DOI] [PubMed] [Google Scholar]
  34. Weiss L. M., Thiemke W. A. Disseminated Aspergillus ustus infection following cardiac surgery. Am J Clin Pathol. 1983 Sep;80(3):408–411. doi: 10.1093/ajcp/80.3.408. [DOI] [PubMed] [Google Scholar]
  35. Wiest P. M., Flanigan T., Salata R. A., Shlaes D. M., Katzman M., Lederman M. M. Serious infectious complications of corticosteroid therapy for COPD. Chest. 1989 Jun;95(6):1180–1184. doi: 10.1378/chest.95.6.1180. [DOI] [PubMed] [Google Scholar]
  36. 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 (Baltimore) 1970 Mar;49(2):147–173. doi: 10.1097/00005792-197003000-00002. [DOI] [PubMed] [Google Scholar]
  37. Yu V. L., Muder R. R., Poorsattar A. Significance of isolation of Aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergillosis. Results from a three-year prospective study. Am J Med. 1986 Aug;81(2):249–254. doi: 10.1016/0002-9343(86)90259-7. [DOI] [PubMed] [Google Scholar]
  38. Zellner S. R., Selby J. B., Loughrin J. J. Aspergillosis. An unusual presentation. Am Rev Respir Dis. 1969 Aug;100(2):217–220. doi: 10.1164/arrd.1969.100.2.217. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES