TABLE 1.
Description of patients with pulmonary aspergillosisa
| Age (yr) (sex) | Underlying disease(s) | Reason(s) for BAL | Antibiotic(s) used prior to or at the time of BAL | CXR/chest CT scan result | BAL GM level(s) | Serum GM level(s) | Microscopy result, TBBX result | Culture | Diagnosis | Treatment | Outcome at follow-up |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 66 (M) | CAD, DM, and obesity; admitted with acute pneumococcal sepsis | Fever, septic shock | CFP, Levo, Vanc | Bil parenchymal opacity, diffuse GGO, nodule | 1.18 | 1.41 (+1 day)b | Inflammatory cells (yeasts), not done | BAL, A. flavus; sputum (−1 days),bA. flavus | Proven IPAc | No antifungal | Died, 4 daysb |
| 61 (M) | Previously healthy; admitted with severe upper GI bleed | Shock | CFP, Metro, Vanc, Tim | Nodular infiltrates | 8.44 | 2.58 (−4 days),b 2.69 (−2 days)b | Not done, not done | BAL, A. fumigatus; sputum (−1 days, −2 days),bA. fumigatus | Presumed IPA | VORI until death | Died, 10 daysb |
| 67 (F) | COPD; cavitary lung lesion was found on admission CXR | Respiratory symptoms for 4 mo and cavitary lung lesion | Cipro, Metro | Consolidation with cavitation | 2.0; after antifungal treatment, −0.62 (+19 days)b | 0.05 (+5 days)b | Hyphae, inflammation and necrosis; hyphae seen in tissue | BAL, Candida and A. fumigatus | Proven CNPA | VORI and antibiotics until death | Died, 2 mob (from ruptured AAA) |
| 56 (M) | Healthy, admitted after a stroke; cavitary lung lesion was found on admission CXR | Wt loss, cough, hemoptysis, abnormal CXR | None | Cavitary lesion with surrounding consolidation | 7.41, 7.34d | 0.98 (−2 days)b | Hyphae, chronic and granulomatous inflammation, presence of eosinophils (no hyphae) | BAL, A. fumigatus; sputum (−3 days),bA. fumigatus | Probable CNPA | VORI for 1.3 yr | Lived (F/u, 1.3 yr) |
| 51 (M) | Lung cancer, in remission for 5 yr; admitted for hemoptysis | Fever, respiratory complaints, and hemoptysis | Gati | Cavitary lesion with fungus ball; surrounding consolidation | 1.43, 1.15d | 0.08 (+3 days),b 0.11 (+4 days),b 0.08 (+5 days)b | No hyphae, not done | BAL, Candida and A. fumigatus | Proven aspergilloma; MAI pneumonia and cavitary lesion | VORI for 1 year and Rx for MAI | Lived (F/u, 1 yr) |
| 46 (M) | Crohn's colitis, in remission, MAI pneumonia on treatment; admitted with hemoptysis | Fever, respiratory complaints, and hemoptysis | Mero and meds against MAI | Cavitary lung lesion with fungus ball | 8.89 (LLL), 8.64d (RL) | Not done | Inflammatory cells (no hyphae), chronic and acute inflammation (no hyphae) | A. fumigatus | Proven aspergilloma; MAI cavitary lung lesion | VORI for 6 mo and Rx for MAI | Lived (F/u, 6 mo) |
Abbreviations: TBBX, transbronchial biopsy; M, male; F, female; CAD, coronary artery disease; DM, diabetes mellitus; COPD, chronic obstructive lung disease; AAA, abdominal aortic aneurysm; CXR, chest X ray; Bil, bilateral; GGO, ground glass opacification; MAI, Mycobacterium avium-Mycobacterium intracellularae; RLL, right lower lobe; LLL, left lower lobe; RL, right lung; F/u, follow-up time; Rx, treatment; meds, medications; CFP, cefipime; Levo, levofloxacin; Vanc, vancomycin; Cipro, ciprofloxacin; Gati, gatifloxacin; Metro, metronidazole; Tim, timentin; Mero, meropenem; VORI, voriconazole.
Date given relative to the initial BAL (e.g., +1 day indicates 1 day after BAL, and −1 day indicates 1 day before BAL).
Fungal hyphae were found within the lung parenchyma and blood vessels upon autopsy.
BAL was performed on several lung specimens.