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. 1968 Sep;23(5):519–523. doi: 10.1136/thx.23.5.519

Treatment of bronchopulmonary aspergillosis with observations on the use of natamycin

A H Henderson 1,1, J E G Pearson 1
PMCID: PMC471841  PMID: 5303008

Abstract

The problems of treatment in bronchopulmonary aspergillosis are discussed and illustrated by 11 case reports—four with aspergilloma, six with allergic aspergillosis, and two with probable allergic aspergillosis. A simple and effective treatment of aspergilloma, by local surgical evacuation of the cavity followed by irrigation with natamycin (Pimaricin), is described in three cases. Prior treatment of these cases with inhalations or intrabronchial instillations of natamycin was of doubtful benefit. The therapy of allergic aspergillosis is reviewed and an active approach is urged, based on the probable pathogenesis of the disease. This includes consideration of physical methods of removing bronchial plugs, mucolytic agents, steroids, and antifungal drugs given by aerosol in the absence of any that are suitable for systemic use. Steroids improved ventilatory function and were effective in resolving and preventing further episodes of pulmonary eosinophilia, but not usually in clearing the fungus from the bronchial tree, probably because permanent damage had already been sustained; they also carry the theoretical risk of allowing fungal invasion. Natamycin inhalations alone are considered of little value in the active disease, although their place in prophylaxis and when used with steroids remains to be evaluated. Mucolytic agents may help to clear the bronchial secretions, especially when these have become chronically impacted.

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Selected References

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

  1. ANDRIOLE V. T., KRAVETZ H. M. The use of amphotericin B in man. JAMA. 1962 Apr 28;180:269–272. doi: 10.1001/jama.1962.03050170001001. [DOI] [PubMed] [Google Scholar]
  2. CONEN P. E., WALKER G. R., TURNER J. A., FIELD P. Invasive primary aspergillosis of the lung with cerebral metastasis and complete recovery. Dis Chest. 1962 Jul;42:88–94. doi: 10.1378/chest.42.1.88. [DOI] [PubMed] [Google Scholar]
  3. EDWARDS G., LATOUCHE C. J. THE TREATMENT OF BRONCHOPULMONARY MYCOSES WITH A NEW ANTIBIOTIC--PIMARICIN. Lancet. 1964 Jun 20;1(7347):1349–1353. doi: 10.1016/s0140-6736(64)92038-0. [DOI] [PubMed] [Google Scholar]
  4. ELLIS R. H. TOTAL COLLAPSE OF THE LUNG IN ASPERGILLOSIS. Thorax. 1965 Mar;20:118–123. doi: 10.1136/thx.20.2.118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Fraser J. W. Aspergilloma following pulmonary tuberculosis. Scott Med J. 1965 Aug;10(8):318–324. doi: 10.1177/003693306501000804. [DOI] [PubMed] [Google Scholar]
  6. Henderson A. H. Allergic aspergillosis: review of 32 cases. Thorax. 1968 Sep;23(5):501–512. doi: 10.1136/thx.23.5.501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Henderson A. H., English M. P., Vecht R. J. Pulmonary aspergillosis. A survey of its occurrence in patients with chronic lung disease and a discussion of the significance of diagnostic tests. Thorax. 1968 Sep;23(5):513–518. doi: 10.1136/thx.23.5.513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. NEWCOMER V. D., STERNBERG T. H., WRIGHT E. T., REISNER R. M. Current status of amphotericin B in the treatment of the systemic fungus infections. J Chronic Dis. 1959 Apr;9(4):353–374. doi: 10.1016/0021-9681(59)90056-6. [DOI] [PubMed] [Google Scholar]
  9. PECORA D. V., TOLL M. W. Pulmonary resection for localized aspergillosis. N Engl J Med. 1960 Oct 20;263:785–787. doi: 10.1056/NEJM196010202631605. [DOI] [PubMed] [Google Scholar]
  10. PEER E. T. Case of aspergillosis treated with amphotericin 'B'. Dis Chest. 1960 Aug;38:222–230. doi: 10.1378/chest.38.2.222. [DOI] [PubMed] [Google Scholar]
  11. Pepys J. Pulmonary hypersensitivity disease due to inhaled organic antigens. Postgrad Med J. 1966 Nov;42(493):698–702. doi: 10.1136/pgmj.42.493.698. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. ROBINSON C. L., McPHERSON A. R. Bronchopulmonary aspergilloma. Can J Surg. 1962 Oct;5:411–417. [PubMed] [Google Scholar]
  13. SEABURY J. H., SAMUELS M. The pathogenetic spectrum of aspergillosis. Am J Clin Pathol. 1963 Jul;40:21–33. doi: 10.1093/ajcp/40.1.21. [DOI] [PubMed] [Google Scholar]

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