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Surgical treatment of pulmonary aspergillosis: A single center experience

BACKGROUND: Aspergillus fumigatus is a saprophytic fungus which colonizes in the cavitary lesions in the lungs. In our part of the world, where tuberculosis is endemic, the healed tubercular cavities form a good nidus for this fungus. The fungus forms a fungal ball or aspergilloma within the cavity,...

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Autores principales: Mohapatra, Biswajeet, Sivakumar, Poornima, Bhattacharya, Subhankar, Dutta, Santanu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748676/
https://www.ncbi.nlm.nih.gov/pubmed/26933300
http://dx.doi.org/10.4103/0970-2113.173077
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author Mohapatra, Biswajeet
Sivakumar, Poornima
Bhattacharya, Subhankar
Dutta, Santanu
author_facet Mohapatra, Biswajeet
Sivakumar, Poornima
Bhattacharya, Subhankar
Dutta, Santanu
author_sort Mohapatra, Biswajeet
collection PubMed
description BACKGROUND: Aspergillus fumigatus is a saprophytic fungus which colonizes in the cavitary lesions in the lungs. In our part of the world, where tuberculosis is endemic, the healed tubercular cavities form a good nidus for this fungus. The fungus forms a fungal ball or aspergilloma within the cavity, which erodes the walls of the cavity and causes hemoptysis by erosion of the bronchial vessels. Hemoptysis is the main symptom. Antifungal agents are not useful against the fungal ball. Surgery in the form of lobectomy is the primary treatment. Surgery for aspergilloma is known to be risky because of intra-pleural adhesions, obliteration of the interlobar fissures, massive hemorrhage during dissection and poor pulmonary reserve of the patient due to the underlying disease. MATERIALS AND METHODS: Clinical presentation, radiological investigations, operative techniques, postoperative outcome, and follow-up of 24 cases of pulmonary aspergilloma treated surgically were studied prospectively between August 2010 and July 2013 at IPGMER and SSKM Hospital, Kolkata. RESULTS: There were 15 male (62.5%) and 9 female (37.5%) patients. Mean age of the study population was 34.54 years. All the patients had complex aspergilloma. Tuberculosis was the underlying disease in 22 patients (91%). Hemoptysis was the main symptom in 79.16% cases. Chest X-ray was the first investigation, which gave a clue to the diagnosis. Computed tomography scan was diagnostic in all cases. Lobectomy was done in 16 patients (66.67%). There was one mortality and the overall complication was 33.33%. The average follow-up period was 21.65 months, during which there was no mortality and no recurrence of hemoptysis in these patients. CONCLUSIONS: Though surgery for aspergilloma is considered to be risky, excision of the cavity along with the involved lobe can be done with acceptable morbidity and mortality to provide the patient complete cure and symptom-free survival.
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spelling pubmed-47486762016-03-01 Surgical treatment of pulmonary aspergillosis: A single center experience Mohapatra, Biswajeet Sivakumar, Poornima Bhattacharya, Subhankar Dutta, Santanu Lung India Original Article BACKGROUND: Aspergillus fumigatus is a saprophytic fungus which colonizes in the cavitary lesions in the lungs. In our part of the world, where tuberculosis is endemic, the healed tubercular cavities form a good nidus for this fungus. The fungus forms a fungal ball or aspergilloma within the cavity, which erodes the walls of the cavity and causes hemoptysis by erosion of the bronchial vessels. Hemoptysis is the main symptom. Antifungal agents are not useful against the fungal ball. Surgery in the form of lobectomy is the primary treatment. Surgery for aspergilloma is known to be risky because of intra-pleural adhesions, obliteration of the interlobar fissures, massive hemorrhage during dissection and poor pulmonary reserve of the patient due to the underlying disease. MATERIALS AND METHODS: Clinical presentation, radiological investigations, operative techniques, postoperative outcome, and follow-up of 24 cases of pulmonary aspergilloma treated surgically were studied prospectively between August 2010 and July 2013 at IPGMER and SSKM Hospital, Kolkata. RESULTS: There were 15 male (62.5%) and 9 female (37.5%) patients. Mean age of the study population was 34.54 years. All the patients had complex aspergilloma. Tuberculosis was the underlying disease in 22 patients (91%). Hemoptysis was the main symptom in 79.16% cases. Chest X-ray was the first investigation, which gave a clue to the diagnosis. Computed tomography scan was diagnostic in all cases. Lobectomy was done in 16 patients (66.67%). There was one mortality and the overall complication was 33.33%. The average follow-up period was 21.65 months, during which there was no mortality and no recurrence of hemoptysis in these patients. CONCLUSIONS: Though surgery for aspergilloma is considered to be risky, excision of the cavity along with the involved lobe can be done with acceptable morbidity and mortality to provide the patient complete cure and symptom-free survival. Medknow Publications & Media Pvt Ltd 2016 /pmc/articles/PMC4748676/ /pubmed/26933300 http://dx.doi.org/10.4103/0970-2113.173077 Text en Copyright: © Lung India http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Mohapatra, Biswajeet
Sivakumar, Poornima
Bhattacharya, Subhankar
Dutta, Santanu
Surgical treatment of pulmonary aspergillosis: A single center experience
title Surgical treatment of pulmonary aspergillosis: A single center experience
title_full Surgical treatment of pulmonary aspergillosis: A single center experience
title_fullStr Surgical treatment of pulmonary aspergillosis: A single center experience
title_full_unstemmed Surgical treatment of pulmonary aspergillosis: A single center experience
title_short Surgical treatment of pulmonary aspergillosis: A single center experience
title_sort surgical treatment of pulmonary aspergillosis: a single center experience
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748676/
https://www.ncbi.nlm.nih.gov/pubmed/26933300
http://dx.doi.org/10.4103/0970-2113.173077
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