Chronic forms of pulmonary aspergillosis

Aspergillus is a genus of fungi commonly found in all environments. Remarka bly, only a few species cause disease and equally remarkably. those same sp ecies cause multiple diseases. In the lung, exposure to the fungus, the imm unological status of the individual and the condition of the lung determine the pattern of disease. In asthmatic patients and those with cystic fibros is, allergic bronchopulmonary aspergillosis (ABPA) is a complication that r educes pulmonary function and, in asthmatics, is substantially improved by itraconazole therapy. patients with pre-existing lung cavities develop aspe rgillomas (fungal masses inside the cavity). Aspergillomas carry a 40% 5 ye ars survival, and it not clear whether antifungal therapy is helpful. Simil ar in presentation to aspergilloma is chronic necrotizing pulmonary aspergi llosis (CNPA). Development of new or expansion of existing pulmonary caviti es with surrounding paracavitary shadowing is the hallmark of CNPA These tw o entities are probably a continuum of the same pathological process. Patie nts with CNPA respond to systemic antifungal therapy, but this may need to be lifelong. Surgery is appropriate for isolated aspergillomas, but not ple ural or multicavity lesions. Aspergillus empyema is a complication of asper gilloma and CNPA, or surgery for these diseases and is slow to respond to t reatment.