CHRONIC NECROTIZING PULMONARY ASPERGILLOSIS - APPROACH TO MANAGEMENT

Objective: To describe our experience with 6 patients and to review th e current literature to update the approach to the diagnosis and treat ment of chronic necrotizing pulmonary aspergillosis. Design: Patient r eports and MEDLINE(R) review of English-language literature published after 1980. Results: Chronic necrotizing pulmonary aspergillosis (CNPA ) is a subacute infection most commonly seen in patients with altered local defense from preexisting pulmonary disease or in patients with r isk factors that alter systemic immune status. Delays in diagnosis are common. Although initial reports advocated intravenous amphotericin B , itraconazole has emerged as a better initial therapy because of its documented efficacy and minimal toxicity. The dose and duration of the rapy should be based on clinical response. In patients who do not resp ond to medical therapy, pulmonary resection can be considered, but pos toperative morbidity is high. Recurrent or relapsing infections occur; chronic maintenance therapy with itraconazole can be considered in pa tients with residual parenchymal scarring. A nide range of mortality r ates has been reported for CNPA. Outcome is most likely influenced by severity of comorbid conditions, extent of underlying pulmonary diseas e, delays in diagnosis, and initiation of effective therapy.