Aspergillus β
Table1 Laboratoryfindingsonadmission Hematology WB Seg Band Lymph Eos Baso RB Hb Hct Plt Biochemistry AST ALT LD ALP γ-gtp K 17,700 /mm 3 70.0 % 7.0 % 17.0 % 2.0 % 1.0 % 337 10 4 /mm 3 11.5g/dl 34.8 % 38.7 10 4 /mm 3 19IU/L 44IU/L 142IU/L 744IU/L 168IU/L 47IU/L TP Alb BUN r T-cho TG Glu HgA1 T-bil Na K l Sputum Gram stain: Gafky: ulture:α-streptococcussp. ytology:classi 6.6g/dl 3.0g/dl 10g/dl 0.6mg/dl 136mg/dl 61mg/dl 126mg/dl 5.4 % 0.3mg/dl 141mEq/L 3.9mEq/L 102mEq/L Serology RP 17.3mg/dl ESR >110mm/hr IgE(RIST) 170IU/ml IgE(RAST)Aspergilus AspergilusAg0.1 AspergilusAb (+) andidaag 2 β-d-glucan <5.0pg/ml HIV Ab Bloodgasanalysis(room air) ph 7.438 PaO2 41.9Torr PaO2 75.0Torr HO3 27.7mmol/l BE 3.2mmol/l SaO2 96.4 % EG Urinalysis PPD test W.N.L. W.N.L. 10 10 28 23 Fig.2 hestt scanonadmissionshowingalarge cavityformationwithanair-fluidlevelandinfiltration intherightupperlobe,andaninfiltrativeshadow in theleftupperlobe. Fig.1 hestx-rayonadmissionshowingacavityformationwithanair-fluidlevelandinfiltrationinthe rightupperlungfield,andaninfiltrativeshadow in theleftlungfield. Aspergillus Aspergillus fumigatus
Fig.3 linicalcourse Fig.4 Transbronchiallung biopsy specimensfrom rights 2 ands 5 showingthickenedalveolarseptawith infiltrationofneutrophilsandeosinophils,andorganizingpneumoniawithmassonbodies.noaspergilus hyphaewereseeninthisbiopsyspecimen.(h.e.) Fig.5a,b hestt scanaftertreatmentshowingdiminishedcavitysizeanddisappearanceofinfiltrative shadowsinbothupperlobes.
Table2a,b asereportsofnpa (ncludingsemi-invasiveaspergilosis)injapansince1992 a No. References Age Sex Underlyingconditions 1) Symptoms 2) hestx-ray findings 3) 1 (10)1992 70 F DM RULinf 2 (11)1993 84 F OTb 3 (4)1994 63 M None 4 (12)1995 49 M P-Ope LULcav+ inf 5 (3)1995 52 M OTb 6 (2)1998 46 M OTb LULcav+ inf 7 (13)1999 52 M None LUL/LLLcav+ inf 8 (13)1999 19 M None M RULcav 9 (13)1999 69 M DM M LLLinf 10 (14)1999 76 M PF 11 (9)2001 45 M L LULcav+ inf 12 (15)2003 65 M P+ PE D RLLcav+ inf 13 Ourcase 42 M PE 1) DM,diabetesmelitus;OTb,oldtuberculosis;P-Ope,post-operativeaspergiloma;PF,pulmonaryfibrosis;L,lungcancer;P, pneumoconiosis;pe,pulmonaryemphysema 2),cough;F,fever;M,medicalcheck-up;D,dyspnea 3) RUL,rightupperlobe;RLL,rightlowerlobe;LUL,leftupperlobe;LLL,leftlowerlobe;cav,cavity;inf,infiltration b No. AspergilusDetection Asp.Ab/Ag 4) Pathology 5) ulture 6) Antifungalagents 7) Operation Outcome 1 (+ )/ PNB(+ ) Ti(+ ) MZ(i.v.),5-F(p.o) 2 (+ )/(+ ) Sp(+ ) FLZ(i.v.),ITZ(p.o.) 3 (+ )/ Sp MZ(i.v.+p.o.) 4 (+ )/ Sp Ti(+ ) MZ(i.v.+i.c.),AMPH (i.v.) 5 (+ )/ Sp(+ ) MZ(i.v.),ITZ(p.o.),AMPH (i.h.) 6 (+ )/ PNB(+ ) Ti(+ ) AMPH (i.v.+i.c.),mz(i.v),flz (p.o.+i.c.),itz(p.o.) (+) 7 / FLZ(i.v.) 8 / ITZ(p.o.) Nochange 9 / ITZ(p.o.) 10 /(+ ) AMPH (i.v.),flz(i.v.),itz(p.o.) Nochange 11 / TBLB(+ ) AMPH (i.v.+i.c.),itz(p.o.) (+) 12 / PNB(+ ) Flu(+ ) AMPH (i.v.+i.c.),itz(p.o.) 13 (+ )/ TBLB MFG(i.v.),AMPH (i.c.+i.h.), ITZ(p.o.) 4) Asp.Ab,Aspergilusantibody;Ag,Aspergilusantigen,,notdone 5) PNB,percutaneousneedlebiopsy;TBLB,transbronchiallungbiopsy;,notdone 6) Ti,tissue;Sp,sputum;BL,bronchiallavage;Flu,intracavitaryfluid 7) i.v.,intravenous;p.o.,peroral;i.c.,intracavitary;i.h.,inhaled β
β
Aspergillus flavipes Aspergillus