A Case Series of Chronic Necrotizing Pulmonary Aspergillosis and a New Proposal
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概要
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Chronic necrotizing pulmonary aspergillosis (CNPA) is an indolent, cavitating process in the lungs resulting from invasion of lung tissue by Aspergillus spp. However, most previous reports have not found any clear evidence of parenchymal invasion, and clinical distinction between CNPA and chronic cavitary pulmonary aspergillosis (CCPA) is difficult. We performed a histopathological study of lung specimens obtained by autopsy, surgical resection, or biopsy to clarify the characteristic pathological and clinical features of CNPA. We present 4 cases of proven CNPA, diagnosed by histological demonstration of tissue invasion by the fungus, and present its clinical features. These 4 patients were male, and the mean age was 62 years (range, 51–75 years). Their underlying conditions were chronic obstructive pulmonary disease (n = 3), sequelae of pulmonary tuberculosis (n = 2), and diabetes mellitus (n = 1). Aspergillus precipitation tests were positive for 3; and Aspergillus antigen tests were positive for 2 on admission, and subsequently, for all 4. The isolated pathogens were Aspergillus niger for 1 and A. fumigatus for 1. Initial radiographic findings were infiltrates or nodular lesions, which slowly progressed and cavitated before the appearance of fungus balls. Although CNPA has characteristic pathological features, it is clinically difficult to distinguish CNPA from CCPA. We propose to use the term chronic progressive pulmonary aspergillosis for both CNPA and CCPA.
著者
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KOHNO Shigeru
Department of Internal Medicine, Nagasaki University School of Medicine
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IZUMIKAWA Koichi
Department of Laboratory Medichine, Nagasaki University School of Medicine
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Nagayasu Takeshi
Department of Bioscience and Biotechnology, Faculty of Engineering, Okayama University
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Tashiro Masato
Department Of Viral Disease And Vaccine Control National Institute Of Infectious Disease
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Nakamura Shigeki
Department Of General Medicine Nagasaki University School Of Medicine
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Hayashi Tomayoshi
Department Of Cardiovascular Surgery And Pathology Nagasaki University School Of Medicine
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Yamamoto Yoshihiro
Department Of Biological Science Graduate School Of Science Hiroshima University
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IMAMURA Yoshifumi
Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences
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MIYAZAKI Taiga
Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences
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Imamura Yoshifumi
Department Of Molecular Microbiology And Immunology Nagasaki University Graduate School Of Biomedical Sciences
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Yanagihara Katsunori
Department Of Clinical Laboratory Nagasaki University Hospital
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Kakeya Hiroshi
Department Of Molecular Microbiology And Immunology Nagasaki University Graduate School Of Biomedical Sciences
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Morinaga Yoshitomo
Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Tashiro Takayoshi
Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences
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Nagayasu Takeshi
Department of Translational Medical Science, Nagasaki University Graduate School of Biomedical Sciences
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Tashiro Masato
Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences
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Morinaga Yoshitomo
Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences
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Imamura Yoshifumi
Department of Chemistry, Faculty of Science, Nagoya University
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Yamamoto Yoshihiro
Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences
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