침입성 아스페르길루스증

강재명,우준희,류지소 대한의진균학회 2002 대한의진균학회지 Vol.7 No.1

Invasive aspergillosis remains a major cause of morbidity and mortality in immunocompromised patients, And there has been substantial increase in the number of cases documented at autopsy in all developed nations. There are probable many factors responsible for this substantial increase, but they include the following: greater numbers of transplantation patients; more aggressive chemotherapy for such conditions as myeloma, breast cancer, and certain lymphomas; more aggressive immunosuppressive regimens for patients with autoimmune disease; and the emergence of AIDS. The use of hepafiltration and, in particular, laminar air flow reduces the risk of invasive aspergillosis. The portal of entry for Aspergillus include the respiratory tract, damaged skin or other operative wounds, the cornea, and the ear. The majority of patients (80∼90%) have pulmonary disease, but some have other manifestations of disease, including aspergillus rhinosinusitis. Prognosis of invasive aspergillosis has in general relied on making a prompt diagnosis of infection, and early treatment. Unfortunately, the rapid diagnosis of invasive aspergillosis is difficult, as no rapid methods to establish definitely the diagnosis of infection are available in most clinical settings. An ELISA for detecting Aspergillus galactomannan is used to establish an early diagnosis in Western Europe. Invasive aspergillosis carries a nearly 100% mortality if untreated. There are currently two antifungal agents with activity against Aspergillus-amphotericin B and itraconazole. Several novel agents are under investigation, including Liposomal nystatin(Nyotran), Voriconazole, Posaconazole, Caspofungin. The most advanced azole is the voriconazole, which has shown good clinical efficacy and tolerability among immunocompromised patients with invasive aspergillosis. [Kor J med Mycol 7(1): 14-21]

CASE REPORT : Invasive Pulmonary Aspergillosis after Influenza A Infection in an Immunocompetent Patient

( Oh Kyung Kwon ),( Myung Goo Lee ),( Hyo Sun Kim ),( Min Sun Park ),( Kyoung Min Kwak ),( So Young Park ) 대한결핵 및 호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Invasive aspergillosis has emerged as a major cause of life-threatening infections in immunocompromised patients. Recently, patients with chronic obstructive pulmonary disease, who have been receiving corticosteroids for a long period, and immunocompetent patients in the intensive care unit have been identified as nontraditional hosts at risk for invasive aspergillosis. Here, we report a case of invasive pulmonary aspergillosis after influenza in an immunocompetent patient. The patient`s symptoms were nonspecific, and the patient was unresponsive to treatments for pulmonary bacterial infection. Bronchoscopy revealed mucosa hyperemia, and wide, raised and cream-colored plaques throughout the trachea and both the main bronchi. Histologic examination revealed aspergillosis. The patient recovered quickly when treated systemically with voriconazole, although the reported mortality rates for aspergillosis are extremely high. This study showed that invasive aspergillosis should be considered in immunocompetent patients who are unresponsive to antibiotic treatments; further, early extensive use of all available diagnostic tools, especially bronchoscopy, is mandatory.

Imaging Features of Gastric Invasive Aspergillosis: A Report of Two Cases

양동진,조승현,김성훈,신지열,이일기 대한영상의학회 2012 대한영상의학회지 Vol.66 No.5

Invasive aspergillosis is an opportunistic infection that usually occurs in immunocompromised patients. Although there are a few rare reports of isolated invasive aspergillosis affecting the small intestine, isolated or disseminated gastric invasive aspergillosis is extremely rare. Herein, we report 2 cases of gastric invasive aspergillosis in a 72-year-old woman and a 43-year-old man; the woman had been recovering from ruptured left posterior communicating artery aneurysm, which presented as emphysematous gastritis and the man from acute subdural haemorrhage in the intensive care unit, which presented as a pseudoaneurysm on CT imaging.

동종조혈모세포이식후 발생한 다발성 뇌농양을 동반한 파종성 침 습성 아스페르질루스증: Voriconazole과 신경외과적 중재술로 치 료된 1례

임재형,박인서,김은영,이진수,임주한,이문희,김철수,이현정,이현규 대한감염학회 2012 Infection and Chemotherapy Vol.44 No.5

Invasive aspergillosis is a serious infectious complication, which can occur after hematopoietic stem cell transplantation (HSCT). In particular, despite antifungal treatment, invasive aspergillosis involving the central nervous system (CNS) shows very high mortality. In principle, a neurosurgical procedure with an antifungal agent is recommended for treatment of CNS invasive aspergillosis. We encountered a patient suffering from disseminated invasive aspergillosis involving the lung, brain,and soft tissues after allogeneic HSCT for treatment of relapsed acute myeloid leukemia who was cured with voriconazole and stereotactic drainage of the brain abscess.

Evaluation of Galactomannan Enzyme Immunoassay and Quantitative Real-Time PCR for the Diagnosis of Invasive Pulmonary Aspergillosis in a Rat Model

( Jian Cong Lin ),( Yan Li Xing ),( Wen Ming Xu ),( Ming Li ),( Pang Bo ),( Yuan Yuan Niu ),( Chang Ran Zhang ) 한국미생물 · 생명공학회 2014 Journal of microbiology and biotechnology Vol.24 No.8

Since there is no consensus about the most reliable assays to detect invasive aspergillosis from samples obtained by minimally invasive or noninvasive methods, we compared the efficacy of an enzyme-linked immunosorbent assay (ELISA) for galactomannan (GM) detection and quantitative real-time PCR assay (qRT-PCR) for the diagnosis of invasive pulmonary aspergillosis. Neutropenic, male Sprague-Dawley rats (specific pathogen free; 8 weeks old; weight, 200 ± 20 g) were immunosuppressed with cyclophosphamide and infected with Aspergillus fumigatus intratracheally. Tissue and whole blood samples were harvested on days 1, 3, 5, and 7 post-infection and examined with GM ELISA and qRT-PCR. The A. fumigatus DNA detection sequence was detected in the following number of samples from 12 immunosuppressed, infected rats examined on the scheduled days: day 1 (0/12), day 3 (0/12), day 5 (6/12), and day 7 (8/12) post-infection. The sensitivity and specificity of the qRT-PCR assay was 29.2% and 100%, respectively. Receiver operating characteristic curve (ROC) analysis indicated a Ct (cycle threshold) cut-off value of 15.35, and the area under the curve (AUC) was 0.627. The GM assay detected antigen in sera obtained on day 1 (5/12), day 3 (9/12), day 5 (12/12), and day 7 (12/12) post-infection, and thus had a sensitivity of 79.2% and a specificity of 100%. The ROC of the GM assay indicated that the optimal Ct cut-off value was 1.40 (AUC, 0.919). The GM assay was more sensitive than the qRT-PCR assay in diagnosing invasive pulmonary aspergillosis in rats.

Invasive Pulmonary Aspergillosis after Influenza A Infection in an Immunocompetent Patient

권오경,이명구,김효선,박민선,곽경민,박소영 대한결핵및호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Invasive aspergillosis has emerged as a major cause of life-threatening infections in immunocompromised patients. Recently, patients with chronic obstructive pulmonary disease, who have been receiving corticosteroids for a long period, and immunocompetent patients in the intensive care unit have been identified as nontraditional hosts at risk for invasive aspergillosis. Here, we report a case of invasive pulmonary aspergillosis after influenza in an immunocompetent patient. The patient’s symptoms were nonspecific, and the patient was unresponsive to treatments for pulmonary bacterial infection. Bronchoscopy revealed mucosa hyperemia, and wide, raised and cream-colored plaques throughout the trachea and both the main bronchi. Histologic examination revealed aspergillosis. The patient recovered quickly when treated systemically with voriconazole, although the reported mortality rates for aspergillosis are extremely high. This study showed that invasive aspergillosis should be considered in immunocompetent patients who are unresponsive to antibiotic treatments; further, early extensive use of all available diagnostic tools, especially bronchoscopy, is mandatory.

Invasive Pulmonary Aspergillosis after Influenza A Infection in an Immunocompetent Patient

Kwon, Oh Kyung,Lee, Myung Goo,Kim, Hyo Sun,Park, Min Sun,Kwak, Kyoung Min,Park, So Young The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Invasive aspergillosis has emerged as a major cause of life-threatening infections in immunocompromised patients. Recently, patients with chronic obstructive pulmonary disease, who have been receiving corticosteroids for a long period, and immunocompetent patients in the intensive care unit have been identified as nontraditional hosts at risk for invasive aspergillosis. Here, we report a case of invasive pulmonary aspergillosis after influenza in an immunocompetent patient. The patient's symptoms were nonspecific, and the patient was unresponsive to treatments for pulmonary bacterial infection. Bronchoscopy revealed mucosa hyperemia, and wide, raised and cream-colored plaques throughout the trachea and both the main bronchi. Histologic examination revealed aspergillosis. The patient recovered quickly when treated systemically with voriconazole, although the reported mortality rates for aspergillosis are extremely high. This study showed that invasive aspergillosis should be considered in immunocompetent patients who are unresponsive to antibiotic treatments; further, early extensive use of all available diagnostic tools, especially bronchoscopy, is mandatory.

Case Reports : Invasive Aspergillosis Involving the Lungs and Brain after Short Period of Steroid Injection: A Case Report

( Young Rak Choi ),( Jeong Tae Kim ),( Jeong Eun Kim ),( Heo Won Jung ),( Kang Hyeon Choe ),( Ki Man Lee ),( Jin Young An ) 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.5

Invasive pulmonary aspergillosis (IPA) has emerged as a severe infection in patients with immunocompromised hosts. However, recently, several IPA cases, without an apparent predisposition to immunodeficiency, has been reported. A 72-year-old woman was admitted for evaluation of general weakness and poor oral intake. She reported no medical history, except for intraarticular injection of a corticosteroid for joint pain for the duration of two months. A chest radiography revealed multiple cavitary nodules in both lungs. Examination of specimens, obtained by percutaneous needle biopsy, led to a diagnosis of invasive aspergillosis. Brain magnetic resonance imagining revealed numerous peripheral thin enhancing cystic nodules in both cerebral hemispheres. We initiated intravenous administration of amphotercin B. However, the patient died after nine days. Here, we report an invasive aspergillosis case, which involves the lungs and brain after a short period of steroid injection.

신이식 환자에서 발생한 뇌 Aspergillosis 에서 Liposomal Amphotericin B 와 내시경적 수술을 이용한 성공적인 치료

우영식(Young Sik Woo),김미정(Mi Jung Kim),장재혁(Jae Heuk Jang),황수은(Soo Eun Hwang),정지성(Ji Sung Chung),신미정(Mi Jung Sin),양철우(Chul Woo Yang),김용수(Yong Soo Kim),방병기(Byung Kee Bang),박주현(Joo Hyun Park) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4

Aspergillosis involving central nervous system is a rare but life-threatening complication in renal transplant recipients. Its mortality rate approaches almost 100% in spite of various therapeutic regimens. We here report a case of successful treatment of brain aspergillosis with liposomal amphotericin B and endoscopic surgery. A 58-year- old renal transplant recipient admitted due to headache which was developed 5 months ago. He received renal transplant 10 years ago. After admission, brain MRI revealed brain abscess on frontal lobe and this was treated with antibiotics and amphotericin B. On 20 th hospital day, endoscopic surgery via intranasal approach was performed and pathologic finding was consistent with aspergillosis. During treatment, his graft function was progressively deteriorated(serum creatinine level 2.27 mg/dL4.1 mg/dL) and amphoterinc B was replaced with ambisome. Thereafter, renal function was improved(serum creatinine 2.0 mg/dL on 46 th hospital day). Second operation was performed on 50 th hospital day to remove remnant pathologic lesion, and ambisome was continously adminstered. The brain MRI which was performed on 70 th hospital day showed much improvement. He was discharged with oral antifungal drug(itraconazole). Our case demonstrates the successful treatment of brain aspergillosis with medial treatment and minimal invasive surgery.

침습성 Aspergillosis의 임상적 고찰

김양수,김성민,백경란,신형식,조성욱,배현주,우준희,송영욱,최강원 대한내과학회 1990 대한내과학회지 Vol.38 No.4

The clinical aspect of 11 patients of Invasive aspergillosis were studied. The patients were admitted the department of internal medicine of SNUH between April, 1980 and July 1988. The following results were observed. 1) The age distribution was 15 years to 61 years with mean of 41 years. 2) The underlying disease were renal transplant in 4, BM transplant in 1, AML in 2, SLE 1, DM 1, DM & LC in 1. One patient was complicated of radical mastodectomy. 3) The organ involvement were as follows. Lung in 4, brain parenchyme in 2, skin 2, orbit & sphenoid sinus in 1. Two were disseminated disese. 4) The specific diagnosis were made by autopsy in 3, open lung biopsy 2, TTA 1, and biopsy of each involved organ in 4. 5)Seven patinets were diagnosed early. 5 patients received therapy with Amphotericin-B alone, 2 reveived Amphotericin-B and surgery. 6) Among these 7 patiens, 5 were followed up without evidence of recurrence and 2 dided of the invasive aspergillosis. 7) Other patients who did not received therapy expired.