中华医学杂志（英文版）Issue(7)：1236-1241,6.DOI:10.3760/cma.i.issn.0366-6999.2012.07.009
Pseudomembranous necrotizing tracheobronchial aspergillosis:an analysis of 16 cases
Pseudomembranous necrotizing tracheobronchial aspergillosis:an analysis of 16 cases
HUANG Hai-dong 1LI Qiang 1HUANG Yi 1BAI Chong 1WU Ning 1WANG Qing 1YAO Xiao-peng 1CHEN Bin2
作者信息
- 1. Department of Respiratory Diseases, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
- 2. Department of Clinical Laboratory, People's Hospital ofPudong New Area, Shanghai 201200, China(Chen B)
- 折叠
摘要
Abstract
Background In our clinical practice we have been attracted by a group of patients with airway aspergillosis who have airway obstruction; we termed the condition as pseudomembranous necrotizing tracheobronchial aspergillosis (PNTA).In this study we analyzed the clinical data from patients with PNTA,so as to guide the diagnosis and treatment of the disease.Methods A total of 16 PNTA patients were treated in Changhai Hospital from January 2000 to January 2009.Their clinical data,including the demographic information,clinical symptoms,imaging findings,bronchoscopy findings,treatment strategies and efficacy,and prognosis,were retrospectively analyzed.Results All 16 patients were found to have primary systemic immunodeficiency diseases and/or damage of the focal airways.Nine patients (9/16,56.3％) had pulmonary and tracheobronchial tumors,5/16 (31.3％) had tracheobronchial involvement secondary to non-pulmonary tumors,and 2/16 (12.5％) had lung transplantation.The most common causes of PNTA included local radiotherapy (10/16,62.5％),repeated chemotherapy (7/16,43.8％) and recurrent intervention therapy by bronchoscope (4/16,25.0％).Aspergillus fumigatus was the most frequent pathogen (62.5％,10/16).The main clinical manifestations included progressive dyspnea (14/16,87.5％) and irritable cough (12/16,75.0％).The trachea was involved in 9/16 patients (56.3％),right main bronchus in 10/16 (62.5％).All 16 patients were treated with systemic anti-aspergillosis agents,local anti-aspergillosis agents with amphotedcin B inhalation and direct perfusion of amphotericin B by bronchoscope,and interventional treatment by bronchoscope to ensure an unobstructed airway.The total efficiency was 31.3％.Conclusions PNTA is an infectious disease caused by aspergillus and it mainly involves the trachea,primary bronchus and segmental bronchus.A.fumigatus is the most common pathogen.PNTA can pose a severe clinical threat and often occurs after systemic immunodeficiency and/or local airway damage,with the main symptoms including dyspnea and irritable cough.Bronchoscopic findings supply the main evidence for diagnosis of PNTA.Treatment of PNTA is difficult and requires a long course.Systemic and local anti-aspergillosis agents plus bronchoscopy debridement can improve the prognosis of the disease.关键词
aspergillus/infection/pseudomembranous necrotizing tracheobronchial aspergillosis/flexible bronchoscope/diagnosis/interventional therapyKey words
aspergillus/infection/pseudomembranous necrotizing tracheobronchial aspergillosis/flexible bronchoscope/diagnosis/interventional therapy引用本文复制引用
HUANG Hai-dong,LI Qiang,HUANG Yi,BAI Chong,WU Ning,WANG Qing,YAO Xiao-peng,CHEN Bin..Pseudomembranous necrotizing tracheobronchial aspergillosis:an analysis of 16 cases[J].中华医学杂志（英文版）,2012,(7):1236-1241,6.
