amphotericin-b and Hemoptysis

Isolated tracheobronchial mucormycosis (ITBM) is an uncommonly reported entity. Herein, we report a case of ITBM following coronavirus disease 2019 (COVID-19) and perform a systematic review of the literature.. A 45-year-old gentleman with poorly controlled diabetes mellitus presented with cough, streaky haemoptysis, and hoarseness of voice 2 weeks after mild COVID-19 illness. Computed tomography and flexible bronchoscopy suggested the presence of a tracheal mass, which was spontaneously expectorated. Histopathological examination of the mass confirmed invasive ITBM. The patient had complete clinical and radiological resolution with glycaemic control, posaconazole, and inhaled amphotericin B (8 weeks). Our systematic review of the literature identified 25 additional cases of isolated airway invasive mucormycosis. The median age of the 26 subjects (58.3% men) was 46 years. Diabetes mellitus (79.2%) was the most common risk factor. Uncommon conditions such as anastomosis site mucormycosis (in two lung transplant recipients), post-viral illness (post-COVID-19 [n = 3], and influenza [n = 1]), and post-intubation mucormycosis (n = 1) were noted in a few. Three patients died before treatment initiation. Systemic antifungals were used in most patients (commonly amphotericin B). Inhalation (5/26; 19.2%) or bronchoscopic instillation (1/26; 3.8%) of amphotericin B and surgery (6/26; 23.1%) were performed in some patients. The case-fatality rate was 50%, primarily attributed to massive haemoptysis.. Isolated tracheobronchial mucormycosis is a rare disease. Bronchoscopy helps in early diagnosis. Management with antifungals and control of risk factors is required since surgery may not be feasible.

Topics: Amphotericin B; Antifungal Agents; COVID-19; Female; Hemoptysis; Humans; Male; Middle Aged; Mucormycosis

Aspergilloma, also known as mycetoma or fungus ball, is the most common manifestation of pulmonary involvement by Aspergillus species. The fungal ball typically forms within preexisting cavities of the lungs. Diagnosis requires both radiographic evidence along with serologic or microbiologic evidence of Aspergillus species involvement. While clinical features such as hemoptysis, chest pain, shortness of breath, cough, and fever are helpful in diagnosis, they are non-specific symptoms. Surgery is currently the mainstay of treatment for aspergilloma but is associated with considerable mortality and morbidity. Alternative options exist for patients who are poor surgical candidates and for those who prefer a less invasive treatment modality. Systemic treatment with amphotericin B is ineffective and is not recommended as a monotherapy, but systemic azoles is effective in approximately 50-80% of patients. Potential alternatives to surgery include intracavitary instillation or endobronchial administration of antifungal medication, as well as direct transbronchial aspergilloma removal. Bronchial artery embolization and radiotherapy are options to manage hemoptysis until definite eradication of the aspergilloma. More rigorous studies are needed to better establish non-surgical treatment paradigm for inoperable patients.

Topics: Amphotericin B; Antifungal Agents; Azoles; Bronchial Arteries; Conservative Treatment; Embolization, Therapeutic; Female; Hemoptysis; Humans; Instillation, Drug; Male; Pulmonary Aspergillosis

The observation of pulmonary mucormycosis occurring in a patient presenting with aplasia induced therapeutically during treatment for acute myeloblastic leukaemia, has led to a review of the characteristics of this rare opportunistic fungal infection: it occurs in a particular condition; the clinical manifestations are characterised by the thrombotic character and the rapidly necrosing nature of the histological lesions; the diagnosis is usually very difficult to make and is linked to the rarity of the pathology and the frequently negative mycological specimens apart from tissue biopsies; the value of a medicosurgical therapeutic strategy on which the prognosis of the infection depends.

Topics: Amphotericin B; Antifungal Agents; Bronchoalveolar Lavage Fluid; Bronchoscopy; Hemoptysis; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Lung Diseases, Fungal; Male; Middle Aged; Mucormycosis; Necrosis; Opportunistic Infections; Prognosis; Pulmonary Embolism; Tomography, X-Ray Computed

Massive haemoptysis, usually related to lesions of bronchial arteries, is a life-threatening complication of chest lesions. Embolization of bronchial arteries demonstrates immediate favourable results in at least 90% of cases. The main complications of embolization of bronchial arteries are medullary strokes. Consequently it is mandatory to visualize the anterior spinal artery in order to avoid its embolization. Massive haemoptysis of pulmonary arterial origin is far less common. It is also feasible to perform the embolization of the abnormal pulmonary artery in order to control the haemoptysis.

Topics: Amphotericin B; Aspergillosis; Embolization, Therapeutic; Hemoptysis; Humans; Lung Diseases, Fungal; Radiography; Radiology, Interventional

Aspergillus produces diverse pulmonary manifestations, its clinical spectrum extending from harmless saprophytic colonization to universally lethal disseminated infection. Management of the conditions produced by Aspergillus is also diverse and may consist of either observation or treatment with corticosteroid agents or amphotericin B. The factors that influence the expression of Aspergillus into a specific clinical entity are not well understood, but are believed to be related to immune status, both pulmonary and systemic, and the genetic composition of the host.

Topics: Acute Disease; Adrenal Cortex Hormones; Alveolitis, Extrinsic Allergic; Amphotericin B; Antibodies, Fungal; Antifungal Agents; Aspergillosis; Aspergillosis, Allergic Bronchopulmonary; Aspergillus; Diagnosis, Differential; Hemoptysis; Humans; Immunoglobulin G; Lung; Lung Diseases, Fungal; Radiography; Spores, Fungal; Sputum

We report a case of pulmonary cryptococcoma, in an adult with recently detected diabetes, mimicking as lung cancer. A 45-year-old gentleman with past history of pulmonary tuberculosis presented with fever, cough with expectoration, pleuritic chest pain and hemoptysis. Chest radiograph and computed tomography revealed right lower lobe mass which significantly enhanced on contrast administration. Ultrasound guided biopsy was done which on histopathological examination showed non-necrotizing granulomas with narrow-based budding yeast cells suggestive of cryptococcosis. Detailed work-up for dissemination of infection was negative. A dramatic response to anti-fungal treatment was observed and the patient is doing fine on follow-up.

Topics: Amphotericin B; Antifungal Agents; Chest Pain; Cough; Cryptococcosis; Cryptococcus neoformans; Fluconazole; Hemoptysis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome

A young man presented with a history of cough, chest pain and streaky haemoptysis with low-grade fever. Further evaluation revealed a mass in the left hemithorax, which was biopsied to reveal cryptococcoma. The patient was HIV negative. Flow cytometry lymphocyte subset analysis showed reduced CD4+ T lymphocytes. Absolute CD4+ lymphocyte count was only 230 (normal range 530-1300). The patient was started on injectable amphotericin B, which was given for 1 month, and he was discharged on oral fluconazole.

Topics: Adult; Amphotericin B; Antifungal Agents; Chest Pain; Cough; Cryptococcosis; Drug Therapy, Combination; Fluconazole; Hemoptysis; Humans; Lung Diseases, Fungal; Male

Mucormycosis are the fungal infections caused by emerging ubiquitous filamentous fungi classified as zygometes and order as mucorales. They occur mainly in immunosuppressed patients and diabetics. The onset of hemoptysis, in this context, may rapidly become life-threatening.. We report the case of a man of 83 years, Caribbean with a history of non-insulindependent diabetes and HTLV1 seropositive. At admission he presented with fever, cough and cachexia. Chest X-ray revealed a snapshot of excavation within alveolar consolidation. Endoscopy showed a mucopurulent plug obstructing lingula. The histological appearance of bronchial biopsies was in favor of mucormycosis. A combined treatment with liposomal amphotericin B and posaconasole was implemented, but the occurrence of abundant hemoptysis led us to make a left upper lobectomy. Finally, the outcome was favorable and the patient was discharged after hospitalization of 56 days.. A medicosurgical treatment during mucormycosis complicating bronchopulmonary hemoptysis not controlled by medical treatment alone seems to offer an effective therapeutic strategy.

Topics: Aged, 80 and over; Amphotericin B; Combined Modality Therapy; Diabetes Mellitus, Type 2; Hemoptysis; Humans; Lung Diseases, Fungal; Male; Mucormycosis; Opportunistic Infections; Pneumonectomy; Triazoles

We herein report a renal allograft recipient five years post transplant who had bilateral lung abscesses. The abscess grew Candida tropicalis on bronchoalveolar lavage. The patient was administered amphotericin B, but succumbed to massive hemoptysis. The case highlights a fungal complication in renal transplant and need for early suspicion and prompt therapy.

Topics: Amphotericin B; Antifungal Agents; Bronchoalveolar Lavage Fluid; Candida tropicalis; Candidiasis; Fatal Outcome; Hemoptysis; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Lung Abscess; Male; Middle Aged; Treatment Outcome

Mycetoma is defined as a fungus ball that fills a preexisting lung cavity, most frequently being of tuberculous or sarcoid etiology. The most frequently isolated fungus is the species of Aspergillus, but other fungi such as Fusarium or Zygomycetes can also be present. Most patients lack symptoms. However, presentation may also be with hemoptysis, which can be massive and life-threatening. We describe the case of a 50-year-old man with a history of prior pulmonary tuberculosis, with recurrent episodes of cough and hemoptysis. He was diagnosed to have mycetoma in the left upper lobe cavity. The mycetoma was extracted through bronchoscopy under general anesthesia using a cryoprobe. Treatment was completed with amphotericin B instilled in the cavity and the patient was placed on oral itraconazole. This is the first case report to date in which cryotherapy was used to remove a mycetoma.

Topics: Amphotericin B; Antifungal Agents; Bronchoscopy; Cough; Cryotherapy; Fusariosis; Hemoptysis; Humans; Instillation, Drug; Lung Diseases, Fungal; Male; Middle Aged; Mycetoma; Radiography; Recurrence; Tuberculosis, Pulmonary

Pulmonary aspergillomas may cause life-threatening hemoptysis. The treatment of this condition is problematic because poor pulmonary function often precludes definitive surgical resection.. We retrospectively reviewed all patients hospitalized at our institution for hemoptysis associated with an aspergilloma over an 8-year period and who underwent percutaneous intracavitary instillation of amphotericin B (ICAB). ICAB consisted of catheter placement into the aspergilloma cavity with subsequent instillation of 50 mg amphotericin B in 20 mL 5% dextrose solution daily for 10 days.. ICAB was attempted for 23 distinct episodes of severe hemoptysis in 20 individual patients. Catheter placement was successful in 21 of the 23 episodes (91%), and of these, ICAB instillation was successfully completed in 20 episodes (95%). In these 20 episodes, hemoptysis ceased by hospital discharge in 17 of 20 patients (85%) and in all 18 who survived until a follow-up visit 1-month after treatment. Pneumothorax occurred in six of 23 (26%) catheter placement attempts without long-term complications. Recurrence of serious hemoptysis occurred after six of 18 episodes for which follow-up was available. Potential risk factors associated with severe, recurrent hemoptysis were a size increase or reappearance of the aspergilloma on a chest CT scan (P = .001), bleeding diathesis (P = .08), and lack of bronchial artery embolization during index hospitalization (P = .07).. Our data suggest that ICAB is an effective short-term treatment to control severe hemoptysis caused by pulmonary aspergilloma. The long-term benefit of this procedure is unknown. We identified several potential risk factors for recurrent hemoptysis after ICAB that could be examined prospectively in future trials.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillus; Catheters; Female; Hemoptysis; Humans; Instillation, Drug; Longitudinal Studies; Lung; Male; Middle Aged; Pulmonary Aspergillosis; Retrospective Studies; Risk Factors; Secondary Prevention; Severity of Illness Index; Treatment Outcome

Pulmonary cryptococcosis can be clinically silent in non-HIV infected patients but can also present as nodules and masses on the chest radiograph, which can be mistaken for tuberculosis or lung cancer. Common symptoms include fever and cough, and uncommonly haemoptysis. This report illustrates a non-HIV infected patient whose main complaint was haemoptysis and headache. He was diagnosed with pulmonary cryptococcosis from biopsy of an endobronchial mass found on flexible bronchoscopy. Disseminated cryptoccoccal infection should be considered as a differential diagnosis in non-HIV infected patients presenting with haemoptysis and headache. Early recognition and administration of appropriate therapy will improve clinical outcome in these patients.

Topics: Adult; Amphotericin B; Antifungal Agents; Cryptococcosis; Diagnosis, Differential; Fluconazole; Headache; Hemoptysis; Humans; Lung Diseases, Fungal; Lung Neoplasms; Recurrence

We report a case of pulmonary zygomycosis in an adult male diabetic patient who presented with fever and altered sensorium initially and later developed streaky haemoptysis. Bronchoscopy showed picture of necrotizing pneumonia. Sputum was negative for fungal elements on admission but later bronchial wash and repeat sputum samples were positive by microscopy and culture showed growth of Rhizopus species. Immediately the patient was put on amphotericin B but had a bout of massive haemoptysis and succumbed. A high index of suspicion is needed for an early diagnosis and aggressive treatment of this infection in view of the high mortality rate.

Topics: Amphotericin B; Bronchoalveolar Lavage Fluid; Diabetes Complications; Fatal Outcome; Hemoptysis; Humans; Hydroxides; Lung Diseases, Fungal; Male; Middle Aged; Mucormycosis; Pneumonia; Potassium Compounds; Rhizopus; Sputum

We report a case of invasive fungal pulmonary infection in a cystic fibrosis patient. Clinical deterioration coincided with isolation of Wangiella dermatitidis from her sputum, and treatment with amphotericin B followed by voriconazole resulted in clinical improvement and sterilization of the sputum. This case suggests that W. dermatitidis may be an etiologic agent of invasive pulmonary disease in the cystic fibrosis population.

Topics: Adult; Amphotericin B; Antifungal Agents; Cystic Fibrosis; Exophiala; Female; Hemoptysis; Humans; Lung Diseases, Fungal; Magnetic Resonance Imaging; Pyrimidines; Sputum; Triazoles; Voriconazole

To investigate diagnostic aspects of invasive aspergillosis (IA) in allogeneic BMT recipients, the charts of 22 consecutive patients with IA transplanted in 1989-1995 were reviewed. IA was diagnosed 69-466 days (median 131 days) post BMT. In 16 patients (73%), a definite or probable diagnosis of IA was made during life. Respiratory symptoms were the presenting feature in half of the patients followed by neurological symptoms (27%). Chest X-ray revealed single or multiple nodular lesions in 10 patients; cavitation was observed in five patients. Tissue biopsy was the most common method of diagnosis (nine patients: lungs 6, liver 1, subcutaneous tissue 1, brain 1). Five IA cases were detected by nine guided fine needle lung biopsies in eight patients and without complications. Bronchoalveolar lavage was performed in 14 patients with findings suggestive of invasive pulmonary aspergillosis in eight cases. Lungs were the most common organ affected (90%) followed by central nervous system (41%). The diagnosis of IA is still difficult, and a large number of patients have advanced infection at diagnosis. Methods for early diagnosis are needed. Patients with a clinical suspicion of IA should be treated vigorously with antifungal agents during the diagnostic work-up.

Topics: Adolescent; Adult; Amphotericin B; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Aspergillus niger; Autopsy; Biopsy, Needle; Bone Marrow Transplantation; Bronchoalveolar Lavage Fluid; C-Reactive Protein; Cohort Studies; Female; Fever; Graft Survival; Graft vs Host Disease; Hematologic Neoplasms; Hemoptysis; Humans; Lung; Male; Middle Aged; Nervous System Diseases; Neutropenia; Radiography, Thoracic; Respiratory Tract Diseases; Tomography, X-Ray Computed; Transplantation, Homologous

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Hemoptysis; Humans; Lung Diseases, Fungal; Male

In invasive aspergillosis, the duration of neutropenia is an accepted risk factor, and recovery from neutropenia is generally associated with a favourable outcome. However, the rapidity of granulocyte recovery may rarely be associated with adverse sequelae. The purpose of this study was to define the relationship between neutrophil (polymorphonuclear, PMN) recovery after chemotherapy-induced bone marrow aplasia and the occurrence of severe pulmonary complications (haemoptysis, pneumothorax and death) in patients with haematological malignancies who developed invasive fungal pneumonias.. Twenty consecutive patients were retrospectively studied; eight of them had developed pulmonary events between 5 and 11 days after neutrophil recovery that followed deep neutropenia (PMN < 100 microL-1).. Five patients had haemoptysis (one of these also had pneumothorax) and three had pneumothorax. According to the multiplicative logistic model, the odds of occurrence of a pulmonary event increased significantly with increasing PMN count on the fifth day (P < 0.001). Five of the eight patients who had pulmonary complications died. Also, the risk of death was larger in the presence of rapid neutrophil recovery, although the difference was not statistically significant (P = 0.111). Analysis of clinical and laboratory data showed that the risk of pulmonary complications significantly increased when the neutrophil concentration was > 4500 microL-1 on day 5 after deep granulocyte neutropenia (PMN < 100 microL-1). There was no correlation between pulmonary complications, dosage of amphotericin B and deaths.. The occurrence of life-threatening complications in patients with invasive fungal pneumonia is closely related to rapid PMN recovery.

Topics: Adolescent; Adult; Aged; Amphotericin B; Aspergillosis; Female; Granulocytes; Hemoptysis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Neutropenia; Neutrophils; Pneumothorax; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome

A 58-year-old woman with acute myelogenous leukemia in complete remission underwent successful pulmonary resection for massive hemoptysis occurring after resolution of pulmonary aspergillosis. Despite the fact that the role of surgery in the treatment of pulmonary mycosis in immunocompromised hosts is still to be clearly defined, emergency lung resections can be successfully performed in this group of patients with almost immediate recovery of stable clinical parameters. Brisk recovery can reduce overall morbidity and mortality and allow for early resumption of any necessary treatment for underlying disease.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Fatal Outcome; Female; Hemoptysis; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Lung; Lung Diseases; Middle Aged; Radiography, Thoracic; Salvage Therapy

A previously healthy and asymptomatic 7-year-old white boy presented with a history of two episodes of hemoptysis productive of bright red blood in the 5 days preceding admission. After admission he developed massive hemoptysis that, on bronchoscopy, was noted to be emanating from the right lower lobe. An emergency right lower lobe resection was done. Pathological examination revealed hilar adenopathy and peripheral lesions with caseating granulomas containing yeast, morphologically consistent with Histoplasma capsulatum.

Topics: Amphotericin B; Antifungal Agents; Bronchoscopy; Child; Drug Therapy, Combination; Hemoptysis; Histoplasmosis; Humans; Itraconazole; Lung; Lung Diseases, Fungal; Male; Pneumonectomy; Recurrence

We present 2 patients with pulmonary aspergilloma complicated by massive hemoptysis who were not good candidates for surgery and were treated with intracavitary amphotericin B after arterial embolization failed. In spite of the size of the mycetomas, response to treatment was excellent with full regression of the aspergilloma after 3 to 4 weeks; precipitins to Aspergillus fumigatus became negative and the fungus disappeared from transcatheter aspirate samples. Massive hemoptysis was controlled with epsilon-amino-caproic acid instilled by catheter. No complications were observed, the treatment was well tolerated and no recurrence occurred over a follow-up period of 24 and 18 months, respectively. This local treatment is the best therapeutic alternative for patients with pulmonary aspergilloma who are not candidates for surgery.

Topics: Aminocaproic Acid; Amphotericin B; Aspergillosis; Catheterization; Drug Tolerance; Follow-Up Studies; Hemoptysis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Radiography; Time Factors

Mortality due to Invasive Pulmonary Aspergillosis (IPA) remains high in neutropenic patients due to pulmonary haemorrhage. The aim of this study was to evaluate the emergency surgical management of IPA. Seven neutropenic patients, with a mean age of 47 years (range: 30-64) (4 women and 3 men) were treated for (6 cases) acute leukaemia one Myeloma (1 case). Presumptive diagnosis of IPA was based on: Halo sign (n = 6) or air-crescent sign (n = 1) on CT scan, positive serology (n = 4), positive antigenemia (n = 3) and positive broncho-alveolar lavage (n = 1). In 2 cases, IPA diagnosis was only based on CT scan. In all cases, aspergillosis lesions were located near the left (n = 5) or right (n = 2) pulmonary artery. The type of pulmonary resection was: left superior lobectomy in 3 cases, left superior lobectomy and Fowler's segmentectomy in 1 case, Left inferior lobectomy in 1 case, right superior lobectomy in 1 case and middle lobectomy and paracardiac segmentectomy. Sleeve resection of the pulmonary artery was performed in two patients. There were no deaths or major postoperative complications. Mean hospital stay after surgery was 12 days (rang: 8-19). Histological examination confirmed the diagnosis of IPA. CT is essential to determine the optimal timing for surgery.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Combined Modality Therapy; Emergency Medicine; Female; Hemoptysis; Humans; Itraconazole; Lung Diseases, Fungal; Male; Middle Aged; Neutropenia; Pneumonectomy; Preoperative Care

The authors report 30 cases of the percutaneous treatment of symptomatic pulmonary aspergilloma by injection of amphotericine paste in patients who were not considered to be operable. The treated aspergillomas had developed as a sequel to bacilliary infection and pulmonary fibrosis. Surgery was contraindicated in these patients on account of severe respiratory failure. The authors specify the technique for the preparation of the paste and for the type of percutaneous injection, the aim being to obtain complete filling of the cavity and creating an anaerobic environment for the aspergillus. The contribution of this technique for the non-surgical treatment of patients appears interesting but should be carried on a larger series to identify the exact indications and the interaction with other new treatments which have just appeared.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Bronchial Arteries; Contraindications; Embolization, Therapeutic; Female; Hemoptysis; Humans; Injections; Lung Diseases, Fungal; Male; Middle Aged; Ointments; Palliative Care; Pneumonectomy; Pulmonary Fibrosis; Radiography, Interventional; Respiratory Insufficiency; Tomography, X-Ray Computed; Tuberculosis, Pulmonary

Surgery has been the primary choice of treatment for cavitary aspergillomas of the lung, but it is associated with relatively high morbidity and mortality. The effectiveness of percutaneous intracavitary instillation of an antifungal agent in seven patients with hemoptysis caused by cavitary aspergilloma was evaluated.. All patients had hemoptysis associated with a cavitary pulmonary aspergilloma. In four patients who had aspergillomas without lung interposed between the cavity and the chest wall, 50 mg of amphotericin B in 10 ml of 5% dextrose in water and then 8 mg of bromhexine (a mucolytic agent) mixed with 10 ml of normal saline were instilled into the cavity through an 8-French catheter daily for 15 days. In three patients who had lung interposed between the cavity and the chest wall, the treatment was administered twice at 3-day intervals through a 20-gauge needle. The presence or absence of hemoptysis was recorded after each instillation of amphotericin B, and the size of aspergilloma was assessed with follow-up radiographs.. Hemoptysis ceased within 5 days after instillation of amphotericin B in all patients. In the four patients treated through a catheter, the aspergillomas resolved completely in three patients and resolved partially in one. In the three patients treated through a fine needle, the aspergillomas resolved partially. Mild hemoptysis during the procedure, a small pneumothorax, and subcutaneous emphysema occurred in one patient each.. Our results suggest that percutaneous intracavitary instillation of amphotericin B is a safe and effective method of treating hemoptysis caused by aspergillomas.

Topics: Adult; Aged; Amphotericin B; Aspergillosis; Female; Hemoptysis; Humans; Instillation, Drug; Lung Diseases, Fungal; Male; Middle Aged; Radiography, Interventional; Recurrence

Topics: Adult; Amphotericin B; Aspergillosis; Hemoptysis; Humans; Injections, Intralesional; Lung Diseases, Fungal; Male

Surgical therapy for massive hemoptysis associated with pulmonary aspergilloma carries a high morbidity and mortality in patients with limited pulmonary reserve. Bronchial artery embolization has proven ineffective in treating and in preventing recurrent episodes of hemoptysis in this group of patients. Over a four-and-one-half year period, we have successfully treated six episodes of acute hemoptysis in four patients using a percutaneously placed catheter and intracavitary instillation of amphotericin B, N-acetylcysteine, and aminocaproic acid. Advantages of this method of treatment for patients with severely compromised pulmonary reserve include: (1) no further loss of lung function; (2) ease and rapidity of catheter insertion; (3) prompt response to treatment; (4) relatively short hospitalization; and (5) ability to repeat the procedure in the same or another cavity if necessary.

Topics: Acetylcysteine; Aminocaproates; Amphotericin B; Aspergillosis; Catheterization; Catheters, Indwelling; Female; Hemoptysis; Humans; Lung Diseases, Fungal; Male; Middle Aged

Two recent cases of bilateral broncho-pulmonary aspergilloma offer the authors an opportunity to review the treatment of aspergilloma with injections of amphotericin B and Monaldi's intracavitary aspiration technique. In patients with very poor general condition and when surgical excision cannot be contemplated, this technique remains very useful, especially since treatments with intravenous or oral antifungal drugs are frequently ineffective. The indications, method and possible complications of the intracavitary aspiration technique are described. The literature concerning this treatment is reviewed.

Topics: Aged; Amphotericin B; Aspergillosis; Combined Modality Therapy; Drainage; Female; Hemoptysis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Radiography

A 41-year-old man was admitted for evaluation of hemoptysis, dysphagia, and pleuritic chest pain associated with a mediastinal mass. Esophagography demonstrated a fistula between the mass and the esophagus. Results of histoplasmosis complement fixation serologic testing suggested an active infection. A methenamine silver stain of a lymph node obtained at mediastinoscopy revealed Histoplasmosis capsulatum. The patient was successfully treated with amphotericin B. This is believed to be the first reported case of an esophageal fistula as a complication of mediastinal histoplasmosis successfully treated with amphotericin B.

Topics: Adult; Amphotericin B; Ceftriaxone; Drug Therapy, Combination; Esophageal Fistula; Hemoptysis; Histoplasmosis; Humans; Male; Mediastinal Diseases; Metronidazole

During the period 1969 to 1974, 41 patients having cultures positive for aspergillus were seen on the thoracic surgical services of the University of Maryland and Mt. Wilson State Hospitals. Intracavitary mycetoma was present in 36 patients. In 32 the underlying disease was chronic cavitary tuberculosis, 5 had decreased immunity due to other diseases, and in 3 no underlying disease was noted. One final patient developed a mycetoma following repair of tetralogy of Fallot. Hemoptysis, the predominant symptom, occurred in 23 patients, all of whom were from the group with intracavitary mycetoma. Hemoptysis was life-threatening in 8 patients, severe but not life-threatening in 12, and minimal in 3. Fifteen patients underwent pulmonary resection with 2 deaths. Both patients who died had undergone emergency resection for life-threatening hemoptysis; the fungus ball had developed following a previous resection for tuberculosis, and both had poor pulmonary reserve. Of 10 patients with hemoptysis who were not treated surgically, chiefly because they were poor operative risks, 4 died. This study suggests that pulmonary aspergillosis, particularly of the intracavitary type, is a potentially life-threatening disease. Because of the suddenness with which massive hemoptysis may occur, pulmonary resection is recommended for all patients with intracavitary mycetoma who do not constitute prohibitive operative risks.

Topics: Adult; Aged; Amphotericin B; Aspergillosis; Female; Hemoptysis; Humans; Immunologic Deficiency Syndromes; Lung Diseases, Fungal; Male; Middle Aged; Mycetoma; Pneumonectomy; Postoperative Complications; Radiography; Tuberculosis, Pulmonary

Topics: Adolescent; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Asthma; Bronchiectasis; Child; Female; Hemoptysis; Humans; Lung Diseases, Fungal; Recurrence; Staphylococcus

Topics: Aged; Amphotericin B; Aspergillosis; Aspergillus; Blastomycosis; Follow-Up Studies; Hemoptysis; Humans; Lung; Lung Diseases, Fungal; Male; Middle Aged; Radiography

Topics: Adolescent; Adult; Amphotericin B; Aspergillosis; Chlorambucil; Dyspnea; Female; Hemoptysis; Humans; Lung Diseases, Fungal; Male; Nystatin; Prednisone; Radiography; Respiratory Hypersensitivity

Topics: Amphotericin B; Aspergillosis; Contrast Media; Hemoptysis; Humans; Injections; Lung Diseases, Fungal; Nystatin; Radiography; Suspensions