Jpn. J. Infect. Dis., 53, 2000

Laboratory and Epidemiology Communications

Anti‑Fungal Chemotherapy for Symptomatic Pulmonary Aspergilloma
Akihiko Kawana*, Yasuhiro Yamauchiand Koichiro Kudo
Department ofPulmonology, International Medical Center ofJapan,
TToyama 1‑21‑1, Shinjuku‑ku, 7Tob/0 162‑8655
Communicated by Hiroshi Yoshikura(Accepted March 30, 2000)

Although radical treatment of pulmonary aspergilloma is

Table I. A good response was obtained in 9 of2l cases

surgical resection (1 , 2), it is o洗en difrlCult for aged patients(42.8%). In particular, 5 cases showed complete disappearance

withlow pulmonaryfunction･ In this study, we attempted todetermine theindications for systemicanti‑fungal treatment
incases of symptomatic pulmonary aspergilloma･

ofthefungus ball afteranti一血ngal treatment; as revealed by

CT scan, all of them had a "spongiform"fungus ball before
血e血erapy (Fig.).

From January 1994 to July 1998, 40 aspergilloma cases

In terms of the adverse effects ofanti一血ngal drugs, 5 (36%)

admitted with symptoms ofhemoptysisand fever were evalu‑

cases experienced renal dysfunction caused by AMPH,and 4

ated retrospectively･ The diagnosis of aspergilloma was basedon the following findings: 1) existence ofafungus ballinthe(25%) cases experienced abdominal discomfわrt caused byITCZ.

cavitary lesion on chest X‑ray fllmand/or CT scan, 2) detec‑

The surgical group consisted of significantly younger

tion ofAspergilus sp･ ln SPeCimens obtained from the airway,

subjects with better nutritional statesincomparison withthechemotherapy group. Pulmonary function of the surglCal

such as expectorated sputum and broncho‑alveolar lavage

nuid, and 3) positive result of serum aspergillus precipitingroup was slgnificantly better thanthe chemotherapy group

test･ The effectiveness ofanti‑fungal treatment was assessed(Table 2). These results suggestthat agedand/or low pulmonaryby 1) clinical symptoms, 2) radiological findings, and 3)

function patients may beindicated foranti‑fungal treatment.
However, the anti‑fungal chemotherapy for pulmonary

microbiological data･ If the patients remained unchangedinregard to thethree criteria or if at least one criterion showed
unfavorable changes,thetherapy was consideredineffective;
otherwise it was considered effective. Statistical evaluation

aspergilloma has not beenfully evaluated (3). Combination
chemother叩y Wi也AMPH and ITCZ has remained contro‑

was assessed using the Mann‑Whitney test.
Table 1. Outcome ofanti‑fungal systemic chemotherapy for patients

Among也e 40 cases treated, 21 (53%) cases were treatedwith aspergilloma

only withanti‑fungal chemotherapy (chemotherapy group),
17 (43%) cases surgically (surgical group), and 2 cases

No. (%)

symptom atic al ly.

Compl ete

Anti‑fungal therapy was conducted as follows. Fourteenresponse(67%) cases were treated withamphotericin B (AMPH), 16(76%) withitraconazol (ITCZ),and 1 I (52%) withanAMPH‑

Radi ologi cat

ITCZ combination. Fluconazoland 5‑FC were used for 5andfindings

Symptoms

Microbiological

2 cases, respectively.

exam inations

The outcomes of the anti‑fungal treatment are shown inTotaI

As sessment*Corresponding author: Fax: +8 I ‑3‑3207‑ 1 038, E‑mail:akawana

5(24)Improved Unchanged Worsened
10 (48)9 (43)

2 (10)

66410 (48)

29(29)

7 (33)(19)

4 (19)

Effective I neffective
9 (43%)@imcj ･hosp.go.j p(29)

12 (57%)

Jpn. J. Infect. Dis., 53, 2000
scans. Roberts suggested that a spongiform fungus ballreflectsanearly stage offungus ball development (7).
In conclusion, anti‑fungal chemotherapy has a potential
for successfully treatlng aSPergilloma. It canbeindicated for
non‑Operable symptomatic aspergilloma cases, particularly

if the patients have a "Spongiform"fungus ball on CT scans.
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Figure･ …Spongifbrm''fungs ball observed by CT scan (left) andaspergilloma: diagnostic and therapeutic consideratlOnS.

tomography (right).

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Table 2･ Comparison of chemotherapy and surglCal patient groups

ofpulmonary aspergillosis. Am. Rev. Respir. Dis., 109,Chemotherapy group Surgical group P
Age (yrs)

64. 1土1 1.0

55.7土14.3Body weight (kg)45.4j=8.0

53.3j=9.6

VC (1)

2.05士0.90

2.73土0.85

FEVl0(1)

PaO2 (Torr)

1.43土0.5

75.6土12.6

157‑62.

0 0 0 0 0 糾o t似o t007 1 つ一 4 9

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slgnificantantagonism. Mycoses, 36, 42 1 ‑424.

1.98j=0.61

5･ Popp, Ⅰ. A., White, H. M. and Amstrong, D. (1999):

86.3土8.9

Amphotericin B with and without itraconazole fわrmean士S･D･, VC: vital capacity, FEV‑ 0: forced expiratory volume ininvasive aspergillosis: a three‑yearretrospective study.

first second, PaO2: Partialpressure ofO2 in arterialblood.

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versial (4), though it has been reported as effectiveincertain
cases ofaspergillosis (5). In our study, the AMPH and ITCZ

of pulmonary aspergilloma. Kekkaku, 72, 557‑564 (inJapanese).

combination produced a good result･ The response rate of

7. Roberts, C. M., Citron, M. K. and Strickland, B. (1987):

anti‑fungal treatment for aspergillomainour study was 42･8%

Intrathoracic aspergilloma: role of CT in diagnosis andtreatment. Radiology, 165, 123‑128.

in agreement with other reports (6). Good response wasobtained in cases showing uSPOngiformnfungus balls on CT30