Division of Pulmonary Critical Care and Sleep Medicine, Wayne State University School of Medicine, Harper University Hospital, 3990 John R, Detroit, MI 48201, USA.
Eur Respir Rev. 2011 Sep 1;20(121):156-74. doi: 10.1183/09059180.00001011.
Aspergillus is a mould which may lead to a variety of infectious, allergic diseases depending on the host's immune status or pulmonary structure. Invasive pulmonary aspergillosis occurs primarily in patients with severe immunodeficiency. The significance of this infection has dramatically increased with growing numbers of patients with impaired immune state associated with the management of malignancy, organ transplantation, autoimmune and inflammatory conditions; critically ill patients and those with chronic obstructive pulmonary disease appear to be at an increased risk. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has resulted in lower mortality rates associated with this infection. Chronic necrotising aspergillosis is a locally invasive disease described in patients with chronic lung disease or mild immunodeficiency. Aspergilloma is usually found in patients with previously formed cavities in the lung, whereas allergic bronchopulmonary aspergillosis, a hypersensitivity reaction to Aspergillus antigens, is generally seen in patients with atopy, asthma or cystic fibrosis. This review provides an update on the evolving epidemiology and risk factors of the major manifestations of Aspergillus lung disease and the clinical manifestations that should prompt the clinician to consider these conditions. Current approaches for the diagnosis and management of these syndromes are discussed.
曲霉菌是一种霉菌，根据宿主的免疫状态或肺部结构，可能会引发多种感染和过敏疾病。侵袭性肺曲霉病主要发生在严重免疫功能低下的患者中。随着越来越多的恶性肿瘤、器官移植、自身免疫和炎症性疾病患者免疫状态受损的患者数量的增加，这种感染的重要性显著增加；危重症患者和慢性阻塞性肺疾病患者的风险似乎更高。新的非侵入性检测方法的引入，加上更有效和耐受性更好的抗真菌药物，导致与这种感染相关的死亡率降低。慢性坏死性曲霉病是一种局部侵袭性疾病，见于慢性肺部疾病或轻度免疫功能低下的患者。曲霉菌球通常发生在肺部先前形成空洞的患者中，而变应性支气管肺曲霉病是对曲霉抗原的过敏反应，一般见于特应性、哮喘或囊性纤维化患者。这篇综述介绍了曲霉肺病主要表现形式的流行病学和危险因素的最新进展，以及应促使临床医生考虑这些情况的临床表现。讨论了这些综合征的诊断和管理的最新方法。
