Izumikawa Koichi
Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
Respir Investig. 2016 Mar;54(2):85-91. doi: 10.1016/j.resinv.2015.10.003. Epub 2015 Dec 10.
Chronic pulmonary aspergillosis (CPA) is a slowly progressing pulmonary syndrome caused by Aspergillus spp. Specific knowledge regarding the disease entity, diagnosis method, and management is needed. This review focuses on the recent advances in our understanding of CPA. A new clinical disease entity of chronic progressive pulmonary aspergillosis consisting of chronic necrotizing pulmonary aspergillosis and chronic cavitary pulmonary aspergillosis is proposed. Although newer antifungals are not available, evidence describing the treatment of CPA is accumulating. Longer administration of azoles is required for a better prognosis, but there is a risk of inducing azole resistance. Therapeutic drug monitoring and patient education are required. Establishing a drug-susceptibility test that can be performed in the general laboratory and the referral center are also important. Although the number of publications regarding CPA is growing, there are still many unanswered questions. Additional evidence and translational research regarding diagnosis, management, and drug resistance are urgently needed to improve the outcome of CPA.
慢性肺曲霉病（CPA）是一种由曲霉属真菌引起的缓慢进展的肺部综合征。需要有关该疾病实体、诊断方法和管理的具体知识。本综述重点关注我们对CPA认识的最新进展。提出了一种由慢性坏死性肺曲霉病和慢性空洞性肺曲霉病组成的慢性进行性肺曲霉病的新临床疾病实体。尽管尚无更新的抗真菌药物，但描述CPA治疗的证据正在积累。为了获得更好的预后，需要更长时间使用唑类药物，但存在诱导唑类耐药的风险。需要进行治疗药物监测和患者教育。建立可在普通实验室和转诊中心进行的药敏试验也很重要。尽管关于CPA的出版物数量在增加，但仍有许多问题未得到解答。迫切需要关于诊断、管理和耐药性的更多证据及转化研究，以改善CPA的治疗效果。
