Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Mich.
Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Mich.
Am J Med. 2020 Jun;133(6):668-674. doi: 10.1016/j.amjmed.2020.02.025. Epub 2020 Mar 30.
Aspergillus spp. is a ubiquitous mold found commonly in our environment that can cause a spectrum of pulmonary disorders, ranging from a hypersensitivity reaction to an acutely invasive disease with significant mortality. Allergic bronchopulmonary aspergillosis results from airway hypersensitivity from aspergillus colonization almost exclusively in patients with asthma and cystic fibrosis. Chronic pulmonary aspergillosis typically presents in immunocompetent patients with underlying lung pathology. Treatment is primarily with antifungal agents; however, other measures such as surgical resection may be necessary. Invasive pulmonary aspergillosis is a severe infection in immunocompromised patients and is characterized by invasion of pulmonary vasculature by the Aspergillus hyphae. Recent advances in the diagnosis and management of invasive pulmonary aspergillosis include emerging risk factors such as critically ill patients, and those with chronic obstructive pulmonary disease and liver disease. In addition, noninvasive biomarkers have made it easier to suspect and diagnose invasive pulmonary aspergillosis. There are more effective and better-tolerated antifungal agents that have improved patient outcomes. This review introduces the spectrum of pulmonary aspergillosis geared toward generalists, including disease manifestations, most recent diagnostic criteria, and first-line treatment options. Involving a multidisciplinary team is vital to the early diagnosis and management of these diseases.
曲霉菌属是一种普遍存在于我们环境中的霉菌，可引起一系列肺部疾病，从对曲霉菌定植的过敏反应到具有高死亡率的急性侵袭性疾病。过敏性支气管肺曲霉病是由气道对曲霉菌定植的过敏反应引起的，几乎仅发生在哮喘和囊性纤维化患者中。慢性肺曲霉病通常发生在有基础肺部疾病的免疫功能正常的患者中。治疗主要采用抗真菌药物；但是，可能需要其他措施，如手术切除。侵袭性肺曲霉病是免疫功能低下患者的严重感染，其特征是曲霉菌菌丝侵犯肺血管。侵袭性肺曲霉病的诊断和治疗的最新进展包括新出现的危险因素，如危重症患者以及患有慢性阻塞性肺疾病和肝脏疾病的患者。此外，非侵入性生物标志物使得更容易怀疑和诊断侵袭性肺曲霉病。现在有更有效和耐受性更好的抗真菌药物，改善了患者的预后。本综述介绍了面向普通医生的肺部曲霉菌病谱，包括疾病表现、最新诊断标准和一线治疗选择。多学科团队的参与对于这些疾病的早期诊断和管理至关重要。
