[Treatment of chronic pulmonary aspergillosis (fungus ball type, mural thickness type)].

Systemic or topical treatment with antifungal agents are applied for the treatment of chronic pulmonary aspergillosis (fungus ball type, mural thickness type). Recently, the concomitant treatment with elastase inhibitor has been studied for the purpose of relieving tissue destruction by inhibiting elastase derived from aspergillus species. In the present study, we have examined the clinical effect of the topical treatment with Amphotericin B in patients with chronic pulmonary aspergillosis, and the concomitant use of Ulinastatin has also been examined in patients with symptoms such as hemosputum and hemoptysis. Amphotericin B was administered by transcatheter intracavity injection or transbronchial intrapulmonary injection. In some patients, inhalation was concomitantly employed. Amphotericin B was challenged by inhalation before starting the topical treatment, and if the patient experienced an asthma like attack, the present therapies were not conducted. Ulinastatin was administered by intravenous drip infusion concomitantly with antifungal agents and hemostatics. As a result, improvements regarding antifungal effects and clinical symptoms were found in 12 out of 15 patients treated with Amphotericin B. Further, early disappearance of hemosputum and hemoptysis was seen in 11 out of 23 episodes in 14 patients concomitantly treated with Ulinastatin. The treatment-related side effects, leading to discontinuation of those therapies, did not occur. Immunoresponse of allergy was studied in the patients ineligible for Amphotericin B topical treatment and the non-responders to Ulinastatin, and aspergillus specific IgE antibodies in serum were increased in the majority of patients. From the above results, it is desirable to carry out the topical treatment in chronic pulmonary aspergillosis. Also, it was considered valuable to apply the concomitant treatment with Ulinastatin, elastase inhibitor, to patients with severe clinical symptoms of hemosputum and hemoptysis.