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David W. Denning - One of the best experts on this subject based on the ideXlab platform.

  • The incidence of cutaneous squamous cell carcinoma in patients receiving voriconazole therapy for Chronic Pulmonary Aspergillosis.
    Naunyn-Schmiedeberg's archives of pharmacology, 2020
    Co-Authors: Chris Kosmidis, Chris Harris, Anna Mackenzie, Rola A. Hashad, Fiona M Lynch, David W. Denning
    Abstract:

    Voriconazole has been associated with cutaneous squamous cell carcinoma (cSCC) in transplant patients but less is known about the risk in less severely immunosuppressed patients. Our aim was to estimate the incidence of cSCC after voriconazole exposure in patients with Chronic Pulmonary Aspergillosis on a background of Chronic lung disease. The notes of patients seen at a tertiary referral centre from 2009 to 2019 with Chronic Pulmonary Aspergillosis were reviewed for the diagnosis of cSCC and voriconazole use documented. Among 1111 patients, 668 (60.1%) received voriconazole for longer than 28 days. Twelve patients received a diagnosis of cSCC; nine had used voriconazole. Mean duration of voriconazole use was 36.7 months. The crude incidence rate was 4.88 in 1000 person/years in those who had voriconazole and 2.79 in 1000 patient/years in those who did not receive voriconazole for longer than 28 days. On Cox regression, age (HR 1.09, 95% CI 1.02-1.16, p = 0.01) and male gender (HR 3.97, 95% CI 0.84-18.90, p = 0.082) were associated with cSCC. Voriconazole use was associated with a slightly increased risk, which was not significant (HR 1.35, 95% CI 0.35-5.20, p = 0.659). Voriconazole use beyond 28 days did not lead to a significantly increased risk of cSCC in a large cohort of patients with Chronic Pulmonary Aspergillosis.

  • Optimising the cut-off of the Bordier Aspergillus IgG ELISA for the diagnosis of Chronic Pulmonary Aspergillosis.
    Journal of microbiological methods, 2020
    Co-Authors: Bayu A. P. Wilopo, Elizabeth Stucky Hunter, Malcolm Richardson, David W. Denning
    Abstract:

    Aspergillus IgG detection is an essential tool in the diagnosis and treatment of Chronic Pulmonary Aspergillosis (CPA), and is often positive in allergic bronchoPulmonary Aspergillosis and Aspergillus bronchitis. The Bordier ELISA had an 83.3% sensitivity (identical to ImmunoCap at a cut-off of 40mgA/L) and 97.3% specificity using a cut-off of 0.9 and a diagnostic accuracy of 90.9%.

  • Evaluation and comparison of automated and manual ELISA for diagnosis of Chronic Pulmonary Aspergillosis (CPA) in Indonesia
    Diagnostic microbiology and infectious disease, 2020
    Co-Authors: Findra Setianingrum, Riina Rautemaa-richardson, Anna Rozaliyani, Ridhawati Syam, Robiatul Adawiyah, Mulyati Tugiran, Cut Yulia I. Sari, Erlina Burhan, Retno Wahyuningsih, David W. Denning
    Abstract:

    Abstract Pulmonary tuberculosis (TB) is one of the common risk factors for Chronic Pulmonary Aspergillosis (CPA). A positive Aspergillus IgG is a key element of the diagnosis of CPA but this has not been studied in Indonesia. We conducted studies with patients at the end of TB therapy in Indonesia. We performed receiver operating curve (ROC) analysis to determine the optimum cutoff of the Aspergillus-specific IgG level (Immulite and Dynamiker ELISA) in those patients who met criteria of CPA in relation to control groups. In 203 TB patients, 26 (13%) patients had clinical and radiological features of CPA. We derived optimum cutoffs for Immulite Aspergillus-specific IgG of 11.5 mg/L and Dynamiker anti-galactomannan IgG of 106.8 AU/mL (sensitivity 89% and 83%, specificity 78% and 51%, respectively). The currently accepted Aspergillus-specific IgG cutoff of Immulite and Dynamiker assays for CPA diagnosis may require slight adjustment for the Indonesian population.

  • Clinical outcomes of patients with Chronic Pulmonary Aspergillosis managed surgically.
    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2020
    Co-Authors: Findra Setianingrum, Riina Rautemaa-richardson, R. Shah, David W. Denning
    Abstract:

    Objectives Surgical resection is one treatment modality for Chronic Pulmonary Aspergillosis (CPA), and sometimes a preoperative presumption of lung cancer turns out to be CPA. We have audited our surgical experience with regard to risk factors for relapse, and the value of postoperative monitoring of Aspergillus-immunogolubulin G (IgG) titres. Methods All patients with CPA surgically treated at National Aspergillosis Centre (NAC), Manchester, UK (2007-2018), were retrospectively evaluated. Surgical procedures, underlying disorders, Aspergillus-IgG titres (ImmunoCap) and antifungal therapy were evaluated for symptom control, operative complications, CPA relapse and mortality. Results A total of 61 patients with CPA (28 males, 33 females) were operated on primarily for antifungal therapy failure (51%, n = 31) and presumed lung malignancies (38%, n = 23). Procedures included lobectomy (64%, n = 39), wedge resection (28%, n = 17), segmentectomy (n = 3), pneumonectomy (n = 3) and decortication (n = 2). Overall, 25 (41%) patients relapsed, 26 months (standard deviation: 24.8 months) after surgery. Antifungal therapy before surgery (P = 0.002) or both before and after surgery (P = 0.005) were protective for relapse. The relapse rate within 3 years after surgery (33%, n = 20) was higher than the 3-10 years after surgery (8%, n = 5). At the end of follow-up, the median Aspergillus-IgG titre was lower than at relapse in 12 patients (67 vs 126 mg/l) (P = 0.016). Conclusions Surgery in these selected patients with CPA resulted in favourable outcomes. Relapse is common after surgical treatment of CPA but can be minimized with antifungal therapy, emphasizing the importance of an accurate diagnosis prior to surgery.

  • Interferon gamma replacement as salvage therapy in Chronic Pulmonary Aspergillosis: effects on frequency of acute exacerbation and all-cause hospital admission
    Thorax, 2020
    Co-Authors: Edward J M Monk, David W. Denning, Chris Harris, Gemma Hayes, Rainer Döffinger, Chris Kosmidis
    Abstract:

    Chronic Pulmonary Aspergillosis (CPA) is often poorly responsive to antifungal treatment; secondary infections increase morbidity/mortality, particularly in progressive cases. Interferon gamma (IFNγ) has been implicated in not only Aspergillus control but also bacterial clearance. Clinical notes of patients with CPA treated with IFNγ (2011-2018) were retrospectively hand-searched. In patients treated for >12 months (n=20), the frequency of acute exacerbation reduced from 3.1 to 1.4 episodes/year (p=0.006) in the 12 months after treatment initiation compared with the 12 months before. A significant reduction in the frequency of hospital admissions/year was also observed (0.8 to 0.3, p=0.04). These findings support further prospective studies.

Chris Kosmidis - One of the best experts on this subject based on the ideXlab platform.

  • The incidence of cutaneous squamous cell carcinoma in patients receiving voriconazole therapy for Chronic Pulmonary Aspergillosis.
    Naunyn-Schmiedeberg's archives of pharmacology, 2020
    Co-Authors: Chris Kosmidis, Chris Harris, Anna Mackenzie, Rola A. Hashad, Fiona M Lynch, David W. Denning
    Abstract:

    Voriconazole has been associated with cutaneous squamous cell carcinoma (cSCC) in transplant patients but less is known about the risk in less severely immunosuppressed patients. Our aim was to estimate the incidence of cSCC after voriconazole exposure in patients with Chronic Pulmonary Aspergillosis on a background of Chronic lung disease. The notes of patients seen at a tertiary referral centre from 2009 to 2019 with Chronic Pulmonary Aspergillosis were reviewed for the diagnosis of cSCC and voriconazole use documented. Among 1111 patients, 668 (60.1%) received voriconazole for longer than 28 days. Twelve patients received a diagnosis of cSCC; nine had used voriconazole. Mean duration of voriconazole use was 36.7 months. The crude incidence rate was 4.88 in 1000 person/years in those who had voriconazole and 2.79 in 1000 patient/years in those who did not receive voriconazole for longer than 28 days. On Cox regression, age (HR 1.09, 95% CI 1.02-1.16, p = 0.01) and male gender (HR 3.97, 95% CI 0.84-18.90, p = 0.082) were associated with cSCC. Voriconazole use was associated with a slightly increased risk, which was not significant (HR 1.35, 95% CI 0.35-5.20, p = 0.659). Voriconazole use beyond 28 days did not lead to a significantly increased risk of cSCC in a large cohort of patients with Chronic Pulmonary Aspergillosis.

  • Interferon gamma replacement as salvage therapy in Chronic Pulmonary Aspergillosis: effects on frequency of acute exacerbation and all-cause hospital admission
    Thorax, 2020
    Co-Authors: Edward J M Monk, David W. Denning, Chris Harris, Gemma Hayes, Rainer Döffinger, Chris Kosmidis
    Abstract:

    Chronic Pulmonary Aspergillosis (CPA) is often poorly responsive to antifungal treatment; secondary infections increase morbidity/mortality, particularly in progressive cases. Interferon gamma (IFNγ) has been implicated in not only Aspergillus control but also bacterial clearance. Clinical notes of patients with CPA treated with IFNγ (2011-2018) were retrospectively hand-searched. In patients treated for >12 months (n=20), the frequency of acute exacerbation reduced from 3.1 to 1.4 episodes/year (p=0.006) in the 12 months after treatment initiation compared with the 12 months before. A significant reduction in the frequency of hospital admissions/year was also observed (0.8 to 0.3, p=0.04). These findings support further prospective studies.

  • Chronic Pulmonary Aspergillosis update: A year in review
    Medical mycology, 2019
    Co-Authors: Aleksandra Barac, Chris Kosmidis, Ana Alastruey-izquierdo, Helmut J. F. Salzer, Cpanet
    Abstract:

    Chronic Pulmonary Aspergillosis (CPA) is an uncommon, slowly destructive Pulmonary disease characterized by progressive cavitation, fibrosis, and pleural thickening. CPA is usually seen in immunocompetent individuals with underlying respiratory disorders. Estimates suggest that up to 3 million people are affected worldwide causing high rates of morbidity and mortality. Pulmonary tuberculosis (TB) seems to be the most relevant driver for the global burden of CPA with estimates suggesting about 1.2 million patients with CPA as a sequel to TB. Diagnosis of CPA is often challenging and delayed and should be based upon a combination of characteristics. The first guidelines for the diagnosis and management of CPA were published in 2016 jointly by the European Society for Clinical Microbiology and Infectious Diseases (ESCMID), the European Respiratory Society (ERS), and the European Confederation of Medical Mycology (ECMM). CPA continues to receive significant public attention, which resulted in almost 150 newly published papers during 2017. The aim of this mini-review is to highlight the most important published papers from January 2017 to April 2018 to provide an update on current developments in the field of CPA.

  • Chronic Pulmonary Aspergillosis following Pulmonary embolism
    Elsevier, 2019
    Co-Authors: Ruth Tunney, David W. Denning, K. Rodger, Chris Kosmidis
    Abstract:

    Chronic Pulmonary Aspergillosis (CPA) is predominantly found alongside cavitating or bullous lung diseases. Although Pulmonary embolism may cause cavitation, an association with CPA has not been well described. We describe a case of CPA in a 79-year-old female following bilateral Pulmonary emboli. The clinical implications are numerous, including the dilemma of anticoagulation. This link suggests that a lower threshold for suspecting CPA following Pulmonary embolus is required, even in the absence of other respiratory disease. Keywords: Pulmonary, Embolism, Chronic, Aspergillosi

  • Chronic Pulmonary Aspergillosis following Pulmonary embolism.
    Medical mycology case reports, 2018
    Co-Authors: Ruth Tunney, David W. Denning, K. Rodger, Chris Kosmidis
    Abstract:

    Abstract Chronic Pulmonary Aspergillosis (CPA) is predominantly found alongside cavitating or bullous lung diseases. Although Pulmonary embolism may cause cavitation, an association with CPA has not been well described. We describe a case of CPA in a 79-year-old female following bilateral Pulmonary emboli. The clinical implications are numerous, including the dilemma of anticoagulation. This link suggests that a lower threshold for suspecting CPA following Pulmonary embolus is required, even in the absence of other respiratory disease.

Won-jung Koh - One of the best experts on this subject based on the ideXlab platform.

  • Effect of a 150 mg dose of rifabutin on serum itraconazole levels in patients with coexisting Chronic Pulmonary Aspergillosis and Mycobacterium avium complex lung disease
    Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy, 2017
    Co-Authors: Seong Mi Moon, Hye Yun Park, Kyeongman Jeon, Soo-youn Lee, Byung Woo Jhun, Hyun Kyu Lee, Won-jung Koh
    Abstract:

    Patients with coexisting Chronic Pulmonary Aspergillosis and nontuberculous mycobacterial lung disease may undergo treatment with both the antifungal itraconazole and the antimycobacterial rifamycin. However, rifamycins interact with itraconazole. We examined the effects of a 150 mg dose of rifabutin on serum itraconazole levels and found significantly lower levels in 28 patients receiving itraconazole with rifabutin (median, 0.65 μg/ml) compared with 65 patients receiving itraconazole alone (median 3.45 μg/ml, P 

  • Development of Chronic Pulmonary Aspergillosis in a patient with NTM-LD.
    2017
    Co-Authors: Byung Woo Jhun, Hye Yun Park, Kyeongman Jeon, Woo Jin Jung, Na Young Hwang, Eun-suk Kang, Won-jung Koh
    Abstract:

    Chest computed tomography images are shown for a 69-year-old female patient with Mycobacterium intracellulare lung disease. (A) At the time of initiation of antibiotic therapy for M. intracellulare lung disease, there was a large cavitary consolidation in the right upper lobe. Serum Aspergillus precipitin antibody was negative. (B) After 12 months of antibiotic therapy for M. intracellulare lung disease, cavitary consolidation in the right upper lobe was improved, and sputum cultures for NTM were negative. (C) After 18 months of antibiotic therapy for M. intracellulare lung disease, the patient’s respiratory symptoms and the consolidation in the right upper lobe were aggravated. Sputum cultures for NTM were negative. However, serum Aspergillus precipitin antibody was strongly positive, and Chronic Pulmonary Aspergillosis was diagnosed.

  • Effect of Rifampin and Rifabutin on Serum Itraconazole Levels in Patients with Chronic Pulmonary Aspergillosis and Coexisting Nontuberculous Mycobacterial Infection
    Antimicrobial agents and chemotherapy, 2014
    Co-Authors: Seong Mi Moon, Hye Yun Park, Byeong-ho Jeong, Kyeongman Jeon, Soo-youn Lee, Won-jung Koh
    Abstract:

    We investigated the effects of rifampin and rifabutin on serum itraconazole levels in patients with Chronic Pulmonary Aspergillosis. Serum itraconazole concentrations were significantly lower in patients who received itraconazole with rifampin (median, 0.1 μg/ml; P < 0.001) or rifabutin (median, 0.34 μg/ml; P < 0.001) than those receiving itraconazole alone (median, 5.92 μg/ml). Concomitant use of rifampin or rifabutin and itraconazole should be avoided in patients with Chronic Pulmonary Aspergillosis and coexisting mycobacterial infections.

  • Serum galactomannan antigen test for the diagnosis of Chronic Pulmonary Aspergillosis.
    The Journal of infection, 2014
    Co-Authors: Beomsu Shin, Hye Yun Park, Byeong-ho Jeong, Won-jung Koh, Gee Young Suh, O Jung Kwon, Hongseok Yoo, Kyeongman Jeon
    Abstract:

    Summary Background A serum galactomannan (GM) antigen test has been widely used to diagnose invasive Pulmonary Aspergillosis. However, there are limited data on the use of the serum GM antigen test for the serologic diagnosis of Chronic Pulmonary Aspergillosis (CPA). Methods Data were collected from all consecutive patients with a clinical suspicion of CPA who underwent a serum GM antigen test. Results In total, 334 patients who were suspected to have CPA were eligible for this study and 168 (50%) patients were finally diagnosed with CPA. The serum GM antigen test was positive in 38 (23%) patients with CPA and in 25 (15%) patients without CPA. The sensitivity of the serum GM antigen test was 23% (95% confidence interval [CI], 17–30%), and its specificity was 85% (95% CI, 79–90%), with positive and negative predictive values of 60% (95% CI, 47–72%) and 52% (95% CI, 46–58%), respectively. The accuracy of the test was 54%. The area under the receiver operating characteristic curve was 0.538 (95% CI, 0.496–0.580). Conclusion The serum GM antigen test could not be used for the serologic diagnosis of CPA.

  • Clinical characteristics and treatment outcomes of Chronic Pulmonary Aspergillosis.
    Medical mycology, 2013
    Co-Authors: Byung Woo Jhun, Kyeongman Jeon, Jung Seop Eom, Ji Hyun Lee, Gee Young Suh, O Jung Kwon, Won-jung Koh
    Abstract:

    Chronic Pulmonary Aspergillosis (CPA) is a relatively uncommon disease that has been poorly characterized. This study investigated the clinical features and treatment outcomes of CPA through a retrospective review of records of patients with newly diagnosed CPA between January 2008 and January 2012. A total of 70 CPA patients, which included 51 (73%) males, had a median age of 55 years. Fifty-seven patients (81%) had a history of Pulmonary tuberculosis and Pulmonary disease caused by nontuberculous mycobacteria (NTM) was a primary underlying condition in 32 patients (46%). Most patients (n = 66; 99%) were treated with oral itraconazole, for a median of 6.4 months. Treatment response of 73% of patients was based on alleviation of symptoms and in 44% on computed tomography. Laboratory tests improved for more than 60% of patients and overall favorable responses were achieved in 44 patients (62%). Five of the latter (11%) had to restart antifungal therapy after a median of 9.2 months after therapy. Death occurred in 10 patients (14%). This study suggested that NTM lung disease was an important risk factor for CPA development. While treatment with oral itraconazole for approximately 6 months was moderately effective in treating CPA, a more effective treatment is required.

Jacques Cadranel - One of the best experts on this subject based on the ideXlab platform.

  • Chronic Pulmonary Aspergillosis: Prevalence, favouring Pulmonary diseases and prognosis
    The European respiratory journal, 2021
    Co-Authors: T. Maitre, C. Godet, Jonathan Cottenet, Adrien Roussot, Nafiz Abdoul Carime, Antoine Parrot, Philippe Bonniaud, Catherine Quantin, Jacques Cadranel
    Abstract:

    Chronic Pulmonary Aspergillosis (CPA) is an emerging disease in patients with common Chronic Pulmonary diseases (CPD). While its prevalence is linked to tuberculosis (TB) in endemic countries, epidemiologic and prognostic data are lacking in low TB incidence countries. The aim of this study was to describe these features in CPA patients hospitalised in France between 2009 and 2018.We estimated the prevalence and mortality of hospitalised CPA patients using the French nationwide administrative hospital database. We also assessed the association with CPDs, thoracic interventions, and malnutrition.From 2009 to 2018, 17 290 patients were hospitalised in France for CPA, with an increasing prevalence during this period. Most patients were male (63.5%) with a median age of 65 years at CPA diagnosis, living in farming regions and large cities. The proportion of underlying Chronic obstructive Pulmonary disease (COPD) and emphysema during the previous 5 years was 44% and 22%, respectively, whereas it was only 3% for both TB and non-TB mycobacterial (NTM) infections. The mortality rates during the first hospitalisation, at 1 year, and at 5 years were 17%, 32%, and 45%, respectively. In multivariate analysis, mortality rates were increased in patients aged over 65 years, males and patients with malnutrition, diabetes, or lung cancer history. The risk of mortality in patients with COPD or emphysema was higher compared to those with previous mycobacterial lung infection.In France CPA is an emerging infection commonly associated with non-mycobacterial CPD. This shift in the distribution profile of underlying CPD will likely worsen CPA mortality.

  • Treatment of Chronic Pulmonary Aspergillosis: Current Standards and Future Perspectives.
    Respiration; international review of thoracic diseases, 2018
    Co-Authors: Ana Alastruey-izquierdo, Chris Kosmidis, Jacques Cadranel, Christoph Lange, Oxana Munteanu, Cendrine Godet, Holger Flick, Christophe Hennequin, Martin Hoenigl, Iain D Page
    Abstract:

    Chronic Pulmonary Aspergillosis (CPA) complicates conditions including tuberculosis, Chronic obstructive Pulmonary disease and sarcoidosis, and is associated with high morbidity and mortality. Surgical cure should be considered where feasible; however, many patients are unsuitable for surgery due to extensive disease or poor respiratory function. Azoles are the only oral drug with anti-Aspergillus activity and itraconazole and voriconazole are considered as first-line drugs. A randomized controlled trial demonstrated improvement or stability in three-quarters of patients given 6 months of itraconazole, but a quarter relapsed on stopping therapy. Long-term treatment may therefore be required in some cases. Itraconazole, voriconazole and posaconazole require therapeutic drug monitoring. No published data are yet available for isavuconazole. Adverse drug effects of azoles are common, including peripheral neuropathy, heart failure, elevated liver enzymes, QTc prolongation and sun sensitivity. Many serious drug-drug interactions occur, including major interactions with rifamycins, simvastatin, warfarin, clopidogrel, immunosuppressant drugs like sirolimus. Furthermore, drug resistance occurs, including cross-resistance to all azoles, but the true prevalence is not yet determined. Intravenous therapy is possible with echinocandins or amphotericin B, but long-term use is challenging. Hemoptysis complicates CPA and can be fatal. Tranexamic acid should be given acutely to reduce bleeding. Bronchial artery embolization can stop acute bleeds. In some circumstances, emergency surgery may be necessary to resect the source of the bleed. Current CPA treatments can be beneficial but have many drawbacks. New oral anti-Aspergillus agents are needed, along with optimization of currently available treatments.

  • Chronic Pulmonary Aspergillosis: rationale and clinical guidelines for diagnosis and management
    The European respiratory journal, 2015
    Co-Authors: David W. Denning, Catherine Beigelman-aubry, Jacques Cadranel, Florence Ader, Arunaloke Chakrabarti, Stijn Blot, Andrew J. Ullmann, George Dimopoulos, Christoph Lange
    Abstract:

    Chronic Pulmonary Aspergillosis (CPA) is an uncommon and problematic Pulmonary disease, complicating many other respiratory disorders, thought to affect ~240 000 people in Europe. The most common form of CPA is Chronic cavitary Pulmonary Aspergillosis (CCPA), which untreated may progress to Chronic fibrosing Pulmonary Aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive Pulmonary Aspergillosis (formerly called Chronic necrotising Pulmonary Aspergillosis) is a more rapidly progressive infection (

  • Characteristics and outcomes of Chronic Pulmonary Aspergillosis: a retrospective analysis of a tertiary hospital registry
    The Clinical Respiratory Journal, 2015
    Co-Authors: Boubou Camara, Emilie Reymond, Christel Saint-raymond, Hubert Roth, Marie-pierre Brenier-pinchart, Claudine Pinel, Jacques Cadranel, Gilbert Ferretti, Hervé Pelloux, Christophe Pison
    Abstract:

    INTRODUCTION: Our objective was to investigate characteristics risk factors and outcomes of patients with Chronic Pulmonary Aspergillosis (CPA). METHODS: The Aspergillosis Committee prospectively collected Aspergillus notifications from January 2000 to December 2011. A retrospective analysis of data was performed.

  • Chronic Pulmonary Aspergillosis: An Update on Diagnosis and Treatment
    Respiration; international review of thoracic diseases, 2014
    Co-Authors: C. Godet, Francois Laurent, B. Philippe, Jacques Cadranel
    Abstract:

    Chronic Pulmonary Aspergillosis (CPA) affects individuals with non-systemic or mildly systemic immunodepression or altered Pulmonary integrity due to underlying disease. It has been reported with a variety of clinical and radiological patterns. The condition should be distinguished from simple aspergilloma and allergic bronchoPulmonary Aspergillosis as well as invasive Aspergillosis in severely immunocompromised patients. CPA generally requires long-term antifungal treatment and surgery may be considered. Life-threatening haemoptysis may be prevented by bronchial arteriography with embolisation. However, currently there are no documented treatment recommendations for CPA. This review provides an up-to-date practical overview of this condition, including a comprehensive update on diagnosis and management.

Kyeongman Jeon - One of the best experts on this subject based on the ideXlab platform.

  • Effect of a 150 mg dose of rifabutin on serum itraconazole levels in patients with coexisting Chronic Pulmonary Aspergillosis and Mycobacterium avium complex lung disease
    Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy, 2017
    Co-Authors: Seong Mi Moon, Hye Yun Park, Kyeongman Jeon, Soo-youn Lee, Byung Woo Jhun, Hyun Kyu Lee, Won-jung Koh
    Abstract:

    Patients with coexisting Chronic Pulmonary Aspergillosis and nontuberculous mycobacterial lung disease may undergo treatment with both the antifungal itraconazole and the antimycobacterial rifamycin. However, rifamycins interact with itraconazole. We examined the effects of a 150 mg dose of rifabutin on serum itraconazole levels and found significantly lower levels in 28 patients receiving itraconazole with rifabutin (median, 0.65 μg/ml) compared with 65 patients receiving itraconazole alone (median 3.45 μg/ml, P 

  • Development of Chronic Pulmonary Aspergillosis in a patient with NTM-LD.
    2017
    Co-Authors: Byung Woo Jhun, Hye Yun Park, Kyeongman Jeon, Woo Jin Jung, Na Young Hwang, Eun-suk Kang, Won-jung Koh
    Abstract:

    Chest computed tomography images are shown for a 69-year-old female patient with Mycobacterium intracellulare lung disease. (A) At the time of initiation of antibiotic therapy for M. intracellulare lung disease, there was a large cavitary consolidation in the right upper lobe. Serum Aspergillus precipitin antibody was negative. (B) After 12 months of antibiotic therapy for M. intracellulare lung disease, cavitary consolidation in the right upper lobe was improved, and sputum cultures for NTM were negative. (C) After 18 months of antibiotic therapy for M. intracellulare lung disease, the patient’s respiratory symptoms and the consolidation in the right upper lobe were aggravated. Sputum cultures for NTM were negative. However, serum Aspergillus precipitin antibody was strongly positive, and Chronic Pulmonary Aspergillosis was diagnosed.

  • Effect of Rifampin and Rifabutin on Serum Itraconazole Levels in Patients with Chronic Pulmonary Aspergillosis and Coexisting Nontuberculous Mycobacterial Infection
    Antimicrobial agents and chemotherapy, 2014
    Co-Authors: Seong Mi Moon, Hye Yun Park, Byeong-ho Jeong, Kyeongman Jeon, Soo-youn Lee, Won-jung Koh
    Abstract:

    We investigated the effects of rifampin and rifabutin on serum itraconazole levels in patients with Chronic Pulmonary Aspergillosis. Serum itraconazole concentrations were significantly lower in patients who received itraconazole with rifampin (median, 0.1 μg/ml; P < 0.001) or rifabutin (median, 0.34 μg/ml; P < 0.001) than those receiving itraconazole alone (median, 5.92 μg/ml). Concomitant use of rifampin or rifabutin and itraconazole should be avoided in patients with Chronic Pulmonary Aspergillosis and coexisting mycobacterial infections.

  • Serum galactomannan antigen test for the diagnosis of Chronic Pulmonary Aspergillosis.
    The Journal of infection, 2014
    Co-Authors: Beomsu Shin, Hye Yun Park, Byeong-ho Jeong, Won-jung Koh, Gee Young Suh, O Jung Kwon, Hongseok Yoo, Kyeongman Jeon
    Abstract:

    Summary Background A serum galactomannan (GM) antigen test has been widely used to diagnose invasive Pulmonary Aspergillosis. However, there are limited data on the use of the serum GM antigen test for the serologic diagnosis of Chronic Pulmonary Aspergillosis (CPA). Methods Data were collected from all consecutive patients with a clinical suspicion of CPA who underwent a serum GM antigen test. Results In total, 334 patients who were suspected to have CPA were eligible for this study and 168 (50%) patients were finally diagnosed with CPA. The serum GM antigen test was positive in 38 (23%) patients with CPA and in 25 (15%) patients without CPA. The sensitivity of the serum GM antigen test was 23% (95% confidence interval [CI], 17–30%), and its specificity was 85% (95% CI, 79–90%), with positive and negative predictive values of 60% (95% CI, 47–72%) and 52% (95% CI, 46–58%), respectively. The accuracy of the test was 54%. The area under the receiver operating characteristic curve was 0.538 (95% CI, 0.496–0.580). Conclusion The serum GM antigen test could not be used for the serologic diagnosis of CPA.

  • Clinical characteristics and treatment outcomes of Chronic Pulmonary Aspergillosis.
    Medical mycology, 2013
    Co-Authors: Byung Woo Jhun, Kyeongman Jeon, Jung Seop Eom, Ji Hyun Lee, Gee Young Suh, O Jung Kwon, Won-jung Koh
    Abstract:

    Chronic Pulmonary Aspergillosis (CPA) is a relatively uncommon disease that has been poorly characterized. This study investigated the clinical features and treatment outcomes of CPA through a retrospective review of records of patients with newly diagnosed CPA between January 2008 and January 2012. A total of 70 CPA patients, which included 51 (73%) males, had a median age of 55 years. Fifty-seven patients (81%) had a history of Pulmonary tuberculosis and Pulmonary disease caused by nontuberculous mycobacteria (NTM) was a primary underlying condition in 32 patients (46%). Most patients (n = 66; 99%) were treated with oral itraconazole, for a median of 6.4 months. Treatment response of 73% of patients was based on alleviation of symptoms and in 44% on computed tomography. Laboratory tests improved for more than 60% of patients and overall favorable responses were achieved in 44 patients (62%). Five of the latter (11%) had to restart antifungal therapy after a median of 9.2 months after therapy. Death occurred in 10 patients (14%). This study suggested that NTM lung disease was an important risk factor for CPA development. While treatment with oral itraconazole for approximately 6 months was moderately effective in treating CPA, a more effective treatment is required.