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Pulmonary aspergillosis following Mycobacterium kansasii lung disease

Abstract number: P1585

Casas S., Gasch O., López M., Lora-Tamayo J., González L., Guerra M.R., Santín M.

Objectives: The aim of the study is to evaluate the incidence, clinical features and outcome of Aspergillus lung disease (ALD) in patients (pts) with Mycobacterium kansasii pulmonary disease.

Methods: Retrospective review of 5 cases of ALD from a cohort of 111 HIV-negative pts with M. kansasii disease, treated in a teaching hospital, between 1990 and 2005. Diagnosis of ALD was based on radiological signs, respiratory sample cultures and serology.

Results: Five men with a mean age of 59 years were diagnosed of ALD (4.5%, incidence rate 1.08 patient-years, 95% CI 0.35–2.53). All patients were smokers, 3 had COPD, 2 malnutrition and 1 was taking corticosteroids. Mean time from diagnosis of M. kansasii disease to the development of ALD was 23 months. ALD developed during treatment for M. kansasii in 2 patients. All 5 presented cavitary lesions in relation to M. kansasii disease. Most important clinical manifestations were hemoptysis (3), dyspnea (2) and weight loss (2). CT showed mycetoma in 3 cases and pseudonodular infiltrates in the other 2. Diagnosis was established by culture of respiratory samples (4) and histological examination (1). Aspergillus fumigatus was identified in the 4 positive culture cases. Precipitins were positive in 2 of the 3 patients in whom they were performed. Antifungal therapy was based on itraconazole (4 courses), voriconazole (3) and amphotericin B (1) with a mean duration of 135 days. Embolisation and surgical resection because of recurrent hemoptysis was required in 2 cases. Two patients died due to postoperative complications and lung cancer respectively, and 3 were alive after a 45.8-month mean follow-up.

Conclusions: ALD is not an uncommon complication of M. kansasii pulmonary disease and implies a poor prognosis. Reappearance of respiratory symptoms in any patient being treated or formerly treated for M. kansasii disease should raise suspicion of ALD.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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