EC Pulmonology and Respiratory Medicine

Aspergillosis is the second most common fungal infection after candidiasis. The causative agents of the infection (Aspergillus) are widely distributed worldwide and can be found everywhere in the environment. They can be constantly found in soil, grains, flour, hay (especially moldy), on building materials, in building ventilation systems, in indoor dust where skin, wool, and yarn are processed. Aspergillus can even be found in the dust of healthcare facilities, which can lead to nosocomial infection.

The main manifestation of aspergilloma is recurrent hemoptysis (diagnosed in 70 - 80% of cases). In 20 - 25% of cases, hemoptysis can be life-threatening due to the progression to massive pulmonary hemorrhage. The ability of Aspergillus to secrete toxins that cause erosion of the vessel wall and interfere with clot formation is the cause of hemoptysis. Even after radical removal of the aspergilloma, there is an increased risk of bleeding in the first 2 days postoperatively.

Over the past 15 years, 24 patients with pulmonary aspergillosis were treated in the Department of Thoracic Surgery and Invasive Diagnostic Methods at the National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the National Academy of Medical Sciences of Ukraine. In 18 (75.0%) cases, pulmonary aspergilloma was diagnosed; in 1 (4.2%) patient, aspergilloma of the residual pleural cavity developed, and in 5 (20.8%) patients, invasive aspergillosis was diagnosed after video-assisted thoracoscopic lung biopsy.

VATS lung biopsy was performed in 5 (20.8%) patients. Based on the results of histological and microbiological examinations, the diagnosis of invasive aspergillosis was established in 4 (16.7%) cases, and 1 (4.2%) patient was diagnosed with drug-resistant pulmonary tuberculosis in combination with invasive aspergillosis. The main indications for lung biopsy in these patients were atypical disease course with persistent resistance to conservative therapy, including antifungal agents for aspergillosis. The postoperative period was uneventful in 4 (16.7%) patients, while 1 (4.2%) patient died 2 weeks after the operation due to progressive invasive aspergillosis with the development of bronchopleural fistula and Aspergillus empyema of the pleura. The underlying condition for the development of aspergillosis in this patient was primary immunodeficiency.

Surgical treatment is the preferred method for managing pulmonary aspergilloma and achieves an overall treatment effectiveness of 93.3%. The administration of antifungal medications before and after surgery is a mandatory requirement for effective treatment of pulmonary aspergilloma. The issue of pulmonary aspergillosis is far from resolved, and therefore, effective communication among physicians of different specialties will contribute to its gradual resolution.

Keywords: Pulmonary Aspergillosis; Video-Assisted Thoracoscopic Lung Biopsy; Hemoptysis

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