| Background and objectivePulmonary aspergillosis is a group of diseases with acute or chronic onset, caused by aspergillus, with Invasive aspergillosis (IA) as a leading disease in severely immunocompromised patients. The incidence of IPA has increased during the past two decades due to widespread use of chemotherapy and immunosuppressive agents, and is a frequently lethal complication of acute leukemia or other malignant tumor patients that occurs following both chemotherapy and bone marrow transplantation (BMT).IPA generally presents as an acute infection. Sudden onset of shortness of breath, pleuritic chest pain, hemopthysis, pulmonary infiltrates, and fever un-responsive to broad-spectrum antibiotics constitute the characteristic clinical picture of the disease. Image study shows pulmonary infiltration as bronchitis a common present. Localized or multiple infiltrations can been seen in both side of lungs in the early stage of IPA, with pathological changes close to pleura. The course of IPA is aggressive and multiple infiltration can be fused as lung consolidation or become a cavity with a aspergilloma inside the cavity, due to tissue necrosis.. The distinctive manifestation of CT scan is a "halo" sign, which correlates with hemorrhage and edema surrounding an infarct by thrombosis occurs early in the course of infection and is highly suggestive of IPA. Air crescent sign, which is a central necrotic nodule with circumferential air density, develops mainly at the time of BM recovery. A cavitary lesion is the late stage of IPA.Most IPA can not been diagnosed till autopsy. Histology and growth of aspergillus in culture medium are two major methods to confirm the diagnosis of IPA. Samples, such as bronchoalveolar lavage fluid, bronch-sucking secretion, should be sent for cytology and fungal culture, and the positive rate can raise by 15%～20%. Detection of antibody in serum is not suitable for diagnosing IPA, because it often presents in immunocompromised patient and the development of IPA is too quickly to produce antibody. Detection of aspergillus antigen in serum and bronchoalveolar lavage fluid also is playing an important role in the diagnosis of IPA.Because it's difficult to diagnose and treat IPA, morbidity and mortality rate is extreme high, almost 100% dead without treatment except that some patients whose immocomprised status recovered are self-limited. Antifungal treatment in combination with surgery improves survival in patients with IPA.This article observes and summarizes the diagnosis and treatment of 6 cases of IPA in order to provide an early diagnose and effective treatment of this disease.Materials and methodsAll cases of IPA were collected from July 2005 to March 2007 in the First Affiliated Hospital of Zhengzhou University. There were 3 males and 3 females, and aged from 17 to 74 years. To approach diagnostic and therapeutic experience by observing patients' symptoms, signs, laboratory examination and drug therapeutic efficacy.Results1. All the patients present with cough and expectoration, 5/6 with fever, 6 2/6 with chest pain. In addition to EPA, other diagnosis included pulmonary squamous carcinoma (1 case), adult still disease (1 case), nephrotic syndrome (1 case), and esophageal carcinosectomy (1 case). The diagnosis of IPA were confirmed by sputum culture in 2 cases and chest CT scan in 4 cases in addition to history and correlated symptoms and signs.2. All the patients were orally given Itraconazole at 400mg, twice a day. Treatment was effective, and all symptoms were disappeared within a week while image study showed that focus of infection was partly absorbed. Conclusions1.Because the clinical manifestations of IPA are not so typical, it's necessary to diagnose IPA with laboratory examinations and CT. IPA is characterized by typical cavity and halo sign, which are useful in diagnosis of patients.2. It's a cheaper and effective method to give oral Itraconazole for the treatment of IPA.
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