A Case Of Report Primary Invasive Pulmonary Aspergillosis And The Review Of Literatures

ObjectiveTo explore the clinical characteristics and the diagnostic thinking of primary invasive pulmonary aspergillosis (PIPA), which help to increase the knowledge about the PIPA and to make the early and right diagnosis.MethodsThe clinical characteristics and diagnostic thinking of 1 case of PIPA were presented first, and 20 cases reported in the Chinese and abroad literature from January 1979 to January 2009 were reviewed.Results20 cases of PIPA were reviewed, including 5 bliuding workers (25%),4 peasants (20%),2 gardeners (10%).9 patients were died, and 11 patients were cure. Clinical symptom mainly included cough 16 cases (80%), dyspnea 9 cases (45%), fever 9 cases (45%), chest pain 8 cases (40%), hemoptysis 6 cases (30%), wheeze 6 cases (30%), chest tightness 5 cases (25%), influenza-like symptoms 2 cases (10%). White Sputum, yellow or brown-yellow sputum, and pus bloody sputum usually could be seen. The common signs were tachypnoea, and the breath frequency was always more than 30 times per minute. The auscultation of lung showed both dry and wet rales. Blood-air analysis shows hypoxemia. Chest CT displayed diffuse infiltration, multi-nodules of double lungs in 8 cases,3 cases with halo sign and 2 cases with mini-cavity.3 cases had both lungs interstitial infiltration. Mass shadow was present in 2 cases. As the disease increased, nodules increasing and fusion, consolidation of lung lobe, multi-cavity formed and pleural effusion could be appeared, and would change sharply. Among 20 cases,19 cases were misdiagnosised (95%), and 70% cases were misdiagnosised as pneumonia.ConclusionsIn the differential diagnosis of community acquired pneumonia (CAP), when the patient is a nonimmunosuppressed host, with suspected occupational history or special exposure history, the first symptom begins with breathing, dry cough, and gradually appears fever and cough, lung imaging shows multiple lesions in both lungs, and progressively increases with cavity formation, and empirical systematical anti-infection treatment is invalid, we should be alert to the presence of PIPA, and need to dynamically observe change of lung CT, and repeat the lower respiratory tract secretions for culture, and make lung biopsy timely, in order to have early recognition and make accurate diagnosis of PIPA.