The Explore Of Clinical Characteristic Of Saprophytic Pulmonary Aspergillosis

Objective To describe the clinical features, imaging features, surgical procedures and postoperative complications and pathological features, follow-up data of saprophytic pulmonary aspergillosis. The purpose of this study was to improve the level of awareness of saprophytic pulmonary aspergillosis(SPA) and help to refine indications and optimal timing for surgical treatment and facilitate proper selection of patients who would most benefit from surgery while maintaining perioperative mortality and morbidity at acceptable levelsMethods Fifty patients diagnosed as SPA from cardiothoracic surgery and respiratory department in the first affiliated hospital of Zhejiang University were reviewed retrospectively from2006to2011. Underlying diseases, clinical manifestation, laboratory tests, imaging features, therapeutic schedule and prognosis were comparative analyzed.Results Most SPA occurred in the in middle-aged patients, and predilection in pre-existing cavities or cystic cavity of pulmonary Structural lesion, cavitary pulmonary tuberculosis, cavitary bronchiectasis were fertile grounds for aspergillus to smolder. Univariate analysis confirmed that there was no significant difference between CNPA and PA, in the age, gender, and clinical symptoms."Air crescent"sign at radiography was typical in both CNPA and PA, which both occur in the upper lobe of both lungs. But the thickening Pleural and the thicker and irregular wall of cavity, infiltrates were often to be seen around the cavity in CNPA. Comparative analysis confirmed that there were significant differences between CNPA and PA in the imaging features. Histollogically, CNPA and PA both showed septate fungal hyphae branching an acute angle. CNPA was characterized with the presence of tissues bleeding, tissue necrosis, micro-abscesses, inflammatory cell infiltration. Comparative analysis confirmed that there were significant differences between CNPA and PA in the pathological features. Univariable analysis identified weight loss and massive hemoptysis as risk factors for postoperative morbidity. Five year cumulative survival in CNPA and PA was73.5%and77.8%, respectively(p=0.586). Multivariable analysis by Cox Proportional hazard model showed that younger age and lack of massive hemoptysis were independent unfavorable predictive and prognostic factor in the surgical treatment of SPA.Conclusion Histopathology is gold standard of differential diagnosis of CNPA and PA."Air crescent sign" at radiography is typical feature in SPA, massive hemoptysis is independent risk factor in the surgical postoperation of SPA. In operable cases, early surgical resection may be recommended even in asymptomatic patients. This strategy may prevent development of life-threatening symptoms and offers a realistic chance of permanent cure. In the simple PA, it is not recommended for routine prophylactic anti-fungal treatment in asymptomatic patients with complete surgical resection. Patients need prophylactic anti-Aspergillus treatment in postoperation of CNPA, and Patients with multiple lesions in the lungs also need anti-Aspergillus therapy.