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Query: UMLS:C0019079 (hemoptysis)
 6,129 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Invasive pulmonary aspergillosis is an important cause of morbidity and mortality in granulocytopenic patients. The purpose of this article is to review the current understanding of the microbiology, hospital epidemiology, clinical manifestations, diagnosis, prevention, and treatment of invasive pulmonary aspergillosis. Aspergillus conidia (spores) are inhaled from environmental sources into the paranasal sinuses and lower respiratory tract. Persistent fever, pulmonary infiltrates, and pleuritic pain in granulocytopenic patients receiving antibacterial antibiotics is a common manifestation of invasive pulmonary aspergillosis. Computerized tomographic scans of the chest often reveal characteristic peripheral nodules that also may progress to characteristic cavitary lesions. Hemoptysis may develop due either to hemorrhagic infarction during granulocytopenia or to the rupture of mycotic aneurysms during recovery from granulocytopenia. Aspergillus organisms may extend locally from the lung to involve other thoracic structures, including the heart and chest wall, and may disseminate to extrapulmonary sites, such as the brain, where focal neurological deficits ensue. Early diagnosis of invasive pulmonary aspergillosis may be difficult. Isolation of Aspergillus organisms from respiratory secretions of a persistently febrile granulocytopenic patient is usually indicative of invasive pulmonary aspergillosis and should not be dismissed as a contaminant or saprophyte. Amphotericin B is the treatment of choice; however, high dosages (1.0 to 1.5 mg/kg/day) are often necessary. Aspergillosis may develop in granulocytopenic patients who are already receiving empirical amphotericin B in lower doses (0.5 to 0.6 mg/kg/day). It is hoped that further investigation directed toward an understanding of pathogenesis, improving diagnostic methodology, and developing new therapeutic and preventive strategies will improve the outcome of this life-threatening infection.
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PMID:Invasive pulmonary aspergillosis in patients with neoplastic diseases. 224 6

The problems associated with pulmonary aspergilloma were assessed retrospectively in 23 patients presenting from 1953 to 1982. Haemoptysis occurred in over half the patients and in two it was fatal. Invasive aspergillosis occurred in five patients, a higher proportion than in earlier reports, and two of these died. Amphotericin B in combination with either flucytosine or natamycin and, more recently, ketoconazole have proved useful in the treatment of this condition.
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PMID:What happens to patients with pulmonary aspergilloma? Analysis of 23 cases. 661 48

We have performed percutaneous intracavitary treatment with anti-fungal reagents in 8 patients with pulmonary aspergilloma (6 males and 2 female) over the past decade. Ages ranged from 43 to 84 years old. All of the patients had underlying lung diseases, seven having old pulmonary tuberculosis and one pneumoconiosis. Five patients had a history of hemoptysis or hemosputum. Amphotericin B (AMPH) was injected daily in 5 patients, Fulconazol (FCZ) in 2 patients, and both in the remaining patient. For AMPH, maximal dose, total dose, and treatment duration were 20 to 50 mg, 285 to 1560 mg, and one to 7.5 months, respectively, and for FCZ, 20 to 30 mg, 450 to 1600 mg, 3 weeks to 4 months, respectively. At the end of treatment, fungus balls disappeared in 2 patients, decreased in size in 3 patients and were unchanged in 3 patients. After follow up periods of 7 months through 6.5 years, 5 of 6 patients remained in roentogenologically better condition than before treatment, and 3 of 5 patients with episodes of hemoptysis or hemosputum have not since had airway bleeding. The prognosis of the other two patients are unknown, since they died of other diseases before this survey. One patient had aspergillus empyema 7 months after treatment. There were no serious side effects or complications directly related to treatment. It was suggested that continuous percutaneous intracavitary treatment with anti-fungal reagents is safe and effective for inoperable patients with aspergilloma.
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PMID:[Percutaneous intracavitary treatment of pulmonary aspergilloma-clinical efficacy and prognosis]. 808 40

Eight patients with acute leukemia (AL) and invasive pulmonary aspergillosis (IPA) developing during previous antileukemic therapy underwent BMT (autologous in 6 cases and allogeneic 2). IPA was treated prior to BMT with full doses of amphotericin B, associated with surgical resection in three cases. One patient was treated with amphotericin B and itraconazole. Prior to BMT, seven patients had minimal residual pulmonary lesions. All patients received amphotericin B (0.5 mg/kg/day) during the aplastic period prior to engraftment. One patient died of Gram-negative septic shock before engraftment. Seven patients achieved complete hematological engraftment without any evidence of IPA reactivation. Amphotericin B was well tolerated with only minimal transient renal dysfunction in three patients. Later pulmonary complications related to IPA were observed in only one patient who developed a self-limited episode of hemoptysis. One patient died of CMV pneumonitis and two of leukemia relapse. Four patients survive disease-free and without complications related to IPA. We conclude that the reactivation of correctly treated IPA can be successfully prevented in BMT patients by use of prophylactic amphotericin B. With this approach, prior IPA is not a contraindication to BMT.
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PMID:Invasive pulmonary aspergillosis prior to BMT in acute leukemia patients does not predict a poor outcome. 824 83

Systemic or topical treatment with antifungal agents are applied for the treatment of chronic pulmonary aspergillosis (fungus ball type, mural thickness type). Recently, the concomitant treatment with elastase inhibitor has been studied for the purpose of relieving tissue destruction by inhibiting elastase derived from aspergillus species. In the present study, we have examined the clinical effect of the topical treatment with Amphotericin B in patients with chronic pulmonary aspergillosis, and the concomitant use of Ulinastatin has also been examined in patients with symptoms such as hemosputum and hemoptysis. Amphotericin B was administered by transcatheter intracavity injection or transbronchial intrapulmonary injection. In some patients, inhalation was concomitantly employed. Amphotericin B was challenged by inhalation before starting the topical treatment, and if the patient experienced an asthma like attack, the present therapies were not conducted. Ulinastatin was administered by intravenous drip infusion concomitantly with antifungal agents and hemostatics. As a result, improvements regarding antifungal effects and clinical symptoms were found in 12 out of 15 patients treated with Amphotericin B. Further, early disappearance of hemosputum and hemoptysis was seen in 11 out of 23 episodes in 14 patients concomitantly treated with Ulinastatin. The treatment-related side effects, leading to discontinuation of those therapies, did not occur. Immunoresponse of allergy was studied in the patients ineligible for Amphotericin B topical treatment and the non-responders to Ulinastatin, and aspergillus specific IgE antibodies in serum were increased in the majority of patients. From the above results, it is desirable to carry out the topical treatment in chronic pulmonary aspergillosis. Also, it was considered valuable to apply the concomitant treatment with Ulinastatin, elastase inhibitor, to patients with severe clinical symptoms of hemosputum and hemoptysis.
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PMID:[Treatment of chronic pulmonary aspergillosis (fungus ball type, mural thickness type)]. 907 Oct 95

Children acquire blastomycosis, with rare exceptions, through the respiratory route. Nearly half of those who are infected may be asymptomatic. Cough is the most common symptom and is usually without sputum production, and hemoptysis is not noted. Other symptoms are chest pain (described as tightness or pain when breathing), weight loss, night sweats, and loss of appetite. The severity of illness is variable and may simulate an upper respiratory infection, bronchitis, pleuritis, or pneumonia. As in adults, an overwhelming infection may cause respiratory failure even in immunocompetent children and in immunocompromised children who live in or travel to endemic areas are susceptible to infection. Some reports based on consecutive cases note extrapulmonary dissemination commonly in children, whereas dissemination is rarely noted in outbreak cases. Chronicity of the disease favors extrapulmonary dissemination. Chest radiograph patterns are alveolar infiltrates, consolidation, and nodule(s), and these may be accompanied by cavitation. Diagnosis is suspected when the symptoms that mimic common respiratory infections persist for more than 2 weeks and by a history of residence or travel to an endemic area. Chest radiographic findings of nodule(s) or cavitation further increase the suspicion. Confirmation of diagnosis is by microscopic examination and culture of sputum. When expectorated sputum is unavailable, bronchoscopy with lavage and biopsy or percutaneous needle biopsy of lung is the appropriate next step. Disease that is progressive or severe or disseminated to other organs should be treated. Amphotericin B is effective and results in excellent cure rates. Experience using oral azoles is limited in children.
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PMID:Blastomycosis in children. 931 95

Invasive pulmonary aspergillosis (IPA) remains a life threatening complication in immuno-compromised and especially in neutropenic patients. We report our experience in the diagnosis and therapeutic management of IPA in 8 patients with acute leukemia. All patients were neutropenic (PNN < 100/mm3, mean duration = 37 days) when IPA was diagnosed. Clinical signs included fever above 39 degrees and cough in all cases, chest pain in 4 cases, hemoptysis in 3 cases, rales in 5 cases. Chest x ray showed one lesion in 4 cases and multiple lesions in 4 cases. The diagnosis of IPA was established by bronchoalveolar lavage (BAL) in 5 cases, tissue biopsy in one case, positive sputum in one case and it was highly probable in one case. Thoracic computed tomographic (CT) scans were preformed after diagnosis confirmation of IPA and showed one or multiple lesions with air crescent signs. Serological tests were positive in 4 cases late in the course of IPA. All patients were treated with i.v. Amphotericin B. Outcome was favorable in 5 cases and three patients died by massive hemoptysis (in two cases) and systemic aspergillosis (in one case). Early diagnosis and appropriate treatment are essential to improve IPA prognosis.
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PMID:[Invasive aspergillosis in the leukemic patient]. 1192 79

Mucormycosis is an emerging and fatal fungal infection. A high index of suspicion and the knowledge of its potential manifestations are essential for early diagnosis. We describe a patient with acute lymphoblastic leukaemia (L2 subtype) who developed a neck mass following a course of induction chemotherapy. Doppler ultrasonography and angiography of the neck revealed a pseudoaneurysm of the right common carotid artery. The patient then developed haemoptysis. Surgical exploration revealed a necrotic right common carotid artery with anteromedial pseudoaneurysm and adjacent tracheal wall perforation. Local debridement and tracheal repair were performed. Nonseptate hypheal invasion (mucormycosis) was found on the microscopic examination of the excised arterial wall. A subsequent recurrence of pseudoaneurysm was treated with local surgical debridement and intravenous amphotericin B (Fungizone) administration. Although rare, clinicians should be aware of these possible presenting features of mucormycosis as early diagnosis and treatment may potentially improve the survival.
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PMID:Mucormycotic pseudoaneurysm of the common carotid artery with tracheal involvement. 1885 46

Visceral leishmaniasis is characterized by fever, cachexia, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. Cough may be a presenting symptom as well. However, pulmonary involvement is considered rare and mainly described in immunocompromised patients. We describe a case of an immunocompetent adult whose clinical presentation was dominated by cough and hemoptysis. Bronchoscopy revealed a discreet polypoid mucosal endobronchial lesion whose biopsy yielded Leishmania amastigotes within histiocytes. Transbronchial needle biopsy of a right paratracheal lymph node was also positive. Leishmania amastigotes were also found on bone marrow and liver biopsies. Treatment with IV Amphotericin B was successful. In conclusion, cough should not be overlooked as a presenting symptom of visceral leishmaniasis and may be a sign of pulmonary involvement.
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PMID:Visceral leishmaniasis with endobronchial involvement in an immunocompetent adult. 2157 61

A 48-year old woman with a recent diagnosis of Graves' disease arrived at the emergency room with fever, palpitations, and a sore throat. Her regular treatment included methimazole. On admission, laboratory results showed suppressed TSH, elevated free thyroxine, and neutropenia. She was admitted and started on antibiotics and granulocyte-macrophage colony stimulating factor (gm-csf). After ten days, the patient developed leukocytosis, fever, and hemoptysis. Chest CT scan showed a lung cavity with multiple nodules in the upper right lobe. Cultures from a lung biopsy were positive for Aspergillus Fumigatus and Aspergillus Flavus. Amphotericin B was started but then switched to voriconazole, with both treatments failing to result in clinical improvement. The patient died of multi-organ failure.
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PMID:[Pulmonary aspergillosis due to methimazole-induced neutropenia: a case report]. 2285 75


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