Clinical Analysis Of 20 Cases Of Mixed Types Of Pulmonary Aspergillosis

Objective: To analyze the clinical data of mixed types of pulmonary aspergillosis,summarize its clinical manifestations,diagnosis and treatment,improve the awareness of the disease,and reduce missed diagnosis and misdiagnosis.Methods: The clinical characteristics of 20 patients of MTPA admitted to our hospital from January 2013 to January 2020 were analyzed retrospectively and discussed in combination with domestic and foreign literature.Results:(1)All the 20 cases of MTPA were ABPA+IPA or aspergilloma+IPA overlap,95% of which had pulmonary structural lesions,accounting for4.2? of the total number of inpatients with respiratory diseases in our hospital during the same period,accounting for 0.25? of the total number of inpatients during the same period.(2)There were 3 cases of ABPA overlap IPA,with an average age of(38.0±14.4)years.Among them,2 cases(66.7%)had a history of asthma,3 cases(100%)had pulmonary structural lesions,and 0 cases(0%)had extrapulmonary basic diseases.There were 17 cases of aspergilloma overlap IPA,average age was(55.2±11.8)years old,0 cases(0%)had a history of asthma,16cases(94.1%)had pulmonary structural lesions,and 6 cases(35.3%)had extrapulmonary basic diseases.There were statistically significant differences in age and history of asthma between the two groups(P<0.05).(3)Clinical symptoms and signs: In the ABPA overlap IPA group,there were 3 cases(100%)of cough and sputum,2 cases of dyspnea(66.7%),2 cases of fever(66.7%),and3 cases of pulmonary rales(100%).In the aspergilloma overlap IPA group,there were 17 cases(100%)of cough and sputum,10 cases of hemoptysis(58.8%),7cases of dyspnea(41.2%),and 10 cases of pulmonary rales(58.8%).(4)10 cases(10/18)had positive serum GM test results,and 9 cases(9/11)had positive BALF GM test results.(5)Basic immune function indicators: 20 cases had no neutropenia or deficiency,17 cases(17/20)had normal lymphocyte count,and 3cases had reduced lymphocyte count.Immunoglobulin test was normal in 14cases(14/14);T cell subsets test was performed in 13 cases,normal in 10 cases(10/13),and decreased in 3 cases.The HIV antibody of 18 cases and autoantibody spectrum of 13 cases were normal.(6)Imaging findings: In the ABPA overlap IPA group,there were 3 cases(100%)of pulmonary nodules,mass and high-density shadow,2 cases(66.7%)of toothpaste sign and gloved finger sign,3 cases(100%)of bronchiectasis,and 1 case(33.3%)of halo sign.In the aspergilloma overlap IPA group,there were 17 cases(100%)of pulmonary nodules,mass and high-density shadow,0 cases(0%)of toothpaste sign and gloved finger sign,9 cases(52.9%)of bronchiectasis,10 cases(58.8%)of cavity,3 cases(17.6%)of halo sign,15 cases of aspergilloma(the remaining 2 cases were IPA after aspergilloma resection),and 7 cases(41.2%)of air crescent sign.There were statistically significant differences between the two groups in toothpaste sign and gloved finger sign(P<0.05),but no statistically significant differences in other imaging findings.(7)Treatment and outcome: In the ABPA overlap IPA group,3 cases(100%)all improved after being treated with antifungal combined with systemic hormone therapy.In the aspergilloma overlap IPA group,15 cases(88.2%)improved,2 cases(11.8%)deteriorated.9cases(52.9%)received only antifungal therapy,3 cases(17.7%)received only lobectomy,and 5 cases(29.4%)received lobectomy combined with antifungal therapy.2 cases with exacerbations underwent lobectomy combined with antifungal therapy.Conclusions: 1 MTPA is relatively rare.2 Pulmonary structural lesions are one of the main host factors of MTPA.3 The main symptoms of ABPA overlap IPA are cough and sputum,dyspnea;the main symptoms of aspergilloma overlap IPA is cough and sputum,hemoptysis.4 GM test is helpful to diagnose MTPA patients who overlap IPA;chest imaging is important for the diagnosis of MTPA.5 Antifungal therapy combined with systemic hormone therapy is an effective method for the treatment of ABPA overlap IPA.6 The treatment of patients of aspergilloma overlap IPA needs to be individualized,and surgical treatment is effective in some patients.