Nine Cases Report Of Primary Pulmonary Aspergillosis And Literature Review

Purpose:primary pulmonary aspergillosis are less common than secondary pulmonary aspergillosis in clinic because the onset of primary pulmonary aspergillosis is difficult to find and easily ignored by clinicians. This essay will analyse the clinical materials of primary pulmonary aspergillosis in order to arouse the awareness of this disease and reduce the cases of missed diagnosis and misdiagnosis.Method:This paper would retrospectively analyze the clinical materials of9patients with primary pulmonary aspergillosis and their disease was proven histopathologically in the first affiliated hospital of Guangxi Medical University from the January,2001to December,2011. Then the clinic, iconography, pathology, laboratory examinations and treatment will be analyzed combining with the discussion of domestic and international literature.Result:9patients were previous healthy and had no history of underlying diseases.Immune function was normal, no long-term glucocorticoids, immunosuppressant, and history of using antibiotic.9patients were all confirmed histopathologically.①5female cases and4male cases, age29-58, average age was (42±10).②Vocation:farmers7cases (7/9),4of these case cound be found with clear mildew and have once toughed old things, workers2cases (2/9).③Clinical symptoms:hemoptysis with8cases (8/9),3cases with traces of hemoptysis, from1to10ml.5cases with large amount of hemoptysis, at most200ml.8cases with cough (8/9),1case with febricity, the highest temperature was40℃and2cases with night sweat (2/9).1case was found with little humidus-rale in diseased region (left superior lung) and no special physical examination for other parts.④imaging:7cases with cavitation,7cases with phymatoid-shadow and6cases with "crescent sign",1case with micro nodular shadow,2with phymatoid shadow. Diseased region:main diseased region was the rear of upper leaf epiphyll and lobus inferior, involving in multi-lung and multi-lobe. There was no strengthening in lesion after Enhanced.㎜aboratory and instrumental examinations:blood examination and liver-kidney function and tumor maker were normal and9phlegm smear in fungus and phlegm fungus nutrient solution. There were9cases with normal pulmonary function examination,6cases were found with mucosal congestion and edema in bronchoscope’s focal trachea and bronchus,1of the9were found with total content of mycotoxins glucan in blood serum is960.5pg/ml.⑥reatment:Six patients which were misdiagnosed for long time with pulmonary tuberculosis had been anti-TB treatment repeatedly for up to more than10years,3another cases were misdiagnosed with lung cancer. After admission, surgical lesion had been operated on six cases, two cases of which were treated with Vorionazole, Itraconazole and Amphotericin B after operation, while three another cases merely had antifungal therapy.⑦Outcome:5cases were completely recovered, one case of which was operated again owing to partial lesions removed; the rest of six cases were better under the combined antifungal treatment and operation. Having treated with antifungal drugs, three another cases’ conditions were alleviated. No patients died.Conclusion:1. Patient with primary pulmonary aspergillosis always have a history of inhale or exposure to moldy stale things.2. Primary pulmonary aspergillosis is a disease with relative slow progress characterized by a chronic course and an insidious onset.3.The most common clinical symptoms of primary pulmonary aspergillosis is hemoptysis and cough, fever and other systemic symptoms are rare.4. The imaging features of the most common types of Primary pulmonary aspergillosis is cavity,"crescent sign" and Isolated mass, upper lobe apicoposterior segment and posterior segment of lower lobe are the most common diseased parts.5. The luminal involvement is commonly seen with the fiberoptic bronchoscope, the pulmonary function is normal and the airway responsiveness is not high.6.The disease can be diagnosed by finding aspergillus hyphae through lesions histopathological examination, surgery and TBLB is the most commonly used and effective method to obtain the specimen.7. The disease is often misdiagnosed with tuberculosis or the lung cancer.8.The Surgical treatment or antifungal therapy have relatively satisfactory effect on The pulmonary aspergillosis.