Surgical Outcome of Chronic Pulmonary Aspergilloma: An Experience from Two Tertiary Referral Hospitals in Addis Ababa, Ethiopia

Overview

Journal Ethiop J Health Sci

Specialty Health Services

Date 2021 Apr 26

PMID 33897212

Citations 3

Authors

Berhanu N Alemu

Affiliations

Soon will be listed here.

Abstract

Background: Surgical management of pulmonary aspergillosis is challenging and controversial. This study is designed to assess the clinical profile, indications and surgical outcome of Pulmonary aspergilloma.

Methods: A retrospective cross-sectional analysis of 72 patients who underwent pulmonary resection for pulmonary aspergilloma over the period from November, 2014, to November, 2019 was done. Data on demographic, clinical and surgical out come were retrieved. Analysis was done using SPSS version 23. Chi-square test was used to assess for significance of the association between variables and surgical outcome.

Results: There were 46(63.9%) males and 26(36.1%) female patients with a mean age of 35.2+/-11.6 years (Range 16- 65 years). All patients were previously treated for tuberculosis. Cough, hemoptysis, and shortness of breath were the main symptoms identified. A ball of fungus together with the surrounding lung was removed. Accordingly, 32(44,4%) lobectomies, 12(16.7%) pneumonectomy, 7(9.7%) Bi-lobectomy, and 21(29.2%) cavernostomy were done. Intraoperative and Postoperative complications were seen in 8(11.1%) and 21(29.1%) patients respectively. Major morbidity encounters included massive intraoperative blood loss, prolonged air leak, empyema, air space, bronchopleural fistula, and wound infection. The hospital mortality was 3(4.2%) and the average hospital stay was 14.8days. Postoperative complications were evaluated for the difference in socio-demographic characteristics and other variables and a statistically significant difference was detected only for the location of aspergilloma, site of the lung involved and type of surgery done. (P-value =0.05.).

Conclusion: Pulmonary resection done for pulmonary aspergilloma showed favorable outcomes when done with good patient selection, meticulous surgical techniques, and good postoperative management. However, its long term outcome and role of antifungal treatment as adjunctive therapy for surgical resection need further investigation.

Citing Articles

Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, treatment, and unresolved challenges.

Tashiro M, Takazono T, Izumikawa K Ther Adv Infect Dis. 2024; 11:20499361241253751.

PMID: 38899061 PMC: 11186400. DOI: 10.1177/20499361241253751.

Ethiopia's first minimally invasive surgery program: A novel approach in global surgical education.

Bondzi-Simpson A, Keshishi M, Ademe Y, Rose M, Tizazu A, Uddin S JTCVS Open. 2023; 13:459-467.

PMID: 37063147 PMC: 10091276. DOI: 10.1016/j.xjon.2022.11.015.

Mapping of Chronic Pulmonary Aspergillosis in Africa.

Olum R, Osaigbovo I, Baluku J, Stemler J, Kwizera R, Bongomin F J Fungi (Basel). 2021; 7(10).

PMID: 34682212 PMC: 8541146. DOI: 10.3390/jof7100790.

References

Shirakusa T, Ueda H, Saito T, MATSUBA K, Kouno J, Hirota N . Surgical treatment of pulmonary aspergilloma and Aspergillus empyema. Ann Thorac Surg. 1989; 48(6):779-82. DOI: 10.1016/0003-4975(89)90670-x. View

Csekeo A, Agocs L, Egervary M, Heiler Z . Surgery for pulmonary aspergillosis. Eur J Cardiothorac Surg. 1998; 12(6):876-9. DOI: 10.1016/s1010-7940(97)00272-8. View

Sagawa M, Sakuma T, Isobe T, Sugita M, Waseda Y, Morinaga H . Cavernoscopic removal of a fungus ball for pulmonary complex aspergilloma. Ann Thorac Surg. 2004; 78(5):1846-8. DOI: 10.1016/j.athoracsur.2003.07.021. View

Farid S, Mohamed S, Devbhandari M, Kneale M, Richardson M, Soon S . Results of surgery for chronic pulmonary Aspergillosis, optimal antifungal therapy and proposed high risk factors for recurrence--a National Centre's experience. J Cardiothorac Surg. 2013; 8:180. PMC: 3750592. DOI: 10.1186/1749-8090-8-180. View

Silva P, Marsico G, Araujo M, Braz F, Santos H, Loureiro G . Complex pulmonary aspergilloma treated by cavernostomy. Rev Col Bras Cir. 2015; 41(6):406-11. DOI: 10.1590/0100-69912014006005. View

Babatasi G, Massetti M, Chapelier A, Fadel E, Macchiarini P, Khayat A . Surgical treatment of pulmonary aspergilloma: current outcome. J Thorac Cardiovasc Surg. 2000; 119(5):906-12. DOI: 10.1016/S0022-5223(00)70085-7. View

Felton T, Baxter C, Moore C, Roberts S, Hope W, Denning D . Efficacy and safety of posaconazole for chronic pulmonary aspergillosis. Clin Infect Dis. 2010; 51(12):1383-91. DOI: 10.1086/657306. View

Sambatakou H, Dupont B, Lode H, Denning D . Voriconazole treatment for subacute invasive and chronic pulmonary aspergillosis. Am J Med. 2006; 119(6):527.e17-24. DOI: 10.1016/j.amjmed.2005.11.028. View

Cesar J, Resende J, Amaral N, Alves C, Vilhena A, Silva F . Cavernostomy x resection for pulmonary aspergilloma: a 32-year history. J Cardiothorac Surg. 2011; 6:129. PMC: 3197487. DOI: 10.1186/1749-8090-6-129. View

10.

Nonga B, Bang G, Jemea B, Savom E, Yone P, Mbatchou N . Complex Pulmonary Aspergilloma: Surgical Challenges in a Third World Setting. Surg Res Pract. 2018; 2018:6570741. PMC: 5821956. DOI: 10.1155/2018/6570741. View

11.

Sapienza L, Gomes M, Maliska C, Norberg A . Hemoptysis due to fungus ball after tuberculosis: A series of 21 cases treated with hemostatic radiotherapy. BMC Infect Dis. 2015; 15:546. PMC: 4660718. DOI: 10.1186/s12879-015-1288-y. View

12.

Akbari J, Varma P, Neema P, Menon M, Neelakandhan K . Clinical profile and surgical outcome for pulmonary aspergilloma: a single center experience. Ann Thorac Surg. 2005; 80(3):1067-72. DOI: 10.1016/j.athoracsur.2005.03.078. View

13.

Mohapatra B, Sivakumar P, Bhattacharya S, Dutta S . Surgical treatment of pulmonary aspergillosis: A single center experience. Lung India. 2016; 33(1):9-13. PMC: 4748676. DOI: 10.4103/0970-2113.173077. View

14.

Denning D, Pleuvry A, Cole D . Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ. 2012; 89(12):864-72. PMC: 3260898. DOI: 10.2471/BLT.11.089441. View

15.

Jain L, Denning D . The efficacy and tolerability of voriconazole in the treatment of chronic cavitary pulmonary aspergillosis. J Infect. 2006; 52(5):e133-7. DOI: 10.1016/j.jinf.2005.08.022. View

16.

Daly R, Pairolero P, Piehler J, Trastek V, Payne W, BERNATZ P . Pulmonary aspergilloma. Results of surgical treatment. J Thorac Cardiovasc Surg. 1986; 92(6):981-8. View

17.

Chen J, Chang Y, Luh S, Lee J, Lee Y . Surgical treatment for pulmonary aspergilloma: a 28 year experience. Thorax. 1997; 52(9):810-3. PMC: 1758650. DOI: 10.1136/thx.52.9.810. View

18.

Camuset J, Nunes H, Dombret M, Bergeron A, Henno P, Philippe B . Treatment of chronic pulmonary aspergillosis by voriconazole in nonimmunocompromised patients. Chest. 2007; 131(5):1435-41. DOI: 10.1378/chest.06-2441. View

19.

Tseng Y, Wu M, Lin M, Lai W . Intrathoracic muscle flap transposition in the treatment of fibrocavernous tuberculosis. Eur J Cardiothorac Surg. 2000; 18(6):666-70. DOI: 10.1016/s1010-7940(00)00594-7. View

20.

Brik A, Salem A, Kamal A, Abdel-Sadek M, Essa M, El Sharawy M . Surgical outcome of pulmonary aspergilloma. Eur J Cardiothorac Surg. 2008; 34(4):882-5. DOI: 10.1016/j.ejcts.2008.06.049. View