Chronic necrotizing aspergillosis

Chronic necrotizing aspergillosis (chronic necrotizing pulmonary aspergillosis, CNPA, semi-invasive or subacute invasive aspergillosis) is an infectious process of the lung parenchyma that develops in response to local invasion commonly A. fumigatus.

Clinical picture
It is a rare syndrome and, unlike IPA, CNPA develops slowly, from weeks to months and vascular invasion or dissemination to other organs usually does not occur. It can be difficult to distinguish from aspergillosis. However, CNPA is a local invasion of lung tissue, and a cavity filled with Aspergilus fungi may form secondarily as a result of fungal damage to the parenchyma. CNPA is characterized by necrosis of lung tissue, acute or chronic inflammation of the cavity wall, and the presence of hyphae.

Risk factors
It mainly affects older people with chronic lung diseases such as COPD, pulmonary TB, pneumoconiosis, cystic fibrosis, sarcoidosis, pulmonary infarction.

Symptomatics
Patients often complain of fever, malaise, fatigue, weight loss, chronic productive cough and hemoptysis. However, the course of CNPA can also be asymptomatic.

Diagnostics
A CT scan of the chest is used to diagnose CNPA, on which thickening of the pleura is visible, which can lead to the formation of a broncho-pleural fistula and a cavity lesion in the upper lung lobes. Serum IgG antibodies to A. fumigatus are also found in most patients. Again, histopathological examination and cultivation are necessary to confirm the diagnosis.

Treatment
Voriconazole or itraconazole are most commonly used to treat mild to moderate forms of CNPA, with severe forms being treated with amphotericin B and intravenous voriconazole.

Related articles

 * Aspergillosis
 * Allergic bronchopulmonary aspergillosis (ABPA)
 * Aspergillus
 * Invasive aspergillosis
 * Aspergil infections
 * Invasive fungal infections