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Vol. 17. Issue 2.
Pages 80-84 (March - April 2011)
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Vol. 17. Issue 2.
Pages 80-84 (March - April 2011)
Caso clínico
DOI: 10.1016/S0873-2159(11)70019-8
Open Access
Aspergilose pulmonar necrotizante: a propósito de dois casos clínicos
Necrotizing pulmonary aspergillosis: regarding two clinical cases
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S. Carreira
Corresponding author
sbcarreira@gmail.com

Autor para correspondência.
, A. Lopes, R. Pinto Basto, I. Faria, J. Pontes da Mata
Serviço de Pneumologia 2, Centro Hospitalar Lisboa Norte, EPE – Hospital Pulido Valente, Lisboa, Portugal
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Resumo

Os autores apresentam dois casos clínicos de aspergilose pulmonar necrotizante. Esta patologia faz parte de um espectro de condições clínicas provocadas pela inalação de esporos do fungo Aspergillus. A aspergilose pulmonar necrotizante (APN) corresponde a um processo indolente de destruição do pulmão pelo Aspergillus, geralmente A. fumigatus. O diagnóstico definitivo faz-se através da demonstração histológica de invasão tecidual pelo Aspergillus e do seu crescimento em cultura 2. Pela dificuldade em obter um diagnóstico definitivo foram estabelecidos os seguintes critérios de diagnóstico que, quando reunidos, são fortemente indicativos de APN: aspectos clínicos e radiológicos consistentes com o diagnóstico, elevação dos parâmetros inflamatórios (PCR, VS) e marcadores serológicos positivos para Aspergillus ou isolamento de Aspergillus em amostras do aparelho respiratório. Deve ser feita a exclusão de tuberculose activa, micobacterioses não tuberculosas, histoplasmose cavitária e coccidiomicose. É necessário elevar o grau de suspeição desta patologia e realizar os exames de diagnóstico indicados de forma a iniciar terapêutica atempadamente.

Palavras-chave:
Aspergilose pulmonar necrotizante
Aspergillus fumigatus
Abstract

The authors present two case reports of necrotizing pulmonary aspergillosis. This disease is part of a spectrum of clinical conditions caused by the inhalation of Aspergillus spores. The necrotizing pulmonary aspergillosis (NPA) corresponds to an indolent, destructive process of the lung due to invasion by Aspergillus species, usually A. fumigatus. The diagnosis is confirmed by a histological demonstration of tissue invasion by Aspergillus species and its growth on culture. Due to the difficulty in confirming the diagnosis, the following diagnosis criteria were established and when combined are highly indicative of NPA: characteristic clinical and radiological findings, elevation of inflammatory markers and either serological results positive for Aspergillus or the isolation of Aspergillus from respiratory samples. Active tuberculosis, non tuberculosis mycobacteriosis, cavitary histoplasmosis and coccidioidomycosis should be excluded. It is necessary to raise the level of suspicion and perform the adequate diagnostic tests in order to start therapy and avoiding disease progression.

Keywords:
Necrotizing pulmonary aspergillosis
Aspergillus fumigatus
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Bibliografia
[1.]
C.D. Sánchez, A.L. Viña.
Aspergillus y pulmón.
Arch Bronconeumol, 40 (2004), pp. 114-122
[2.]
A.O. Soubani, P.H. Chandrasekar.
The Clinical Spectrum of Pulmonary Aspergillosis.
Chest, 121 (2002), pp. 1988-1999
[3.]
J.L. Saraceno, D.T. Phelps, T.J. Ferro, R. Futerfas, D.B. Schwartz.
Chronic Necrotizing Pulmonary Aspergillosis: Approach to Management.
Chest, 112 (1997), pp. 541-548
[4.]
T. Franquet, N.L. Müller, A. Giménez, P. Guembe, J. Torre, S. Bagué.
Spectrum of Pulmonary Aspergillosis: Histologic. Clinical and Radiologic Findings.
[5.]
S.Y. Kim, K.S. Lee, J. Han, J. Kim, T.S. Kim, S.W. Choo, S.J. Kim.
Semiinvasive Pulmonary Aspergillosis.
Am J Roentgenol, 174 (2000), pp. 795-798
[6.]
D.W. Denning.
Chronic forms of pulmonary aspergillosis.
Clin Microbiol Infect, 7 (2001), pp. 25-31
[7.]
O.S. Zmeili, A.O. Soubani.
Pulmonary aspergillosis: a clinical update.
Q J Med, 100 (2007), pp. 317-334
[8.]
H. Sambatakou, B. Dupont, H. Lode, D.W. Denning.
Voriconazole Treatment of Subacute Invasive and Chronic Pulmonary Aspergillosis.
Am J Medicine, 119 (2006), pp. 527
[9.]
T.J. Walsh, E.J. Anaissie, D.W. Denning, R. Herbrecht, D.P. Kontoyiannis, K.A. Marr, V.A. Morrison, B.H. Segal, W.J. Steinbach, D.A. Stevens, J.A. van Burik, J.R. Wingard, T.F. Patterson.
Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America.
Clin Infect Dis, 46 (2008), pp. 327-360
Copyright © 2011. Sociedade Portuguesa de Pneumologia
Pulmonology

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