Pseudomembranous necrotizing tracheobronchial aspergillosis:an analysis of 16 cases

Background In our clinical practice we have been attracted by a group of patients with airway aspergillosis who have airway obstruction; we termed the condition as pseudomembranous necrotizing tracheobronchial aspergillosis (PNTA).In this study we analyzed the clinical data from patients with PNTA,so as to guide the diagnosis and treatment of the disease.@@Methods A total of 16 PNTA patients were treated in Changhai Hospital from January 2000 to January 2009.Their clinical data,including the demographic information,clinical symptoms,imaging findings,bronchoscopy findings,treatment strategies and efficacy,and prognosis,were retrospectively analyzed.@@Results All 16 patients were found to have primary systemic immunodeficiency diseases and/or damage of the focal airways.Nine patients (9/16,56.3％) had pulmonary and tracheobronchial tumors,5/16 (31.3％) had tracheobronchial involvement secondary to non-pulmonary tumors,and 2/16 (12.5％) had lung transplantation.The most common causes of PNTA included local radiotherapy (10/16,62.5％),repeated chemotherapy (7/16,43.8％) and recurrent intervention therapy by bronchoscope (4/16,25.0％).Aspergillus fumigatus was the most frequent pathogen (62.5％,10/16).The main clinical manifestations included progressive dyspnea (14/16,87.5％) and irritable cough (12/16,75.0％).The trachea was involved in 9/16 patients (56.3％),right main bronchus in 10/16 (62.5％).All 16 patients were treated with systemic anti-aspergillosis agents,local anti-aspergillosis agents with amphotedcin B inhalation and direct perfusion of amphotericin B by bronchoscope,and interventional treatment by bronchoscope to ensure an unobstructed airway.The total efficiency was 31.3％.@@Conclusions PNTA is an infectious disease caused by aspergillus and it mainly involves the trachea,primary bronchus and segmental bronchus.A.fumigatus is the most common pathogen.PNTA can pose a severe clinical threat and often occurs after systemic immunodeficiency and/or local airway damage,with the main symptoms including dyspnea and irritable cough.Bronchoscopic findings supply the main evidence for diagnosis of PNTA.Treatment of PNTA is difficult and requires a long course.Systemic and local anti-aspergillosis agents plus bronchoscopy debridement can improve the prognosis of the disease.