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Treatment of chronic pulmonary aspergillosis

David W Denning, MBBS, FRCP, FRCPath, FMedSci
Section Editor
Carol A Kauffman, MD
Deputy Editor
Anna R Thorner, MD


Chronic pulmonary aspergillosis includes several disease manifestations, including aspergilloma, Aspergillus nodules, chronic cavitary pulmonary aspergillosis, and chronic fibrosing pulmonary aspergillosis. Subacute invasive pulmonary aspergillosis (formerly known as chronic necrotizing pulmonary aspergillosis) is on the spectrum between chronic and acute forms of pulmonary aspergillosis (see 'Definitions' below). A duration of disease longer than three months distinguishes chronic pulmonary aspergillosis from acute and subacute invasive pulmonary aspergillosis.

The treatment of chronic pulmonary aspergillosis will be reviewed here. The pathophysiology, clinical manifestations, and diagnosis of chronic pulmonary aspergillosis are discussed separately; the treatment of allergic bronchopulmonary aspergillosis and invasive aspergillosis are also reviewed elsewhere. (See "Clinical manifestations and diagnosis of chronic pulmonary aspergillosis" and "Clinical manifestations and diagnosis of allergic bronchopulmonary aspergillosis" and "Treatment and prevention of invasive aspergillosis".)


Chronic pulmonary aspergillosis describes several patterns of disease. However, the terminology that has been developed can be difficult to apply to a spectrum of disease entities that have considerable overlap and variation in severity. The following terminology will be used to describe the spectrum of disease; each entity is characterized by specific radiographic findings [1].

Aspergilloma — An aspergilloma is a fungus ball composed of Aspergillus hyphae, fibrin, mucus, and cellular debris found within a pulmonary cavity [2]. Aspergillomas arise in preexisting pulmonary cavities that have become colonized with Aspergillus spp or develop in chronic cavitary pulmonary aspergillosis [1].

If the aspergilloma is single, the cavity stable over months, and the patient has few symptoms (ie, a mild cough only) and little evidence of systemic inflammation, a simple aspergilloma may be diagnosed. We will use the term "simple aspergilloma" to distinguish this entity from the more complex forms of chronic pulmonary aspergillosis. (See "Diagnosis of invasive aspergillosis", section on 'Diagnostic modalities'.)

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Literature review current through: Nov 2017. | This topic last updated: Jul 26, 2017.
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