Aspergillosis surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Haytham Allaham, M.D. [2]; Yazan Daaboul, M.D.; Serge Korjian M.D. ; Rithish Nimmagadda,MBBS.[3]
Overview
Surgery is required for the treatment of an aspergilloma fungus ball. Endocarditis caused by Aspergillus is treated by surgical repair of the heart valve.
Surgery
Surgery is required for the treatment of an aspergilloma fungus ball. Emergent debridement of Aspergillus rhinosinusitis can limit extension to the orbit and brain and can be lifesaving [1]
Radical surgical debridement is required in some cases to achieve cure and sometimes requires multiple surgeries. The need for surgery may depend on the degree of fungal bone invasion at diagnosis and anticipated risks in the setting of severe thrombocytopenia; we have treated some patients successfully with medical therapy alone
Primary cutaneous infection – Debridement is recommended for primary cutaneous infection associated with burns or massive soft tissue wounds
Pulmonary infection – Surgical excision of a pulmonary cavity has been performed in patients with a single pulmonary lesion and recurrent hemoptysis or bacterial superinfection[2]. Surgery may be helpful for patients who have lesions near the pericardium or great arteries and are at high risk of bleeding into them, for patients who bleed uncontrolled, or for patients who have pleural space or chest wall invasion.Patients with a single pulmonary lesion before intense chemotherapy or HCT, as well as those with localized pulmonary disease that is resistant to antifungal therapy, may be candidates for it; however, there are significant risks involved, and its usefulness is unclear given that the availability of current antifungals by itself may be sufficient.Persistent pneumothorax and the release of viable fungus into the pleural cavity are risks. We advise starting pulmonary aspergillosis treatment with medication and then following up to see if surgery is required, unless there is an imminent risk of significant bleeding. Surgery is not usually necessary for individuals with invasive pulmonary aspergillosis. In one retrospective analysis, 41 patients with hematologic illness that was worse by invasive pulmonary aspergillosis and neutropenia were assessed.
endocarditis- In an effort to avoid embolic consequences and valvular decompensation, individuals with Aspergillus endocarditis should have early valve replacement surgery.
central nervous system- Although some small studies have indicated a mortality advantage to surgery combined with voriconazole antifungal medication for the treatment of cerebral lesions [3]
Endocarditis caused by Aspergillus is treated by surgical repair of the heart valve.
References
- ↑ Patterson TF I. "Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America". PMID 27365388. Check
|pmid=value (help). - ↑ Herbrecht R. "Invasive pulmonary aspergillosis. Semin Respir Crit Care Med. 2004". PMID 16088462.. Check
|pmid=value (help). - ↑ Schwartz S. "Improved outcome in central nervous system aspergillosis, using voriconazole treatment". PMID 15998833. Check
|pmid=value (help).