Abstract：
Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ~240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferably via video-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with single Aspergillus nodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up.
摘要：
慢性肺曲霉病（CPA）是一种罕见且有问题的肺部疾病，使许多其他呼吸系统疾病复杂化，被认为影响了欧洲约24万人。CPA最常见的形式是慢性空洞性肺曲霉病（CCPA），未经治疗可能会发展为慢性纤维化肺曲霉病。不太常见的表现包括：曲霉菌结节和单个曲霉菌瘤。所有这些实体都存在于先前或当前患有肺病的非免疫受损患者中。亚急性侵袭性肺曲霉病（以前称为慢性坏死性肺曲霉病）是一种更快速进展的感染（<3个月），通常在中度免疫功能低下患者中发现。应该作为侵袭性曲霉病进行管理。先前很少提出用于CPA的诊断或管理的临床指南。一组专家召集来开发临床,放射学和微生物学指南。CPA的诊断需要结合以下特征：一个或多个有或没有真菌球存在的腔或胸部成像结节，曲霉感染的直接证据（显微镜检查或活检培养物）或对曲霉属的免疫反应。排除替代诊断，所有存在至少3个月。超过90%的患者中曲霉抗体(沉淀)升高。建议手术切除单纯性曲菌瘤，如果技术上可行,最好是通过电视辅助胸外科技术。建议CCPA长期口服抗真菌治疗，以改善整体健康状况和呼吸道症状，阻止咯血并防止进展。仔细监测唑血清浓度，建议药物相互作用和可能的毒性。咯血可以通过氨甲环酸和支气管动脉栓塞来控制，很少手术切除，并且可能是治疗失败和/或抗真菌耐药性的迹象。单个曲霉结节的患者如果未完全切除，则仅需要抗真菌治疗，但是如果有多个，它们可能会从抗真菌治疗中受益，需要仔细跟进。
