Chronic cavitary pulmonary aspergillosis (CCPA)
- Typically occurs in patients with chronic underlying lung diseases +/- comorbidities (e.g. diabetes, malnutrition) and/or inhaled/systemic corticosteroids but without severe immunosuppression.
- Follow patients every 3-6 months. If they develop pulmonary symptoms, weight loss or significant fatigue, treat for minimum of 6 months with antifungal therapy.
- Diagnosis requires:
- 3 months of chronic pulmonary symptoms/chronic illness or progressive radiographic abnormalities with cavitation, pleural thickening, pericavitary infiltrates ± fungal ball
- elevated Aspergillus IgG antibody
- no or minimal immunocompromise with one or more underlying pulmonary disorders.
- Surgical resection of CCPA can be considered for localized disease, unresponsive to medical treatment, pan-azole resistant A. fumigatus or persistent hemoptysis despite bronchial artery embolization.
- Infectious Diseases consult recommended.
Usual Pathogens
Aspergillus spp
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Itraconazole | 200mg PO bid | 12 months, possibly lifelong for progressive disease |
Alternative
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Posaconazole |
300mg DR tab PO bid on day 1, then 300mg DR tab PO daily |
12 months, possibly lifelong for progressive disease |