BACKGROUND

Pulmonary aspergilloma is the most common pulmonary involvement due to Aspergillus. It usually develops in a pre-existing cavity in the lung, most often due to tuberculosis. Hemoptysis occurs secondary to local invasion of the blood vessels lining the cavity. Recurrence of which, is an indication to do surgery, lobectomy in particular. Antifungals like amphotecin B given intravenously and itraconazole given orally, have been the traditional management. But with the emergence of newer antifungals, Echinocandins in particular, which functions to inhibit the β-(1,3) p-glucan synthase, an enzyme necessary for the synthesis of an essential component of the cell wall of fungi, one may need not undergo surgery. The most common antifungal medication for Aspergillus is voriconazole, a second-generation triazole. This case demonstrates the efficient utilization of Voriconazole along with Anidulafungin, which is necessary for the fungal cell wall integrity. For immunocompromised patients with pulmonary aspergilloma, this dual therapy presents a viable substitute for surgical intervention and an efficient treatment approach.

CASE

We present a case of a 54-year-old married patient, who presented with massive hemoptysis four days before consulting a private physician. She had ten episodes of hemoptysis four hours before admission and was rushed to the hospital. The patient had multiple comorbidities, including diabetes, hypertension, and asthma, contributing to an immunocompromised state. She had a history of anti-tuberculosis treatment in 2000, which was discontinued due to an allergic reaction. During her hospital stay, she experienced febrile episodes, and capillary glucose monitoring was beyond acceptable levels, prompting antibiotic initiation. A chest CT scan revealed pulmonary tuberculosis with cicatricial atelectasis of the lingular segment and infected cavitary formation. A bronchoscopy and biopsy of the cavitary lesion were scheduled. Surgical intervention, particularly lobectomy, was not pursued due to multiple factors, including the patient's immunocompromised status, her underlying comorbidities, and the response to antifungal therapy. After eight to 14 fourteen (8-14) hospital days, no episodes of hemoptysis were noted, and the biopsy result revealed fungal colonization consistent with Aspergillus species. The patient was discharged with oral Voriconazole and other maintenance medications. A repeat chest CT scan after five months of antifungal therapy showed regression of the fungus ball.

CONCLUSION

In this case, pulmonary aspergilloma in an immunocompromised patient was successfully treated with a combination antifungal therapy utilizing anidulafungin and voriconazole. The favorable clinical response to dual antifungal therapy provides a feasible non-surgical alternative to surgical intervention, which has historically been the preferred option for treating recurrent hemoptysis, particularly in high-risk patients. The fungus ball's regression and the fungal infection's resolution support the growing role of more recent antifungal medications in the treatment of complicated pulmonary infections. This case suggests that echinocandins combined with triazole therapy are a viable less invasive treatment option for pulmonary aspergilloma than surgery.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Anidulafungin ; Immunocompromised Host ; Patients ; Therapeutics ; Voriconazole

BACKGROUND: Congenital heart diseases (CHD) pose a major global concern due to its increasing survival trend in the adult stage; but data in our country is lacking. Despite improvement in management, formal assessment for anxiety and depression in patients with adult CHD is not routinely done. The Hospital Anxiety and Depression Scale (HADS) is a popular and simple self-administered instrument highly reliable for detecting states of anxiety and depression for use in medical practice. Identifying the prevalence of anxiety and depression through a simple screening tool that may lead to a proper psychiatric referral may help health-care providers consider the contribution of these components of the disease and identify additional points of holistic care for our patients.

OBJECTIVES: We aim to determine the prevalence of anxiety and depression in adult CHD Filipino patients using the HADS-P questionnaire (validated Tagalog version of the HADS). We also aim to determine association between depression & anxiety and disease characteristics.

METHODS: This is a cross-sectional study using nonprobability sampling of adult Filipinos with CHD in the Philippine General Hospital (UP-PGH). The HADS-P is a 14-item, self-administered rating scale with independent subscales for anxiety and depression (seven items each) was administered to both the study and control groups after securing consent.

A cut-off score of > 8.0 points on either of the depression and anxiety subscale of the HADS was used to determine their respective prevalence. Logistic regression analysis was used to determine the association of clinical variables with anxiety or depression.

RESULTS: A total of 92 patients with CHD with a mean age of 33 years old were recruited. The prevalence of anxiety and depression was higher among those with CHD compared to local literature (61% and 34% respectively). Majority had an atrial septal defect, ventricular septal defect, and patent ductus arteriosus. On the basis of a HADS-P score of >8.0 per category, 56 patients had anxiety and 31 patients had depression. Simple logistic regression identified employment status, a higher NYFC, low distance six-minute walk test, uncorrected defects, and heart failure as predictors of anxiety; whereas lower educational achievement, higher functional class, right-to-left shunt or Eisenmenger physiology, low distance six-minute walk test, and heart failure were predictors of depression. Multiple logistic regression identified only employment status (ie. being unemployed) as a significant predictor of anxiety [OR 4.54, 95% CI 1.38 - 14.28, p 0.012]; while having a rightto-left shunt or Eisenmenger physiology was a significant predictor of depression [OR 6.44, 95% CI 1.82-22.76, p 0.004].

CONCLUSION: This cohort of adult Filipinos with CHD has higher HADS-P scores, suggestive of a higher prevalence of anxiety and depression compared to available data. Factors associated with anxiety and/or depression were related to their underlying CHD and sociodemographic profile. Screening for emotional disorders is of paramount importance to provide holistic care for this vulnerable population. Health care professionals should be alert for the possible need for psychological intervention for adult survivors of CHD, even among those that are seemingly emotionally well-adjusted.

Human ; Male ; Female ; Middle Aged ; Adult ; Depression ; Heart Septal Defects, Ventricular ; Ductus Arteriosus, Patent ; Vulnerable Populations ; Anxiety ; Heart Septal Defects, Atrial ; Heart Failure