Clinical characteristics and treatment outcomes of chronic necrotizing pulmonary aspergillosis: a review of 43 cases

Int J Infect Dis. 2010 Jun;14(6):e479-82. doi: 10.1016/j.ijid.2009.07.011. Epub 2009 Nov 11.


Objectives: Chronic necrotizing pulmonary aspergillosis (CNPA) is uncommon, and the optimal therapeutic regimen has not been established. In a retrospective cohort study, we investigated the clinical characteristics and treatment outcomes of patients with CNPA.

Methods: We reviewed the medical records of all patients who had been diagnosed with CNPA at our institution over the last 10 years.

Results: Forty-three patients were identified. Their median age was 60 years (interquartile range (IQR) 45-65 years), and 34 (79%) of the patients were men. The most common underlying lung disease was pulmonary tuberculosis (n=40, 93%). After CNPA was diagnosed, all patients were treated with antifungal drugs, including oral itraconazole (n=39, 91%) or intravenous amphotericin B (n=4, 9%). Seventeen (40%) patients discontinued therapy early (<3 months), 14 patients due to death and three to loss of follow-up. Twenty-six (60%) patients received oral itraconazole at a daily dose of 200-400mg for more than 3 months. The median treatment duration was 6 months (IQR 6-12 months). In these 26 patients, clinical improvement was observed in 15 (58%) and radiological improvement was observed in 11 (42%). Ten (38%) patients showed no improvement. Twenty-two (51%) patients died, including 18 (42%) CNPA-related deaths, during a median follow-up of 15 months (IQR 2.5-32 months). The median survival time was 62 months.

Conclusions: CNPA is difficult to treat and often has a poor outcome. Further studies with more patients are needed to identify the optimal therapy for patients with CNPA.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Amphotericin B / administration & dosage
  • Amphotericin B / therapeutic use*
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / therapeutic use*
  • Cohort Studies
  • Drug Administration Schedule
  • Female
  • Humans
  • Injections, Intravenous
  • Invasive Pulmonary Aspergillosis / drug therapy*
  • Itraconazole / administration & dosage
  • Itraconazole / therapeutic use*
  • Male
  • Medical Records
  • Middle Aged
  • Republic of Korea
  • Retrospective Studies
  • Treatment Outcome


  • Antifungal Agents
  • Itraconazole
  • Amphotericin B