8. Fungi and the lungs

Question 1

What is the most common fungi to affect the lungs?

Answer 1

Aspergillus

Question 2

How does aspergillus cause asthma?

Answer 2

Type I hypersensitivity reactions to fungal spores

Question 3

What is allergic bronchopulmonary aspergillosis (ABPA)?

Answer 3

Results from type I and III hypersenstivity reactions to aspergillus fumigatus. Affects 5% of asthmatics and 20% of CF patients

Question 4

Describe the pathophysiology of ABPA?

Answer 4

Initially bronchoconstriction then permanent damage occurs causing bronchiecstasis

Question 5

What are the symptoms of ABPA?

Answer 5

Wheeze, cough, sputum,

dyspnoea, recurrent pneumonia

Question 6

What investigations can be done for ABPA?

Answer 6

CXR (shadows, segmental collapse, opacification)
Aspergillus skintest
Sputum culture- aspergillus in sputum
Blood tests- serum precipitens, eosinophilia, raised IgE

Question 7

What is the treatment for ABPA?

Answer 7

Prednisolone 5-10mg maintanence dose. Can be used in higher dose for acute attacks

Itraconazole and corticosteroids.

bronchodilators if asthmatic

potential bronchoscopic aspiration of mucous plugs

Question 8

What is an aspergilloma (myectoma)

Answer 8

Fungus ball within a pre-existing cavity(TB/sarcoidosis).

May be asymptomatic but may cause cough, heamoptysis, lethargy and weight loss

Question 9

What investigations can be carried out if an aspergilloma is suspected

Answer 9

CXR- round opacity
Sputum culture
Blood tests- serum precipitens
Aspergillus skin test

Question 10

What is the treatment of aspergilloma?

Answer 10

Only treat if symptomatic

Consider surgical exicision
Oral itroconazole and other antifungals have been tried without success
Amphotericin aste under CT guidance yields some success

Question 11

What is invasive aspergillosis?

Answer 11

Immunocompromised patients have an aspergillus infection spread to other parts of the body such as the brain, heart, kidneys or skin

Question 12

What are the risk factors of invasive asperigllosis?

Answer 12

HIV, leukemia, burns, Wegener’s,

SLE. broad spectrum antibiotic therapy

Question 13

What investigations can be done for invasive aspergillosis?

Answer 13

Sputum culture
biopsy
serum precipitens
CXR
Early chest CT and measurements of serum galactomannan

Question 14

What treatment can be used for invasive aspergillosis

Answer 14

Voriconazole