ASPERGILLOSIS Flashcards
Which groups of patients are most at risk of developing aspergillosis in the respiratory tract?
TB patients COPD patients Lung cancer patients Sarcoidosis patients Asthmatics CF patients Immunosuppressed patients
Define aspergillosis.
Any disease caused by infection by fungi of the genus Aspergillus.
What does ABPA stand for?
Allergic bronchopulmonary aspergillosis
What is the mechanism of pathology in ABPA?
Type I and type III hypersensitivity
Early on allergic response causes bronchoconstriction
Persistent inflammation leads to bronchiectasis
Which patients are commonly affected by ABPA?
Asthmatics
CF patients
Which fungus most often leads to the hypersensitivity response seen in ABPA?
Aspergillus fumigatus
How do patients with suspected ABPA present?
Wheeze Cough Dyspnea Exercise intolerance Sputum production (plugs of sputum containing fungal hyphae) Pleuritic chest pain Fever Hemoptysis Most often have a previous asthma diagnosis
What investigations should be ordered for someone with suspected ABPA?
Skin prick test for sensitivity to aspergillus antigen
Blood test
Chest X-ray
CT
What would you look for in the blood to confirm or exclude a diagnosis of ABPA?
Normal levels of IgE excludes diagnosis of ABPA
Raised levels of IgE raises suspicion
Raised eosinophils
Presence of IgG antigen-antibody complex (precipitin)
What would you look for on a x-ray of someone with suspected ABPA?
Consolidation Mucoid impaction in airways Transient segmental collapse Signs of bronchiectasis Tramline shadowing
What would you look for on a CT of someone with suspected ABPA?
Central (confined to medial two-thirds of medial half of the lung) bronchiectasis that peripherally tapers bronchi is considered a requirement for ABPA.
Mucoid impaction of upper and lower airways
Mucus plugs
Rarely - fibrosis, pleural effusion, nodular opacities and perihilar opacities
How would you treat someone with a confirmed diagnosis of ABPA? Give doses where you can.
Prednisolone - 30-40mg/24hr PO for acute attacks and 5-10mg/24 hr as a maintenance dose
Itraconazole (anti-fungal agent) is sometimes used in conjunction with corticosteroids.
Bronchodilators for asthma.
Sometimes bronchoscopic aspiration of mucus plugs is needed.
What percentage of asthmatics are affected by ABPA?
Roughly 1%
What is an aspergilloma?
A fungus ball within a pre-existing cavity.
Which groups of patients are more susceptible to an aspergilloma?
TB patients
Sarcoidosis patients
How might someone with an aspergilloma present? (Name at least 3)
They are usually asymptomatic Cough Hemoptysis Lethargy Weight loss
What investigations would be carried out on a patient with suspected aspergilloma?
Chest x-ray
Sputum culture
Serum precipitins
Aspergillus skin test
How would you treat someone who was diagnosed with aspergilloma?
You would only treat if they were symptomatic.
Surgical excision
Oral itraconazole
Prednisolone
Local instillation of amphotericin (anti-fungal agent) paste under CT guidance
What might you see on a chest x-ray of someone with aspergilloma?
Round opacity within a cavity (air crescent sign)
Usually apical
I which organs other than the lung can an aspergilloma develop? (Name at least 3)
Brain Kidney Sphenoid sinuses Paranasal sinuses Ear canal Surfaces of heart valves
What is invasive aspergillosis?
This is when the aspergillus infection leads to spores entering the bloodstream via the lungs.
Which patients are particularly susceptible to invasive aspergillosis?
Immunocomprimised patients
HIV patients
Leukaemia patients
SLE patients
What respiratory symptoms might someone with invasive aspergillosis present with?
Cough Hemoptysis Fever Chest pain Dyspnae
What are the extra-respiratory symptoms and complications of invasive aspergillosis? (Name at least 5)
Widespread organ damage Blood clots Fever Chills Shock Delirium Seizures Kidney failure Liver failure Jaundice Death
What investigations would you order to confirm a diagnosis of invasive aspergillosis?
Chest x-ray CT FBC and CRP Blood culture Serum precipitins
What might you expect to see on the chest x-ray of a patient with invasive aspergillosis?
Consolidation
Abscess
What might you expect to see on the CT scan of a patient with invasive aspergillosis?
Halo sign (ground-glass attenuation surrounding a pulmonary nodule) Air crescent sign (lung cavity filled with air containing a round radiopaque mass)
How would you treat someone with invasive aspergillosis?
Voriconazole IV
Alternatives include: Miconazole IV, Ketoconazole IV
What is the prognosis of someone being treated for invasive aspergillosis?
30% mortality
