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ASPERGILLOSIS Flashcards

1
Q

Which groups of patients are most at risk of developing aspergillosis in the respiratory tract?

A 
TB patients
COPD patients
Lung cancer patients
Sarcoidosis patients
Asthmatics
CF patients
Immunosuppressed patients
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2
Q

What does ABPA stand for?

A

Allergic bronchopulmonary aspergillosis

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3
Q

What is the mechanism of pathology in ABPA?

A

Type I and type III hypersensitivity
Early on allergic response causes bronchoconstriction
Persistent inflammation leads to bronchiectasis

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4
Q

Which patients are commonly affected by ABPA?

A

Asthmatics

CF patients

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5
Q

Which fungus most often leads to the hypersensitivity response seen in ABPA?

A

Aspergillus fumigatus

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6
Q

How do patients with suspected ABPA present?

A 
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
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7
Q

What investigations should be ordered for someone with suspected ABPA?

A

Skin prick test for sensitivity to aspergillus antigen
Blood test
Chest X-ray
CT

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8
Q

What would you look for in the blood to confirm or exclude a diagnosis of ABPA?

A

Normal levels of IgE excludes diagnosis of ABPA
Raised levels of IgE raises suspicion
Raised eosinophils
Presence of IgG antigen-antibody complex (precipitin)

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9
Q

What would you look for on a x-ray of someone with suspected ABPA?

A 
Consolidation
Mucoid impaction in airways
Transient segmental collapse
Signs of bronchiectasis
Tramline shadowing
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10
Q

What would you look for on a CT of someone with suspected ABPA?

A

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

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11
Q

How would you treat someone with a confirmed diagnosis of ABPA? Give doses where you can.

A

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.

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12
Q

What percentage of asthmatics are affected by ABPA?

A

Roughly 1%

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13
Q

What is an aspergilloma?

A

A fungus ball within a pre-existing cavity.

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14
Q

Which groups of patients are more susceptible to an aspergilloma?

A

TB patients

Sarcoidosis patients

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15
Q

How might someone with an aspergilloma present? (Name at least 3)

A 
They are usually asymptomatic
Cough
Hemoptysis
Lethargy
Weight loss
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16
Q

What investigations would be carried out on a patient with suspected aspergilloma?

A

Chest x-ray
Sputum culture
Serum precipitins
Aspergillus skin test

17
Q

How would you treat someone who was diagnosed with aspergilloma?

A

You would only treat if they were symptomatic.
Surgical excision
Oral itraconazole
Prednisolone
Local instillation of amphotericin (anti-fungal agent) paste under CT guidance

18
Q

What might you see on a chest x-ray of someone with aspergilloma?

A

Round opacity within a cavity (air crescent sign)

Usually apical

19
Q

I which organs other than the lung can an aspergilloma develop? (Name at least 3)

A 
Brain 
Kidney
Sphenoid sinuses
Paranasal sinuses
Ear canal
Surfaces of heart valves
20
Q

What is invasive aspergillosis?

A

This is when the aspergillus infection leads to spores entering the bloodstream via the lungs.

21
Q

Which patients are particularly susceptible to invasive aspergillosis?

A

Immunocomprimised patients
HIV patients
Leukaemia patients
SLE patients

22
Q

What respiratory symptoms might someone with invasive aspergillosis present with?

A 
Cough
Hemoptysis
Fever
Chest pain
Dyspnae
23
Q

What are the extra-respiratory symptoms and complications of invasive aspergillosis? (Name at least 5)

A 
Widespread organ damage
Blood clots
Fever
Chills
Shock
Delirium
Seizures
Kidney failure
Liver failure
Jaundice
Death
24
Q

Define aspergillosis.

A

Any disease caused by infection by fungi of the genus Aspergillus.

25
Q

What investigations would you order to confirm a diagnosis of invasive aspergillosis?

A 
Chest x-ray
CT
FBC and CRP
Blood culture
Serum precipitins
26
Q

What might you expect to see on the chest x-ray of a patient with invasive aspergillosis?

A

Consolidation

Abscess

27
Q

What might you expect to see on the CT scan of a patient with invasive aspergillosis?

A 
Halo sign (ground-glass attenuation surrounding a pulmonary nodule)
Air crescent sign (lung cavity filled with air containing a round radiopaque mass)
28
Q

How would you treat someone with invasive aspergillosis?

A

Voriconazole IV

Alternatives include: Miconazole IV, Ketoconazole IV

29
Q

What is the prognosis of someone being treated for invasive aspergillosis?

A

30% mortality

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