Aspergillosis

Question 1

What are the five ways in which aspergillus can affect the lungs?

Answer 1

Asthma – type I hypersensitivity
Allergic bronchopulmonary aspergillosis – type I and III hypersensitivity with recurrent asthma and bronchial damage and bronchiectasis. Associated with positive aspergillus skin test, elevated IgE, eosinophilia, serum precipitins.
Mycetoma (aspergilloma) – fungus ball forming in a pre-existing lung cavity
Invasive aspergillosis (in the immunosuppressed) with high mortality
Extrinsic allergic alveolitis – recurrent dyspnoea and dry cough and ultimately fibrosis

Question 2

Symptoms

Answer 2

Cough
Weight loss
Haemoptysis !!
Dynspnoea

Question 3

Investigations

Answer 3

CXR
Sputum for MC and S
Lung function tests
Sputum sample for cytology

Question 4

What might be seen on a cxr

Answer 4

Cavitating lesion

Question 5

Another name for fungal infections of the lung

Answer 5

Mycetoma

Question 6

Further investigations

Answer 6

Bronchoscopy - to check for mucus plugs
Aspergillus skin test (positive in 30%)
Serum precipitins 
CT thorax
Repeat sputum samples for culture

Question 7

What does the skin test look for?

Answer 7

Red bumpb after injection of aspergillus antigen suggests preformed antibodies, in turn suggesting previous exposure

Question 8

Name two predisposing factors for mycetoma

Answer 8

TB

Sarcoidosis

Question 9

Route of antifungals

Answer 9

Percutaneous antifungal injection

Question 10

What changes to the bronchi does aspergillosis cause?

Answer 10

Bronchiectasis (widening)

Question 11

What types of hypersensitivity reactions are associated with allergic bronchopulmonary aspergillosis (ABPA)?

Answer 11

Type I (IgE-mediated) (and eosinophila)
Type III (IgG-mediated immune complex) 
Type IV (cell-mediated)