Aspergillus lung disease Flashcards
1
Q
What is aspergillus fumigatus
A
- Ubiquitous fungi
- Found in soil, decaying vegetable matter
- 5mm spores dispersed by the wind
- Peak levels in late autumn/winter
2
Q
Conditions caused by aspergillus
A
- Allergic bronchopulmonary aspergillosis
- Aspergilloma
- Invasive aspergillosis
3
Q
Allergic broncopulmonary aspergillosis (ABPA)
A
- A hypersensitivity reaction to Aspergillus in the airwaysnComplicates asthma and cystic fibrosis
- Eosinophilic pneumonia
- Allergic reaction in proximal airways
- Symptoms - wheeze, cough, fever, malaise
4
Q
ABPA investigations
A
- neripheral blood eosinophils raised
- Total IgE > 1000 ng/ml
- Positive skin prick test to aspergillus
- Precipitating antibodies (IgE and IgG) in serum
- Sputum eosinophilia and mycelia
- CXR – pulmonary infiltrates – “tooth-paste shadows”
- CT chest – central bronchiectasis
- large plugs can cause lung collapse, upper zone fbrosis if left untrated
5
Q
ABPA treatment
A
- Prednisolone
- May require long-term low dose steroids to prevent recurrence
- Itraconazole and voriconizole
- Asthma component responds to inhaled steroids
6
Q
Aspergilloma
A
- Fungal ball in cavity – usually an area of damaged lung
- CXR ahows round lesion with a “halo”
- May cause massive haemoptysis
Treat with oral voriconizole or IV amphotericin
7
Q
Invasive aspergillosis
A
- Immunocompromised patients
- Consider if pyrexial and failed to settle on standard antibiotics
- CXR – normal or nodular opacities or lung infarcts
- Poor prognosis
- Aggressive anti-fungal treatment
8
Q
How to diagse aspergillus lung disease
A
Skin prick test
- allergic reactions
- looks for IgE release
- histamine release
Precipitans
- IgG levels to aspergillus antigens
- Secretions on agar plate with IgG solutions and see if ig atttach to the fungal antigens
