Aspergillus Lung Disease

Question 1

def

Answer 1

lung disease associated with aspergillus fungal infection

Question 2

aetiology

Answer 2

inhalation of ubiquitous aspergillus spores
1 aspergilloma
-growth of an A. fumigatus mycetoma ball in a preexisting lung cavity (post-TB, infarct)
2 allergic bronchopulmonary aspergillosis
-aspergillus colonization leads to IgE & IgG-mediated immune responses
-proteolytic enzymes & mycotoxins from fungi, IL-4 & IL-5 from CD4/TH2 cells (which mediates eosinophilic inflammation), IL-8 (which mediates neutrophilic inflammation) results in airway damage & central bronchiectasis
3 invasive aspergillosis
-invasion into lung tissue & fungal dissemination
-secondary to immunosuppression (neutropaenia, steroids, AIDS)

Question 3

what is a mycetoma

Answer 3

chronic inflammation of tissues caused by infection

Question 4

epi

Answer 4

uncommon

more common in elderly & immunocompromised

Question 5

history of aspergilloma

Answer 5

asymptomatic

haemoptysis

Question 6

history of ABPA

Answer 6

difficult to control asthma

recurrent episodes of pneumonia with wheeze, cough, fever

Question 7

history of invasive aspergillosis

Answer 7

dyspnoea
rapid deterioration
septic picture

Question 8

examination of aspergilloma

Answer 8

tracheal deviation if large aspergilloma

Question 9

examination of ABPA

Answer 9

dullness in affected lung

decreased breath sounds & wheeze

Question 10

examination of invasive aspergillosis

Answer 10

possible cyanosis

Question 11

investigations in suspected aspergilloma

Answer 11

1 CXR
-round opacity indicating aspergilloma with a crescent of air around it
-usually in upper lobes
2 CT/MRI if CXR unclear
3 cultures
-if negative, there is no communication between cavity & bronchial tree

Question 12

investigations in suspected ABPA

Answer 12

1 immediate skin test reactivity to aspergillus antigens
2 eosinophilia
3 high serum total IgE
4 high serum specific IgE & IgG to A. fumigatus
5 CXR
-transient patchy shadows
-collapse
-distended mucus-filled bronchi producing ‘gloved fingers’ shadows
6 CT
-lung infiltrates
-central bronchiestasis
7 LFTs
-reduced lung volumes in progessive cases

Question 13

what is bronchiestasis

Answer 13

permanent enlargement of the parts of the airways of the lungs

Question 14

investigations in suspected invasive aspergillosis

Answer 14

1 culture
-positive aspergillus indicated by septated hyphae with acute angle branching from bronchoalveolar lavage fluid or sputum
2 Chest CT
-nodules with ground glass appearance is a positive finding in invasive aspergillosis
-indicates haemorrhage into tissue surrounding the area of fungal invasion