Aspergillus Lung Disease

Question 1

Define aspergillus lung disease

Answer 1

Lung disease associated with Aspergillus fungal infection, usually caused by Aspergillus fumigatus.

Question 2

Explain the aetiology and risk factors for aspergillus lung disease

Answer 2

Aspergilloma: growth of an A. fumigates mycetoma ball in a pre-existing lung cavity (post TB, old infarct, or abscess_

Allergic Bronchopulmonary Aspergillosis (ABPA) is the colonisation of the airways by aspergillus, leading to IgE and IgG mediated immune responses.

Usually occurs in asthmatics and is T1 and T3HS reactions that lead to release of proteolytic enzymes, mycotoxins and Ab. This results in airway damage and central bronchiectasis.

Invasive aspergillosis is the invasion into lung tissue and fungal dissemination in the immunocompromised (neutropenia, cancer px, elderly, HIV, post-AB treatment, steroids, leukeamia)

Question 3

Summarise the epidemiology of aspergillus lung disease

Answer 3

UNCOMMON Mainly occurs in the elderly and immunocompromised

Question 4

Recognise the presenting symptoms of Aspergilloma

Answer 4

• ASYMPTOMATIC
• can have severe haemoptysis
• lethargy
• weight loss

Question 5

Recognise the presenting symptoms of ABPA

Answer 5

• Difficult to control asthma
• recurrent pneumonia
• wheeze, wet cough, fever, malaise, SOB

Question 6

Recognise the presenting symptoms of Invasive Aspergillosis

Answer 6

• SOB
• rapid deterioration
• septic picture

Question 7

Recognise the signs of aspergillus lung disease

Answer 7

• Tracheal deviation (aspergilloma)
• Dullness in affected area
• Reduced breath sounds
• Wheeze (ABPA)
• Cyanosis (invasive aspergillosis)

Question 8

Identify the appropriate investigations for Aspergilloma

Answer 8

• Sputum: might be negative if there is no communication with bronchial tree
• Precipitins positive
• CXR: may show round mass with crescent of air around it, usually in the upper lobe
• CT/MRI: used if CXR is unclear

Question 9

Identify the appropriate investigations for ABPA

Answer 9

• Skin test: reactivity to aspergillus antigens
• Precipitin positive
• RAST IgE: raised specific antibodies against antigens
• Bloods: eosinophilia, raised total IgE
• CXR: transient patchy shadows with distended mucous-filled bronchi collapse complications: fibrosis in upper lobe, bronchiectasis
• CT: lung infiltrates, central bronchiectasis
• Lung Fx tests: reversible airflow limitation, reduced lung volumes/ gas transfer

Question 10

Identify the appropriate investigations for Invasive Aspergillosis

Answer 10

• Sputum culture
• Histological Examination
• Serial galactomannan
• Bronchoalveolar lavage fluid
• CT: nodules surrounded by ground glass appearance (halo sign)