Aspergillus lung disease

Question 1

Define:

Answer 1

Lung disease associated with Aspergillus fungal infection

Question 2

Main types of aspergillus lung diseases:

Answer 2

• ABPA (Allergic bronchopulmonary aspergillosis) - type 1 2 hypersensitivity
• Asthma - type 1 hypersensitivity to fungal spores
• Aspergilloma - fungus ball within a pre-exisiting cavity
• Extrensic allergic alveolitis
• invasive aspergillosis

Question 3

Aetiology/risk factors:

Answer 3

Aspergilloma:
-A.fumigates mycetoma ball in a previous cavity (usually post-TB, sarcoidosis or drained abscess)

ABPA:

• IG E and G immune mediated response common in asthmatics and CF
• Leads to release of proteolytic enzymes which damage the airways with inflammation = bronchiectasis

Invasive aspergillosis:

• Fungal dissemination
• In the immunocompromised and broad spec antibiotics

Question 4

Epidemiology:

Answer 4

UNCOMMON

In the elderly or the immunocompromised

Question 5

Symptoms for aspergilloma:

Answer 5

• Asymp
• cough
• haemoptyosis
• weight loss
• lethargy

Question 6

Signs:

Answer 6

Tracheal deviation in large aspergillomas
Dullness in affected lung
reduced breath sounds
wheeze (ABPA)
cyanosis (in invasive aspergillosis)

Question 7

Investigations for aspergilloma:

Answer 7

CXR - mass with air surrounding it. Usually in upper lobes. can use CT or MRI if unclear.

Sputum cultures may be negative as no involvement between the cavity and the bronchial tree

Skin test +ve in 30% of cases

Strongly positive serum precipitins

Question 8

Symptoms for ABPA:

Answer 8

• Difficult to control asthma
• Recurrent pneumonia
• wheeze
• cough
• SOB
• sputum
• fever

Question 9

symptoms in invasive aspergillosis:

Answer 9

• dysponea
• rapid deterioration
• septic picture

Question 10

investigations for ABPA:

Answer 10

o Immediate skin test reactivity to Aspergillus antigens
o Aspergillus-specific IgE radioallergosorbent test – RAST
o Eosinophilia
o Raised total serum IgE
o Raised specific serum IgE and IgG to A. fumigatus – serum precipitins
o Aspergillus in sputum

	CXR
•	Transient patchy shadows 
•	Segmental collapse or consolidation
•	Distended mucous-filled bronchi 
•	Signs of complications:
	Fibrosis in upper lobes 
	Bronchiectasis 

CT
• Lung infiltrates
• Central bronchiectasis

Lung Function Tests
• Reversible airflow limitation
• Reduced lung volumes/gas transfer

Question 11

Investigation for invasive aspergillosis:

Answer 11

Broncheoalveolar lavage

Sputum cultures

Chest CT - Nodules surrounded by a ground-glass appearance (halo sign).
This is caused by haemorrhage into the tissue surrounding the fungal invasion