Aspergillus Lung Disease

Question 1

Define Aspergillus Lung Disease?

Answer 1

Lung disease associated with Aspergillus fungal infection

Question 2

What is Aspergillus Infection caused by?

Answer 2

Aspergillus fumigatus

Question 3

What are the three different clinical pictures caused by inhalation of aspergillus spores?

Answer 3

Aspergilloma
Allergic Bronchopulmonary Aspergillosis (ABPA)
Invasive Aspergillosis

Question 4

What is the aetiology of Aspergilloma?

Answer 4

Growth of an A.fumigates mycetoma ball in a pre-existing lung cavity (e.g. post-TB, old infarct or abscess)

Question 5

What is the aetiology of Allergic Bronchopulmonary Aspergillosis (ABPA)?

Answer 5

Colonisation of the airways by Aspergillus leads to IgE and IgG-mediated immune responses
Usually occurs in asthmatics
The release of proteolytic enzymes, mycotoxins and antibodies leads to airway damage and central brochiectasis

Question 6

What is the aetiology of Invasive Aspergillosis?

Answer 6

Invasion of Aspergillus into lung tissue and fungal dissemination
This occurs in immunosuppressed patients (e.g. neutropenia, steroids, AIDS)

Question 7

What is the epidemiology of Aspergillus Lung Disease?

Answer 7

UNCOMMON

Mainly occurs in the ELDERLY and IMMUNOCOMPROMISED

Question 8

What are the presenting symptoms of Aspergilloma?

Answer 8

ASYMPTOMATIC

Haemoptysis (potentially massive)

Question 9

What are the presenting symptoms of ABPA?

Answer 9

Difficult to control asthma

Recurrent episodes of pneumonia with wheeze, cough, fever and malaise

Question 10

What are the presenting symptoms of Invasive Aspergillosis?

Answer 10

Dyspnoea
Rapid deterioration
Septic picture

Question 11

What are the signs of Aspergillus Lung Disease?

Answer 11

Tracheal deviation (only with very large aspergillomas)
Dullness in affected lung
Reduced breath sounds
Wheeze (in ABPA)
Cyanosis (potentially in invasive aspergillosis)

Question 12

What investigations would you do for Aspergilloma?

Answer 12

CXR
CT or MRI
Sputum Cultures

Question 13

Why do we do a CXR for Aspergilloma?

Answer 13

May show a round mass with a crescent of air around it

Usually found in the upper lobes

Question 14

Why do we do CT or MRI for Aspergilloma?

Answer 14

May be used if CXR is unclear

Question 15

Why might Sputum Cultures be negative for Aspergilloma?

Answer 15

If there is no communication between the cavity colonised by Aspergillus and the bronchial tree

Question 16

What investigations do you do for ABPA?

Answer 16

Immediate skin test reactivity to Aspergillus antigens
Eosinophilia
Raised total serum IgE
Raised specific serum IgE and IgG to A.fumigatus
CXR
CT
Lung Function Tests

Question 17

What do we see on a CXR for ABPA?

Answer 17

Transient patchy shadows
Collapse
Distended mucous-filled bronchi
Signs of complications (Fibrosis in upper lobes, bronchiectasis)

Question 18

What do we see on a CT for ABPA?

Answer 18

Lung infiltrates

Central bronchiectasis

Question 19

What do we see on Lung function tests for ABPA?

Answer 19

Reversible airflow limitation

Reduced lung volumes/gas transfer

Question 20

What investigations do you do for Invasive Aspergillosis?

Answer 20

Aspergillus is detected in cultures or by histological examination
Bronchoalveolar lavage fluid or sputum may be sued diagnostically
Chest CT

Question 21

What do we see on a Chest CT for Invasive Aspergillosis?

Answer 21

Nodules surrounded by a ground-glass apperance (halo sign)

This is caused by haemorrhage into the tissue surrounding the fungal invasion