Aspergillus Related Lung disease

Question 1

What is Aspergillosis?

Answer 1

Lung infection caused by inhalation of aerosolised spored (conidia) of the fungus Aspergillus)

Question 2

Where can the fungus Aspergillus be found?

Answer 2

• ubiquitous environmental mould that grows in organic matter in the soil
• Grows as filamentous form and extends with hyphal stalks, forms spores

Question 3

What is the epidemiology of Aspergillus Lung disease?

Answer 3

• All around the world, normally in immunosuprresed patients (cancer/transplant/other reasons for immunosupression)
• (Normally within single digit percentages in these patient groups)

Question 4

What is the Aetiology of Asgergillus Lung disease?

Answer 4

Infection with Aspergillus

• ubiquitous environmental mould that grows in organic matter in the soil
• Grows as filamentous form and extends with hyphal stalks, forms spores

Question 5

What are risk factors for the development of Aspergillus Lung disease?

Answer 5

• Immunosuppression
  
  • allogeneic stem cell transplantation
  • prolonged severe neutropenia (>10 days)
  • immunosuppressive therapy
  • Solid organ transplant
  • Leukaemia
  • Aplastic anaemia
  • AIDS
• chronic granulomatous disease (CGD)
• Aspergilloma

Question 6

What is chronic granulomatous disease (CGD)?

Answer 6

Hereditary disorders whter immunecells cannot form oxidants –> decreased immunocompetence

Leading to atypical infections

Question 7

Explain the process of an infection with Aspergillus?

Answer 7

• Inhalation of aspergillus spores
• Immunocompetent : Host defence can defeat spores

If immunosuppressed:

• Invasion of pulmonary parenchyma
• Production of pro-inflammatory cytokines
  
  • Fever
• Dissemination of spores to other parts of body e.g.
  
  • Commonly brain and skin
  • Virtually all body sites, including the heart, kidney, liver/spleen, bone, and GI tract, may be affected

Question 8

What is an Aspergilloma?

Answer 8

• Formation of intracavartary mass lesion due to an infection with aspergillus fungus
• Mass consists of
  
  • Aspergillus cells, fibrin, inflammatory cells mucus and tissue debris

Question 9

What are the signs and symptoms of someone with a Invasive Aspergillosis?

Answer 9

• Cough (non-productive, mild to moderate, often absent)
  
  • Might lead to severe haemoptysis (uncommon)
• Pleuritic chest pain
• Headache
  
  • Invasive aspergillosis (sinus/intracranial disease)
• Also: congestion/sinus tenderness
• Fever
  
  • Despite broad-spectrum abx

Question 10

Which Investigations would you consider in a patient with suspected Aspergilliosis?

Answer 10

• Imaging
  
  • CXR Might be normal or non-specific
  • If suspected in high-risk patients: high-resolution CT
    
    • (1 cm or more in size) with or without halo sign or air-crescent sign; non-specific: micronodules, infiltrates, ground-glass opacities,
• MRI sinus/Brain
• Serology IgG for MI brain
• Bronchoscopy and lavage with spores present

Question 11

What would be X-Ray findings in a pateint with aspergillus lung diseae?

Answer 11

• Might be normal or non-specific
  
  • nodules, consolidation, non-specific infiltrates, pleural-based lesions and cavities
• Aspergilloma: CXR seen
  
  • single upple lobe lesions typically

Question 12

What are possible signs on Examination of Invasive Aspergilliosis?

Answer 12

• Skin involvement:

ecthyma gangrenosum

Single or multiple discrete, erythematous, mildly tender nodules of varying sizes with a necrotic and often ulcerated centre

Question 13

What are the presenting signs and symptoms of someone with Aspergiloma?

Answer 13

Normally asymptomatic