Aspergillus & the lung

Question 1

What is ABPA? (Allergic BronchoPulmonary Aspergillosis)

Answer 1

Due to type I or II reactions to aspergillus fumigatus
Can effect asthmatic or CF p’s
Bronchoconstriction initially followed by permanent damage causing bronhiectasis

Question 2

What are the symptoms of ABPA? Allergic BronchPulmonary Aspergillosis

Answer 2

Wheeze
Cough
Sputum
Dyspnoea
Recurrent pneumonias

Question 3

What investigations can be performed in a patient with ABPA?

Answer 3

Sputum culture of aspergillus fumigatus
Skin test for aspergillus +/- aspergillus specific IgE
Eosinophillia
Raised serum IgE

Question 4

What is the treatment for ABPA?

Answer 4

(Per 24hrs) 30-40 mg Prednisolone for acute attacks, 5-10mg maintenance
Itralconazole PO can also be given in combination
Bonchodilators if asthmatic
Bronchoscopic aspiration of mucus plug may be needed

Question 5

What is an Aspergilloma?

Answer 5

Fungus ball in a pre existing cavity (often caused by TB/sarcoidosis).

Question 6

What are the symptoms of an Aspergilloma?

Answer 6

May be asymptomatic
Cough
Haemoptysis
Lethargy
Weight loss

Question 7

What investigations can be performed in a patient with Aspergilloma?

Answer 7

CXR - round opacity with a cavity - usually apical
Sputum culture
Aspergillus skin test

Question 8

What is the treatment of an Aspergilloma?

Answer 8

Surgical excision for solitary symptomatic lesions or severe haemoptysis
Local instillation of anti fungal under CT guidance can be successful in selected patients

Question 9

What is extrinsic allergic alveolitis due to aspergillus called?

Answer 9

Malt workers lung
Give oral prednisolone 40mg and O2
May cause pulmonary fibrosis if untreated