FN: Pulmonary Aspergillus Infections

Question 1

Diseases associated

Answer 1

1. Asthma: T1HS reaction to spores 2. ABPA
2. Aspergilloma (mycetoma)
3. Invasive aspergillosis
4. Extrinsic allergic alveolitis

Question 2

Allergic Boncopulmonary aspergillosis

Answer 2

􏰀 T1 and T3 HS reaction to Aspergillus fumigatus

􏰀 Bronchoconstriction → bronchiectasis

Question 3

Allergic Boncopulmonary aspergillosis Symptoms

Answer 3

Wheeze

Productive cough Dyspnoea

Question 4

Allergic Boncopulmonary aspergillosis Ix

Answer 4

CXR: bronchiectasis
Aspergillus in sputum (black on silver stain) Aspergillus skin test or IgE RAST
+ve se precipitins
↑ IgE and ↑ eosinophils

Question 5

Allergic Boncopulmonary aspergillosis Rx

Answer 5

Pred 40mg/d + itraconazole for acute attacks
Pred maintenance 5-10mg/d
Bronchodilators for asthma

Question 6

Aspergiolloma (mycetoma)

Answer 6

􏰀 Fungus ball within a pre-existing cavity 􏰁 e.g. TB or sarcoid

Question 7

Aspergiolloma (mycetoma) features

Answer 7

􏰀 Usually asympto
􏰀 Can → haemoptysis (may be severe)
􏰀 Lethargy, ↓wt.

Question 8

Aspergiolloma (mycetoma) Ix

Answer 8

􏰀 CXR: round opacity w/i a cavity, usually apical
􏰀 Sputum culture
􏰀 +ve se precipitins
􏰀 Aspergillus skin test / RAST

Question 9

Aspergiolloma (mycetoma) Rx

Answer 9

􏰀 Consider excision for solitary lesions / severe haemoptysis

Question 10

Invasive Aspergillosis

Answer 10

􏰀 Aflatoxins → liver cirrhosis and HCC (especially A. flavus)

Question 11

RF

Answer 11

􏰀 Immunocompromise: HIV, leukaemia, Wegener’s 􏰀 Post-broad spectrum Abx

Question 12

Ix

Answer 12

􏰀 CXR: consolidation, abscess 􏰀 Sputum MCS
􏰀 BAL
􏰀 +ve se precipitins
􏰀 Serial galactomannan

Question 13

Rx

Answer 13

􏰀 Voriconazole (better cf amphotericin)

Question 14

Prog

Answer 14

􏰀 30% mortality

Question 15

Exrinsic Allergic Alveolitis

Answer 15

􏰀

Sensitivity to Aspergillus clavatus → Malt worker’s lung