Lung fungal infection

Question 1

Lung fungal infections

Answer 1

Aspergillus
Candida
Cryptococcus

Question 2

Ways aspergillus affects lung

Answer 2

Asthma - type I hypersensitivity
Allergic bronchopulmonary aspergillosis
Aspergilloma (mycetoma)
Invasive aspergillosis
Extrinsic allergic alveolitis

Question 3

What is ABPA

Answer 3

Allergic bronchopulmonary aspergillosis, type I + III hypersensitivity to A. fumigatus which causes bronchoconstriction then bronchiectasis

Question 4

ABPA investigations

Answer 4

CXR shows segmental collapse or consolidation (bronchiectasis)
+ve Aspergillus in sputum
+ve Aspergillus skin test
+ve Aspergillus specific IgE radioallergosorbent test

Question 5

ABPA treatment

Answer 5

Prednisolone 30-40mg/d PO for acute, 5-10mg maintenance
Itraconazole
Bronchodilators for asthma

Question 6

What is aspergilloma

Answer 6

Fungus ball within pre-existing cavity (e.g. from TB/sarcoidosis)

Question 7

Aspergilloma presentation

Answer 7

Asymptomatic or
Cough
Haemoptysis
Lethargy ± weight loss

Question 8

Aspergilloma investigations

Answer 8

CXR round opacity within cavity (usually apical)
Sputum culture
Aspergillus skin test 30% +ve

Question 9

Aspergilloma treatment

Answer 9

Only treat if symptomatic
Surgical excision for solitary lesions
In massive haemoptysis, local CT guided amphotericin paste may help

Question 10

Invasive aspergillosis RFs

Answer 10

Immunocompromised

Following broad-spec Abx

Question 11

Invasive aspergillosis investigations

Answer 11

Sputum culture
BAL
Biopsy is diagnostic

CXR shows consolidation, abscess
Early chest CT and serum galactomannan (aspergillus antigen) may help

Question 12

Invasive aspergillosis treatment

Answer 12

Voriconazole

IV miconazole/ ketoconazole less effective

Question 13

Invasive aspergillosis prognosis

Answer 13

30% mortality