Pulm. aspergilosis + myastenia crisis 10-28 (1) Flashcards
ch. aspergillosis. diagnosis. criteria?
Diagnosis is made by the presence of all 3 of the following:
a. >3 months of symptoms: i. Fever ii. Weight loss iii. Fatigue iv. Cough v. Hemoptysis vi. Dyspnea
b. Cavitary lesion(s) containing debris, fluid, or an aspergilloma (fungus ball)
c. Positive Aspergillus IgG serology
CHRONIC PULMONARY ASPERGILLOSIS. in what population?
It is seen in immunocompetent patients with a history of pulmonary disease (eg, cavitary TB)
allergic aspergillosis (ABPA)
risk factors and pathogenesis.
Structural airway disease (eg asthma, CF)
fungal spore colonization –> Th2 based sensitization –> allergic inflammation
allergic aspergillosis (ABPA). clinical - asthma control?
difficult to control asthma, thick sputum
allergic aspergillosis (ABPA). chest imaging?
fleeting infiltrates, bronchiectasis, bronchial mucoid impaction
allergic aspergillosis (ABPA). aspergillus sensitization? 3
elevated serum IgE (>1000 IU/ml)
Positive aspergillus skin test and/or IgE
Suggestive: eosinophilis, positive aspergillus IgG
allergic aspergillosis (ABPA). treatment? 3
systemic glucocorticois –> decr. allergic inflammation
Antifungal drugs (eg variconazole) –> decr spore burden
Treatment of underlying asthma (eg bronchodilators)
Invasive pulm. aspergillosis. classic triad?
fever, pleuritic chest pain, hemoptysis
Invasive pulm. aspergillosis. diagnosis? 4
sputum stain/culture
Serum biomarkers for cell wall components
CT scan
Bronchoscopy with BAL lavage
Invasive pulm. aspergillosis. CT scan -?
i. Nodules with surrounding ground-glass opacities (“halo sign”Ϳ
Invasive pulm. aspergillosis. Bronchoscopy with BAL lavage -?
i. This test is done when noninvasive testing is inconclusive
Invasive pulm. aspergillosis. treatment? 2
Treatment:
a. 1-2 weeks of IV voriconazole + echinocandin (eg, caspofungin)
b. Later, patient is transitioned to prolonged therapy with oral voriconazole alone
neutropenic assoc with what 2 infections?
pseudomonas
aspergillus
invasive vs chronic table.
invasive risk factors?
Immunocompromise (NEUTROPENIA, HIV, glucocorticoids)
invasive vs chronic table.
chronic risk factors?
Lung disease/damage (CAVITARY TUBERCULOSIS)
invasive vs chronic table.
invasive findings?
TRIAD: fever, chest pain, hemoptysis
Pulm. nodules with halo sign
positive cultures
positive cell wall biomarkers (galactomannan, beta-D-glucan)
invasive vs chronic table.
chronic findings?
> 3 MONTHS: weight loss, cough, hemoptysis, fatigue
Cavitary lesion +/- FUNGUS BALL
Positive ASPERGILLUS IgG serology
invasive vs chronic table.
invasive treatment?
voriconazole +/- caspofungin
invasive vs chronic table.
chronic treatment? 3
Resect aspergilloma (if possible)
AZOLE medication (voriconazole)
Embolization (if severe hemoptysis)
Simple aspergilloma (fungus ball in preexising lung cavity) is a form of chronic pulmonary aspergillosis but is usually quiscent with occasional hemoptysis
.
myastenic crisis. precipitating factors?
Infection or surgery
pregnancy of childbirth
tapering of immunosuppressive drugs
medications (AMG, BAB, Mg, CCB)
myastenic crisis. symptoms?
incr. generalized and oropharyngeal weakness
respiratory insufficiency/dyspnea
myastenic crisis. management?
Elective intubation
Plasmapheresis or IVIG as well as corticosteroids
myastenic crisis.
intubation - elective. criteria?
Elective intubation
i. It should be performed in patients with impending respiratory failure
ii. Objective measurements that indicate impending respiratory failure are as
follows:
1. Reduced vital capacity of lungs
2. Respiratory acidosis
