Pulmonary Aspergillus Infections

Question 1

what are the five pulmonary aspergillus infections ?

Answer 1

asthma (T1 hypersensivity to spores)

Allergic bronchopulmonary aspergillosis

aspergilloma (mycetoma)

invasive aspergillosis

extrinsic allergic alveolitis

Question 2

what organism cause Allergic bronchopulmonary aspergillosis?

Answer 2

aspergillus fumigatus

Question 3

what stain is used for aspergillus?

Answer 3

Aspergillus in sputum (black on silver stain)

Question 4

what investigations can be done for Allergic bronchopulmonary aspergillosis?

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

what is the treatment for Allergic bronchopulmonary aspergillosis?

Answer 5

Pred 40mg/d + itraconazole for acute attacks

Pred maintenance 5-10mg/d

Question 6

what is Aspergilloma?

Answer 6

Fungus ball within a pre-existing cavity

Question 7

when excision be considered for aspergilloma?

Answer 7

solitary lesion

severe haemoptysis

Question 8

what is invasive aspergillosis ?

Answer 8

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

Question 9

what are RFs for invasive aspergillosis ?

Answer 9

immunocompromised (HIV, malignancy, Wegeners)

post broad spectrum antibiotics

Question 10

what serial serum levels can be taken for invasive aspergillosis?

Answer 10

Serial galactomannan

Question 11

what is the treatment for invasive aspergillosis ?

Answer 11

Voriconazole (better cf amphotericin)

Question 12

what is the mortality of invasive aspergillosis ?

Answer 12

30%

Question 13

what organism causes extrinsic allergic alveolitis ?

Answer 13

Aspergillus clavatus

causes Malt workers lung