Rob's fungal immunity: last 16

Question 1

Give examples of aspergillu environmental organisms

Answer 1

Aspergillus niger Aspergillus fumigatus Inhaled leading to fungal allergic airway disease. Spores get into lungs really easily

Question 2

T/F people with asthma due to fungi like aspergillus are getting it due to immunosupression

Answer 2

F they are getting it because of an exaggerated immune response

Question 3

Outline a type of fungal disease fo each category of hypersensitivity reacton

Answer 3

Type 1 (IgE/histamine mediated) –> allergic rhinitis, allergic asthma, ABPA Type 2 –> unknown Type III–> hypersensitivity pneumoniits/aspergilloma Type IV –> hypersensitivity pneumonitis

Question 4

T/f there is just one allergen in fungi that causes hypersensitive response

Answer 4

F

Question 5

Outline why fungal allergens are confusing for immune system

Answer 5

Cross reactivtiy between candida allegens in the gut and breathed in allergens in the lung (immune system doesn’t know which it is responding to) And Because they are eukaryotic, some allergens from fngi have promoted autoimmue response against self antigens in the lung

Question 6

What leads to allergic and what leads to invasive fungal disease

Answer 6

Wheter host response is ineffective or exaggerated

Question 7

What type of hypersensitivity reactions are occurring in fungal infections

Answer 7

I, III and IV

Question 8

What is the primary driver of allergic fungal disease

Answer 8

Aspergillus

Question 9

What is ABPA

Answer 9

Allergic bronchopulmonary aspergillosus which causes IgE response and is a form of bronchiectasis High eosinophil levels in peripheral blood Loads of mucus Overexagerated immune response

Question 10

Which conditions presispose to ABPA

Answer 10

Asthma or cystic fibrosis

Question 11

Radiological features of ABPA

Answer 11

• Dilated bronchi with thick walls • Ring or linear opacities • Upper or central region predeliction • Proximal bronchiectasis • Lobar collapse due to mucous impaction (hyper dense mucus) • Fibrotic scarring

Question 12

What happens to size of airways with ABPA

Answer 12

DILATION (this is bronchiectasis) Bronchiectasis is a long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection Because of mucus plugging

Question 13

Management of ABPA

Answer 13

Corticosteroids Itraconazole for steroid sparing effect (a triazole) Recombinant IgE monoclonal antibodies

Question 14

What is an anti-IgE antibody

Answer 14

Omalizumab

Question 15

What is hypersensitivity pneumonitis

Answer 15

Fibrotic lung disease Evidence for fungal sensitisation

Question 16

What is diagnosis of fungal hypersensitivity driven by

Answer 16

Diagnosis driven by skin test, IgE and IgM in clinical relevant populations