Flashcards in ASPERGILLOSIS Deck (29):
Any disease caused by infection by fungi of the genus Aspergillus.
Which groups of patients are most at risk of developing aspergillosis in the respiratory tract?
Lung cancer patients
What does ABPA stand for?
Allergic bronchopulmonary aspergillosis
What is the mechanism of pathology in ABPA?
Type I and type III hypersensitivity
Early on allergic response causes bronchoconstriction
Persistent inflammation leads to bronchiectasis
Which patients are commonly affected by ABPA?
Which fungus most often leads to the hypersensitivity response seen in ABPA?
How do patients with suspected ABPA present?
Sputum production (plugs of sputum containing fungal hyphae)
Pleuritic chest pain
Most often have a previous asthma diagnosis
What investigations should be ordered for someone with suspected ABPA?
Skin prick test for sensitivity to aspergillus antigen
What would you look for in the blood to confirm or exclude a diagnosis of ABPA?
Normal levels of IgE excludes diagnosis of ABPA
Raised levels of IgE raises suspicion
Presence of IgG antigen-antibody complex (precipitin)
What would you look for on a x-ray of someone with suspected ABPA?
Mucoid impaction in airways
Transient segmental collapse
Signs of bronchiectasis
What would you look for on a CT of someone with suspected ABPA?
Central (confined to medial two-thirds of medial half of the lung) bronchiectasis that peripherally tapers bronchi is considered a requirement for ABPA.
Mucoid impaction of upper and lower airways
Rarely - fibrosis, pleural effusion, nodular opacities and perihilar opacities
How would you treat someone with a confirmed diagnosis of ABPA? Give doses where you can.
Prednisolone - 30-40mg/24hr PO for acute attacks and 5-10mg/24 hr as a maintenance dose
Itraconazole (anti-fungal agent) is sometimes used in conjunction with corticosteroids.
Bronchodilators for asthma.
Sometimes bronchoscopic aspiration of mucus plugs is needed.
What percentage of asthmatics are affected by ABPA?
What is an aspergilloma?
A fungus ball within a pre-existing cavity.
Which groups of patients are more susceptible to an aspergilloma?
How might someone with an aspergilloma present? (Name at least 3)
They are usually asymptomatic
What investigations would be carried out on a patient with suspected aspergilloma?
Aspergillus skin test
How would you treat someone who was diagnosed with aspergilloma?
You would only treat if they were symptomatic.
Local instillation of amphotericin (anti-fungal agent) paste under CT guidance
What might you see on a chest x-ray of someone with aspergilloma?
Round opacity within a cavity (air crescent sign)
I which organs other than the lung can an aspergilloma develop? (Name at least 3)
Surfaces of heart valves
What is invasive aspergillosis?
This is when the aspergillus infection leads to spores entering the bloodstream via the lungs.
Which patients are particularly susceptible to invasive aspergillosis?
What respiratory symptoms might someone with invasive aspergillosis present with?
What are the extra-respiratory symptoms and complications of invasive aspergillosis? (Name at least 5)
Widespread organ damage
What investigations would you order to confirm a diagnosis of invasive aspergillosis?
FBC and CRP
What might you expect to see on the chest x-ray of a patient with invasive aspergillosis?
What might you expect to see on the CT scan of a patient with invasive aspergillosis?
Halo sign (ground-glass attenuation surrounding a pulmonary nodule)
Air crescent sign (lung cavity filled with air containing a round radiopaque mass)
How would you treat someone with invasive aspergillosis?
Alternatives include: Miconazole IV, Ketoconazole IV