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Flashcards in ASPERGILLOSIS Deck (29):
0

Define aspergillosis.

Any disease caused by infection by fungi of the genus Aspergillus.

1

Which groups of patients are most at risk of developing aspergillosis in the respiratory tract?

TB patients
COPD patients
Lung cancer patients
Sarcoidosis patients
Asthmatics
CF patients
Immunosuppressed patients

2

What does ABPA stand for?

Allergic bronchopulmonary aspergillosis

3

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

4

Which patients are commonly affected by ABPA?

Asthmatics
CF patients

5

Which fungus most often leads to the hypersensitivity response seen in ABPA?

Aspergillus fumigatus

6

How do patients with suspected ABPA present?

Wheeze
Cough
Dyspnea
Exercise intolerance
Sputum production (plugs of sputum containing fungal hyphae)
Pleuritic chest pain
Fever
Hemoptysis
Most often have a previous asthma diagnosis

7

What investigations should be ordered for someone with suspected ABPA?

Skin prick test for sensitivity to aspergillus antigen
Blood test
Chest X-ray
CT

8

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
Raised eosinophils
Presence of IgG antigen-antibody complex (precipitin)

9

What would you look for on a x-ray of someone with suspected ABPA?

Consolidation
Mucoid impaction in airways
Transient segmental collapse
Signs of bronchiectasis
Tramline shadowing

10

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
Mucus plugs
Rarely - fibrosis, pleural effusion, nodular opacities and perihilar opacities

11

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.

12

What percentage of asthmatics are affected by ABPA?

Roughly 1%

13

What is an aspergilloma?

A fungus ball within a pre-existing cavity.

14

Which groups of patients are more susceptible to an aspergilloma?

TB patients
Sarcoidosis patients

15

How might someone with an aspergilloma present? (Name at least 3)

They are usually asymptomatic
Cough
Hemoptysis
Lethargy
Weight loss

16

What investigations would be carried out on a patient with suspected aspergilloma?

Chest x-ray
Sputum culture
Serum precipitins
Aspergillus skin test

17

How would you treat someone who was diagnosed with aspergilloma?

You would only treat if they were symptomatic.
Surgical excision
Oral itraconazole
Prednisolone
Local instillation of amphotericin (anti-fungal agent) paste under CT guidance

18

What might you see on a chest x-ray of someone with aspergilloma?

Round opacity within a cavity (air crescent sign)
Usually apical

19

I which organs other than the lung can an aspergilloma develop? (Name at least 3)

Brain
Kidney
Sphenoid sinuses
Paranasal sinuses
Ear canal
Surfaces of heart valves

20

What is invasive aspergillosis?

This is when the aspergillus infection leads to spores entering the bloodstream via the lungs.

21

Which patients are particularly susceptible to invasive aspergillosis?

Immunocomprimised patients
HIV patients
Leukaemia patients
SLE patients

22

What respiratory symptoms might someone with invasive aspergillosis present with?

Cough
Hemoptysis
Fever
Chest pain
Dyspnae

23

What are the extra-respiratory symptoms and complications of invasive aspergillosis? (Name at least 5)

Widespread organ damage
Blood clots
Fever
Chills
Shock
Delirium
Seizures
Kidney failure
Liver failure
Jaundice
Death

25

What investigations would you order to confirm a diagnosis of invasive aspergillosis?

Chest x-ray
CT
FBC and CRP
Blood culture
Serum precipitins

26

What might you expect to see on the chest x-ray of a patient with invasive aspergillosis?

Consolidation
Abscess

27

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)

28

How would you treat someone with invasive aspergillosis?

Voriconazole IV
Alternatives include: Miconazole IV, Ketoconazole IV

29

What is the prognosis of someone being treated for invasive aspergillosis?

30% mortality