Aspergillus (septate) fungi organism

Question 1

Acquired how?

Answer 1

inhalation of spores aka conidia

Question 2

risk factors

Answer 2

Neutropenia; glucocorticoid treatment; TNF-alpha treatment;
Chronic granulomatous disease (CGD)-a genetic disorder in which white blood cells called phagocytes are unable to kill certain types of bacteria and fungi; immunocompromised host

Question 3

where is aspergillus found?

Answer 3

hay barns, mold, house remodeling, hospital air ducts

Question 4

Lab Diagnosis

Answer 4

BAL-bronchial washing

ELISA for cell wall Galactomannan ((GM) is a polysaccharide antigen that exists primarily in the cell walls of Aspergillus species.)

Microscopy (from tissues) demonstrates acute 45 degree dichotomous (branching in which the axis is divided into two branches) branching and septate hyphae

Agar showcases mold-fluffy pigmented growth of conidia

Question 5

morphology

Answer 5

conidia and groups of septate hyphae

Question 6

pathology

Answer 6

opon inhalation the spores germinate in lung alveoli and invade as filamentous hyphae; first line defense macrophages attempt to kill with non-oxidative mechanism followed by neutophils defense which try to kills with reactive O2 intermediates

Question 7

treatment

Answer 7

Amphotericin B ( mech: bind ergosterols; AE: renal toxicity, anemia, fevers)

Voriconazole

Question 8

where does it invade?

Answer 8

Blood vessels ( angioinvasive!! causing tissue infarction, hemorrhages and necrosis)

Question 9

invasive pulmonary aspergillosis

Answer 9

preexisting pulmonary disease such as CB, asthma, Tb, etc - patient has sever neutropenia (less than 500/mm)

Question 10

In what kind of patient will organism spread to other organs?

Answer 10

those with hematological malignancies, solid organ transplant recipients, neutropenia

Question 11

Allergic broncopulmonary aspergillosis

Answer 11

immune response to exposure causing mucus plugs in lungs to be colonized; elevated IgE levels

Question 12

Allergic reaction

Answer 12

Farmer’s lung due to repeated exposure without mycelial colonization or invasion; pt presents with sinusitis, nasal obstruction and facial pain

Question 13

Aspergilloma

Answer 13

recurrent coughing up of blood due fungal balls colonization of pulmonary and paranasal cavities to although no invasion

Question 14

Superficially invasive sinusitis and apergilloma

Answer 14

seen in diabetics and those on steroid therapies; 2nd most common fungal infection acquired in hospitals