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Aspergillosis

Aspergillosis is an infection or an allergic response caused by a fungus of the Aspergillus type. It may play a role in allergy, but is best known for causing serious pulmonary infections in immunocompromised patients, e.g. those with HIV/AIDS, on chemotherapy or longterm antibiotics. more...

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Causes, incidence, and risk factors

Aspergillosis is caused by a fungus (Aspergillus), which is commonly found growing on dead leaves, stored grain, compost piles, or in other decaying vegetation.

It causes illness in three ways:

  • as an allergic reaction in people with asthma (pulmonary aspergillosis - allergic bronchopulmonary type)
  • as a colonization and growth in a lung injury (such as from tuberculosis or lung abscess) having healed with a resulting cavity, in a nasal sinus or in an aural cavity-where it produces a fungus ball called aspergilloma formed by febrile infiltration of blood or tissue.
  • as an invasive systemic infection with pneumonia, nasal necrosis or aural inflammation and necrosis that is spread to other parts of the body by the bloodstream (pulmonary aspergillosis - invasive type).

The invasive infection can affect the eye, causing blindness, and any other organ of the body, but especially the heart, lungs, brain, and kidneys. The third form occurs almost exclusively in people who are immunosuppressed because of cancer, AIDS, leukemia, organ transplants, high doses of corticosteroid drugs, chemotherapy, or other diseases that reduce the number of normal white blood cells.

Symptoms

Allergic aspergillosis

  • Fever
  • Malaise
  • Coughing
  • Coughing up blood or brownish mucous plugs
  • Wheezing
  • Weight loss
  • Recurrent episodes of lung obstruction

Invasive infection

  • Fever
  • Chills
  • Headaches
  • Cough
  • Shortness of breath
  • Chest pain
  • Increased sputum production, which may be bloody
  • Bone pain
  • Blood in the urine
  • Decreased urine output
  • Weight loss
  • Symptoms involving specific organs
    • Brain: meningitis
    • Eye: blindness or visual impairment
    • Sinuses: sinusitis
    • Heart: endocarditis

Signs and tests

Aspergillosis is detected by:

  • Abnormal chest X-ray or CT scan
  • Sputum stain and culture showing Aspergillus
  • Tissue biopsy (see bronchoscopy with transtracheal biopsy) for aspergillosis
  • Aspergillus antigen skin test
  • Aspergillosis precipitin antibody or galactomannan positivity
  • Elevated serum total IgE (immunoglobulin)
  • Peripheral eosinophilia with allergic disease

Treatment

The goal of treatment is to control symptomatic infection. A fungus ball usually does not require treatment unless bleeding into the lung tissue is associated with the infection; then, surgical excision is required.

Read more at Wikipedia.org


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CT-guided fine needle aspiration for diagnosis of pulmonary aspergillosis
From CHEST, 10/1/05 by Masateru Kawabata

PURPOSE: The prevalence of pulmonary aspergillosis is increasing because of the growing aged population and the diversity of medical treatments. However, it is not easy to diagnose aspergillosis microbiologically or pathologically. Although we frequently utilize CT-guided fine-needle aspiration (CT-FNA) for diagnosis of pulmonary aspergillosis, the usefulness and safety of the procedure is not well established. In this context, we have conducted a study to clarify the value of CT-FNA for making diagnosis of pulmonary aspergillosis.

METHODS: We retrospectively reviewed the medical records of the individuals with pulmonary aspergillosis who underwent CT-FNA from April 2003 to March 2005, and analyzed the accuracy and complications of the procedure. We percutaneously punctured the cavitary lesions or infiltrations with chest CT guiding by using 21 or 23 gauges-needle. If no specimen was obtained, small amount of saline (two to five ml) was infused into the lesions and recollected. The specimens were examined microbiologically and cytologically.

RESULTS: Thirteen patients (8 males and 5 females) were enrolled and the mean age was 60.7 years old (41-77 years old). Six patients had been performed thoracic surgery previously and five had sequelae of tuberculosis. Diabetes mellitus and nontuberculous mycobacteriosis were associated with respective three cases. Two had been under medication with corticosteroid or immunosuppressive agents. Before CT-FNA, serial sputum cultures were negative in all cases, and bronchoscopic examinations were not conclusively diagnostic for aspergillosis in three. All patients were punctured successfully and sufficient specimens for the examinations were obtained. Aspergillus was isolated from six cases and five specimens were cytologically positive for Aspergillus. In total, eight of thirteen (61.5%) could be diagnosed pulmonary aspergillosis definitely by CT-FNA. In all patients, CT-FNA were performed without any serious complications such as pneumothorax or bleeding.

CONCLUSION: CT-FNA is an useful technique in defining diagnosis of pulmonary aspergillosis which could be conducted safely and less invasively.

CLINICAL IMPLICATIONS: If pulmonary aspergillosis is clinically suspected but the diagnosis is undetermined, CT-FNA should be considered as the next diagnostic approach.

DISCLOSURE: Masateru Kawabata, None.

Masateru Kawabata MD * Hisafumi Takaya MD Atsushi Miyamoto MD Keishi Sugino MD Susumu Sakamoto MD Kazuma Kishi MD Eiyasu Tsuboi MD Sakae Homma MD Kunihiko Yoshimura MD Toranomon Hospital, Tokyo, Japan

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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