Aspergillosis - Causes, Symptoms and Treatment .MF .
aspergillosis - a fungal disease caused by fungi of Aspergillus genus, affecting humans and manifests the appearance of primary lesions in lung tissue, a variety of clinical lesions, which in the case of severe immunodeficiency can lead to death.
Fungi of the genus Aspergillus is widely distributed in nature and are found in soil, hay, grain dust in different rooms, especially after handling animal hides and wool.An important epidemiological aspect is part of their sowing in dust particles medical institutions, which determines the possibility of nosocomial fungal infections.
causes of aspergillosis
pathogen - fungi of Aspergillus genus, the most common representative is Aspergillus fumigatus (80% of all cases of aspergillosis), less Aspergillus vlavus, Aspergillus niger, and others.Fungi of the genus Aspergillus (or Aspergillus spp.) Are molds, heat resistant, a favorable condition for the existence of a high humidity.Aspergillus is often presented in a residential area, often f
infection mechanism - aerogenic, and the main way - airborne dust: dust particles from the airways get this kind of mushroom.There are professional risk for infection aspergillosis: agricultural workers;staff weaving mills and spinning enterprises, as well as immunodeficient patients treatment hospitals that are prone to nosocomial infection risk.
additional mechanism of infection - endogenous Aspergillus infection in case this kind of fungi already present on the mucous membranes.The main factor contributing to the spread of endogenous infection - immune deficiency, in which 25% of cases develop fungal infections of various etiologies, but the major share of which (75%) of aspergillosis.
man sick aspergillosis is not contagious to others, such cases are not described.
Susceptibility general population, but the sick persons with weakened immune systems in the course of chronic diseases, oncological processes after transplantation of organs and tissue for HIV infection, and others.Season is not observed at aspergillosis.
Immunity after undergoing unstable infection, the case of relapse in the group of immunodeficient patients.
Pathogenic action of Aspergillus spp.per person
Atrium in most cases is the mucosa of the upper respiratory tract.First Aspergillus located superficially, then deepened, causing mucosal ulceration.
aspergillosis, a place of defeat
1) Even a healthy person by inhalation of high concentrations of Aspergillus spores can develop pneumonia - interstitial pneumonia.A distinctive feature of interstitial pneumonia, aspergillosis is the formation of specific granulomas, consisting of giant epithelial cells (so-called epithelioid cell granulomas).Aspergillus granuloma (aspergilloma) have a spherical shape and are centrally located home purulent inflammation, in which both are fungal hyphae, and on the periphery of the giant cells.Designated locations Aspergillus - is the upper sections of the lungs, as evidenced on the radiographs.Mushrooms are found in the affected mucosa of the bronchi in the lungs cavities, bronchiectasis foci and cysts in the lung tissue in this form of fungi do not penetrate (non-invasive aspergillosis).
2) In parallel with the defeat of the respiratory system with aspergillosis is a reduction in immunological reactivity (immunodeficiency).Cases of complications related diseases of internal organs, mucous membranes and skin.An example may be a lung abscess, chronic bronchitis, bronchiectasis, lung cancer, tuberculosis, against which arose form of pulmonary aspergillosis, which certainly caused a complication of the basic process.Recent decades have shown the incidence of aspergillosis in immunocompromised individuals (people with HIV, cancer patients receiving immunosuppressive therapy, recipients of organs).
3) A possible defeat at aspergillosis - the defeat of the internal organs and systems (invasive aspergillosis), which is found in most cases on the background of a significant reduction in immunity.Up to 90% of patients with this lesion has two possible three features:
• number of granulocytes in the blood of less than 500 cells in 1 mm .;
• therapy with high doses of corticosteroids;
• cytostatic therapy.
In invasive aspergillosis, aspergilloma can be formed in the internal organs.Skid fungi occurs hematogenically (with blood).First, it affects the lungs, later pleura, lymph nodes and other internal organs.Feature - the possibility of formation of abscesses at the site of granulomas in most cases.Character resembles septic process, in which relatively high mortality (50%).
4) allergic alteration of an organism - the fungus antigens are potent allergens that can cause allergic reactions, mainly affecting the bronchopulmonary tree.
symptoms of aspergillosis
incubation period it is not possible to calculate - there is no clear connection after infection with the appearance of the first symptoms of the disease.
aspergillosis is classified as invasive (often affects the place of introduction of the pathogen - sinuses, skin, lower respiratory tract), saprofitichseky (otomycosis, pulmonary aspergilloma) and atopic (allergic bronchopulmonary aspergillosis, Aspergillus sinusitis).
Clinically distinguish the following forms of the disease:
1) bronchopulmonary form;
2) septic form;
3) eye shape;
5) defeat of otolaryngology;
6) bone loss;
7) other more rare forms of aspergillosis (mucous membranes of the mouth, the genital system, and others).
Bronchopulmonary form - the most common form of aspergillosis is characterized by symptoms of tracheitis, bronchitis or tracheobronchitis.Patients complain of weakness, appearance of cough with expectoration gray, maybe streaked with blood, with small lumps (clusters of mushrooms).Current chronic disease.No specific treatment of the disease begins to progress - affects the lungs with the occurrence of pneumonia.Pneumonia develops either acute or chronic complicated during the process.It occurs in acute patient temperature rises to 38-39 ° C, the wrong type of fever (up in the morning or in the afternoon and in the evening is not, as usual).The patient was shivering, worried expression cough with viscous sputum mucopurulent character or blood, shortness of breath, chest pain when coughing and breathing, weight loss, lack of appetite, increasing weakness, profuse sweating.When viewed auscultated wet finely wheezing, pleural friction noise, shortening of percussion sounds.
Aspergillosis, bronchopulmonary form
When sputum microscopy revealed a greenish-grayish lumps, containing clusters of mycelium of Aspergillus.In peripheral blood marked leukocytosis (20 * 109 / L and above), increased erythrocyte sedimentation rate, increased eosinophils.X-ray - inflammatory infiltrates round or oval with infiltrative shaft on the periphery, with a tendency to decay.
Chronic aspergillosis during stormy symptoms arise, fungal process often superimposed on existing disease (bronchiectasis, abscess, etc.).Patients often complain of mold breath, change in sputum character with greenish lumps.Only radiographically mark the appearance of spherical cavities in existing shading with the presence of air gas layer with cavity walls - the so-called "crescent halo."
pulmonary aspergillosis, crescent halo
forecast recovery in bronchopulmonary form depends on the severity of the process and the state of the immune system and is 25 to 40%.
Septic form of aspergillosis occurs during heavy immunosuppression (eg AIDS stage of HIV-infection).The process proceeds as fungal sepsis.Along with a primary lesion of the lungs progressively growing involvement in the process of internal organs and systems of the body of the patient, the spread of fungal infections occur hematogenically.In terms of frequency of defeat is the digestive system - gastritis, gastroenteritis, enterocolitis, in which patients complain of an unpleasant musty smell from the mouth, nausea, vomiting, frustration of a chair with the release of liquid stool with foam containing mushroom mycelium.Often there are skin lesions, organs of vision (specific uveitis), the brain (aspergilloma in the brain).If aspergillosis develops in HIV-infected, the disease is accompanied by other opportunistic infections (candidiasis, cryptosporidiosis, Pneumocystis pneumonia, Kaposi's sarcoma, herpes infection).The prognosis of the disease often unfavorable.
Aspergillosis ENT organs proceeds with the development of external otitis and secondary, lesions of the paranasal sinuses - sinusitis, larynx.With the defeat of the eye formed specific uveitis, keratitis, endophthalmitis rarely.Other forms of the disease are rare.Aspergillosis bone manifested occurrence of septic arthritis, osteomyelitis.
Peculiarities of aspergillosis in HIV-infected patients.
Aspergillosis is the most common form of fungal infections in this group of patients.All patients are in the last stage of HIV - AIDS.Rapidly growing Aspergillus sepsis, having a severe course and prognosis.Number of CD4 is typically less than 50 / ml.Radiological findings reveal bilateral patchy shadowing spherical.Along with the light affects the organs of hearing (otomycosis), the defeat of the development of keratitis, uveitis, endophthalmitis, can often be affected cardiovascular system (fungal infection valvular endocarditis, myocarditis).
aspergillosis Complications occur in the absence of specific treatment, and on the background of immunodeficiency and represent the emergence of large abscesses, chronic obstructive pulmonary disease, pulmonary fibrosis, internal organ damage.
forecast immunodeficiency disease with unfavorable.
diagnosis of aspergillosis
preliminary diagnosis - clinical and epidemiological.The emergence of certain symptoms of the disease in conjunction with the data on the availability of a specific profession, the presence of concomitant diseases, and immunosuppressive therapy, as well as severe immunodeficiency predispose doctors in favor of a possible aspergillosis.
Definitive diagnosis requires laboratory confirmation of the disease.
1) Mycological study material (sputum, bronchi material - swabs, biopsies of affected organs, mucosal scrapings, smears).From the blood of the selection of mushrooms is rare, so a diagnostic blood test is of no value.
2) blood serology to detect antibodies to Aspergillus (ELISA, RSK), the increase in the concentration of IgE.
3) Paraclinical studies: CBC: leukocytosis, eosinophilia, increased ESR.
4) Instrumental studies: X-ray, CT scan (detection of spherical or oval bulk infiltrates unilateral or symmetrical, spherical infiltrates in identifying previously existing cavities with serpovinym enlightenment on the periphery).
5) Special studies: bronchoscopy, bronchial washings, bronchoalveolar lavage or transthoracic needle aspiration biopsy followed by the study of the samples in order to detect pathological changes: biopsy revealed necrosis, gemmorogicheskie heart attacks, vascular lesion link invasive nature, the discovery of the hyphae of Aspergillus.
aspergillosis, fungal growth in
material Differential diagnosis is carried out with other lung lesions fungal etiology (candidiasis, gistopalzmoz), pulmonary tuberculosis, lung cancer, lung abscess, and others.
Treatment of aspergillosis
Organizational-regime activities include hospitalization indications (severe forms of the disease, invasive aspergillosis), bed Regis entire febrile period, complete diet.
Therapeutic activities include surgical methods and conservative therapy.
1) The conservative medical therapy is a complex task and presented appointment protivomikoticheskih medications: itraconazole 400 mg / day vntutr long courses, amphotericin B 1-1.5 g / kg / day intravenously with severe immunodeficiency, voriconazole is 4-6 mg / kg 2p / day intravenously, pospakonazol 200 mg 3 / day orally, caspofungin 70 mg, 50 mg intravenously.The treatment of Aspergillus antibody titers to tend to increase, followed by a gradual decline.The therapy is supplemented by drugs tonic, vitamin therapy.All drugs have contraindications and exclusively appointed doctor and under his supervision.
2) Surgical techniques: conducting lobectomy with removal of the affected areas of the lung.
Often these methods are effective, and confirmed the absence of disease recurrence.With the spread of conservative therapy is connected.
effectiveness of treatment higher with the possibility of reducing the dosage of concomitant glucocorticosteroid and immunosuppressive therapy.
1) Timely and early diagnosis of the disease, timely initiation of specific treatment.
2) Carrying out medical examinations in occupational risk groups (agricultural workers, employees of weaving mills and spinning mills).
3) in terms of Alertness aspergillosis possible group of persons suffering from immune deficiency in patients receiving immunosuppressive therapy, severe infections (HIV, etc.).Seropositive for antibodies to Aspergillus require careful patient screening for the disease.
infectious disease doctor Bykov NI