Forms of aspergillosis
Clinical options are determined by the state of the immune system and lungs. With bronchial asthma and cystic fibrosis, allergic bronchopulmonary aspergillosis develops: the fungus does not grow into the tissue, but triggers a violent immune reaction with bronchospasm and mucus plugs. If there is a ready-made cavity in the lung after tuberculosis, sarcoidosis or an abscess, aspergilloma can form in it - a ball of mycelium lying freely inside. In patients with neutropenia, the fungus grows into the blood vessels and spreads throughout the body; This is the most dangerous, invasive form. Separately, there is damage to the paranasal sinuses, external auditory canal and skin.
- Allergic bronchopulmonary aspergillosis
- Aspergilloma (fungal ball in a cavity)
- Chronic pulmonary aspergillosis
- Invasive aspergillosis
- Aspergillosis of the paranasal sinuses
- Otitis externa and skin lesions
Causes and risk factors
Infection occurs through inhalation of spores, and not from a sick person. A high concentration of spores occurs when working with hay, grain, compost, during renovation and demolition of buildings, in damp rooms with mold. The condition of the body is decisive. The risk of an invasive form is sharply increased by prolonged neutropenia in leukemia, bone marrow and organ transplantation, high doses of glucocorticoids, severe viral pneumonia and cirrhosis of the liver. Chronic forms most often occur in people with scars and cavities in the lungs from tuberculosis, COPD and bronchiectasis.
- Long-term decrease in the number of neutrophils
- Organ and bone marrow transplantation
- Long-term use of glucocorticoids and immunosuppressants
- Previous tuberculosis, cavities and scars in the lungs
- COPD and bronchiectasis
- Bronchial asthma and cystic fibrosis
- Working with grain, hay, compost, construction dust
Symptoms
In the allergic form, asthma ceases to respond to usual treatment: attacks of suffocation and cough intensify, viscous brown sputum appears, sometimes in the form of dense casts of the bronchi, and a low temperature may rise. Aspergilloma does not show itself for a long time, and the first manifestation is often hemoptysis of varying intensity. The chronic form produces a prolonged cough, weakness, weight loss and night sweats - a picture very similar to tuberculosis. Invasive aspergillosis develops in a matter of days: high fever that does not respond to antibiotics, chest pain, shortness of breath, and hemoptysis.
- Cough, often with sputum
- Brown mucus plugs in asthma
- Hemoptysis
- Shortness of breath and wheezing
- Fever not responding to antibiotics
- Chest pain
- Weakness, sweating, weight loss
Diagnostics
The leading method is computed tomography of the chest: it shows a cavity with a round formation inside and a layer of air, lesions with a darkened area around, thickening of the walls of the bronchi and mucus plugs. The blood is checked for galactomannan, a component of the cell wall of the fungus, and if an allergic form is suspected, total IgE, specific IgE and IgG to Aspergillus and the level of eosinophils are determined. Sputum and bronchoalveolar lavage material are inoculated onto media and examined under a microscope. Pulmonary function helps assess bronchial obstruction.
- CT chest
- Galactomannan in blood and lavage fluid
- General and specific IgE, IgG to Aspergillus
- Complete blood count with eosinophil assessment
- Sputum culture and microscopy
- Bronchoscopy with bronchoalveolar lavage
- Spirometry
- Exclusion of tuberculosis
Treatment and prevention
Tactics depend on form. Allergic bronchopulmonary aspergillosis is treated with systemic glucocorticoids with a gradual dose reduction, sometimes adding antifungals and modern biological therapy for asthma. In chronic forms and invasive infections, the basis is antifungal drugs of the triazole group, in long courses and under the control of tests. Asymptomatic aspergilloma is often only observed, and in case of repeated bleeding, removal of the affected area of the lung or embolization of the bronchial arteries is discussed. It is important for all patients to reduce exposure to spores and not self-prescribe hormonal medications.
- Systemic glucocorticoids for allergic form
- Antifungal drugs of the triazole group as prescribed by a doctor
- Long-term monitoring of analyzes and CT scans over time
- Observation for asymptomatic aspergilloma
- Surgery or embolization for repeated hemoptysis
- Avoid damp areas, compost, hay and grain dust
- Respirator for repairs and excavation work for patients at risk
- Control of asthma and COPD with basic therapy