Aspergillosis of the lungs

Pathogens are moldy fungi of the genus Aspergillus. Clinical significance is Aspergillus fumigatus.

Pathogenesis

The disease is caused by inhalation of fungus spores with subsequent penetration into the lungs in patients with immunodeficiency. In 90% of patients at risk of infection, there are 2 or 3 factors: less than 500 granulocytes, high-dose glucocorticoids or cytostatic drugs (azathioprine). Invasive variant of aspergillosis can occur in HIV infection, usually with exhaustion of T-helpers and neutropenia. Characteristic distribution on the blood vessels, the emergence of tissue necrosis, hemorrhagic infiltrates. Aspergillus can also spread through a damaged bronchial tree, colonize still uninfected cysts in the lungs or cavities.

It often appears as a secondary disease in weakened, depleted patients, especially against the background of diabetes, tuberculosis, blood diseases, immunodeficiency states. Occurrence is also facilitated by long-term therapy with antibiotics, corticosteroids, immunosuppressants.

In most cases, aspergillomas occur in sanitized tuberculosis caverns, cavities after abscesses, bronchiectasis and are a tangle of filamentous filaments. Localize in the upper parts of the lungs, more often on the right.

Clinical Manifestation

Characteristic increase in weakness, anorexia, an increase in body temperature, often there are chills and considerable sweating. The main symptom - a strong paroxysmal cough with the release of abundant bloody sputum, containing greenish flakes (accumulations of mycelium fungus) and blood veins. Sometimes there is hemoptysis.

Sometimes the disease is accompanied by attacks of suffocation. This form of the disease often occurs in people with a burdened allergological anamnesis, working on milling, weaving, grain stores and poultry farms, in greenhouses. Attacks of suffocation are often combined with allergic alveolitis, fever and infiltration of lung tissue.

In later stages of the disease, pneumofibrosis, bronchiectasis, pulmonary heart develop.

Diagnosis

In sputum, drusen and mycelium aspergillus are isolated. The repeated isolation of Aspergillus from sputum indicates colonization or infection.

In the blood - leukocytosis, eosinophilia, increased ESR. On the roentgenogram of the chest, small foci are found, partially compacted, sometimes calcified, against the background of pneumosclerosis and compaction of the roots of the lungs. In some cases, the foci have the character of globular formations resembling tuberculoma. For diagnosis, a biopsy is necessary, proving tissue damage and a positive result of culture studies. Blood cultures are rarely positive. IgG antibodies in serum to Aspergillus can be detected in patients with colonization and almost in all patients with balls of filamentous fungi.

Complications

Abscess of the lung: The course of the disease in this case is severe, high fever, shortness of breath, chest pain, hemoptysis. Characteristic increase in weakness, anorexia, increased body temperature, often there are chills and considerable sweating. The main symptom - a strong paroxysmal cough with the release of abundant sputum of bloody color, containing greenish flakes (clusters of mycelium fungus) and veins of blood. In the absence of drainage through the bronchus this symptom is absent. Physically - signs of a cavitary or infiltrative process in the lung.

Pleurisy: In patients with pulmonary tuberculosis, previously treated with artificial pneumothorax, after pneumonectomy or lobectomy performed for tuberculosis or lung cancer and accompanied by the formation of bronchopleural fistula, patients with reduced immunity, as well as with systemic aspergillosis, may develop pleurisy. In the pleural fluid having the character of exudate, brown lumps containing mushrooms are found. Sowing pleural fluid to detect a fungal infection is positive. Positive precipitation reaction in the study of exudate with a specific antiserum. In the pleural fluid, crystals of calcium oxalate are found.

Treatment

When expressed hemoptysisa patient with a cavity filled with fungi is shown lobectomy. In aspergillosis, cavity or endobronchial, conservative treatment is not successful. In patients with an invasive process without severe immunodeficiency, intravenous injection of amphotericin B can stop or eliminate the infection. In the absence of effect in the treatment with amphotericin B, flucytosine is added. Intraconazole 200 mg twice a day is used in patients without severe immunodeficiency