Aspergillosis is caused by fungi of the genus Aspergillus, which cause all sorts of allergic reactions, superficial skin infections, limited invasive infections, open lung infections, and can colonize the entire body. What are the symptoms of aspergillosis? How is the treatment going?

Aspergillosiscovers a wide range of diseases caused by species of the genusAspergillus .Sprinklersare widespread all over the world, and their spores are found in the air, soil and decaying matter. Contact with them can lead to various types of allergic reactions, superficial skin infections, limited invasive infections, open lung infections or colonization of the organism. The most common and most important route of infection is the respiratory system. Infections through the digestive tract or through damaged skin or mucous membranes are less common.

Aspergillosis: classification and clinical symptoms

In case of allergic reactions, the occurrence of symptoms depends on the patient's hypersensitivity to Aspergillus antigens.

  • Aspergillus allergic sinusitisThe characteristic symptoms are nasal congestion, headache, facial pain as well as laboratory evidence of hypersensitivity.
  • Bronchopulmonary aspergillosisproduces symptoms such as asthma, pulmonary infiltrates, peripheral blood eosinophilia, elevated serum IgE, and evidence of antigen hypersensitivityAspergillus, which can be confirmed by skin testing.

Colonization may involve obstructed paranasal sinuses and the lower respiratory tract. This may result in the formation of aspergilloma and the so-called obstructive bronchial aspergillosis.

  • Aspergillomatends to form in the paranasal sinuses or previously formed lung cavities, most often secondary to a history of tuberculosis or other chronic cavernous lung disease. Usually, it is asymptomatic, although it may cause severe and life-threatening pulmonary haemorrhages - in such a situation, surgical removal of the cavity together with the mycelium is suggested. It can be detected by performing a radiological examination.
  • Obstructive bronchialaspergillosisusually accompanies an underlying lung disease such as cystic fibrosis, chronic bronchitis, or bronchiectasis. Symptoms remain as for the underlying disease, there is no tissue damage, and no treatment is required.

Limited invasive forms of aspergillosis most often develop against the background of mild immunosuppression, e.g. with low doses of steroids, but also in the case of diabetes or collagen vascular diseases. They usually form in the lung parenchyma and bronchi - this isnecrotic pseudomembranous aspergillosisorchronic pulmonary necrotic aspergillosis . Their symptoms are:

  • fever
  • shortness of breath
  • cough with production of sputum and hemoptysis.

Radiological examination shows locally destructive pneumonia, with the formation of infiltrates and the presence of aspergilloma. The treatment involves surgical excision of the affected areas and the implementation of antifungal therapy.Invasive pulmonary aspergillosisanddisseminated aspergillosisare extremely debilitating diseases with a very high mortality rate, usually exceeding 70%. They concern patients with severely impaired immunity, with severe neutropenia, after bone marrow and solid organ transplants, and patients with AIDS. The main factors predisposing to the development of infection are neutrophil counts below 500 / cm3, cytotoxic chemotherapy and treatment with corticosteroids. Patients have fever, often accompanied by pleural chest pain and haemoptysis due to the presence of pulmonary infiltrates. Final diagnosis of these forms of aspergillosis is often delayed because blood and sputum cultures are usually negative. Due to the angioinvasiveness of the fungus, blood-borne spread of the infection to extrapulmonary sites is often observed. The most frequently occupied sites are the brain, heart, kidneys, digestive tract, liver, and spleen.

Aspergillosis: laboratory diagnosis

In the diagnosis of infections caused by Aspergillus, microscopic methods and cultures are most often used to determine the presence of characteristic spores. Immunological tests detecting anti-Aspergillus antibodies and Aspergillus galactomannan antigen in the blood serum are also used to assist in the diagnosis of invasive aspergillosis.

Aspergillosis: treatment

Pharmacological treatment includes amphotericin B and voriconazole, which currently provides a more effective and less toxic therapy. It is also recommendedsurgical removal of the affected areas.

Patients with neutropenia and other groups at high risk of developing aspergillosis require special attention. To minimize exposure to Aspergillus spores, they should be kept in rooms where the air is filtered.

Category:

Infectious diseases