DOCSLIB.ORG

Management of Pulmonary Aspergilloma in the Presence of Active Tuberculosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Management of Pulmonary Aspergilloma in the Presence of Active Tuberculosis Thorax 1984;39:862-867 Thorax: first published as 10.1136/thx.39.11.862 on 1 November 1984. Downloaded from Management of pulmonary aspergilloma in the presence of active tuberculosis ADEBAYO 0 ADEYEMO, EZEKIEL 0 ODELOWO, DOROTHY I MAKANJUOLA From the Departments ofSurgery and Radiology, Faculty ofHealth Sciences, University ofIfe, and the Chest Clinic, Ife University Teaching Hospitals Complex, Ile-Ife, Nigeria ABSTRACr Eleven cases of pulmonary aspergilloma complicating active cavitating pulmonary tuberculosis are reviewed. Nine of the 10 patients who had combined medical (antituberculosis drugs) and surgical treatment were cured of their disease; one patient, who had bilateral multiple aspergillomas, died from massive haemoptysis after resection of one of the affected lobes. The only medically treated patient who refused surgery had fatal haemoptysis at home. Pulmonary resection is. recommended for patients who are fit for operation whenever the diagnosis of aspergilloma is made because most published reports indicate that only a few patients benefit from drug treatment alone. The natural history of intracavitary aspergilloma, Patients which is caused by the ubiquitous fungusAspergillus fumigatus, remains unknown. Many reports, how- Of 1345 patients with pulmonary tuberculosis seen copyright. ever, indicate that this opportunistic fungus colon- in the chest clinic of the University of Ife Teaching ises cavities in the upper lobes that result from pul- Hospital, Ile-Ife, Nigeria, from January 1977 to monary tuberculosis, lung cyst, lung abscess, bron- September 1983, 11 were admitted with pulmonary chiectasis, neoplasms,' 3 sarcoidosis, and ankylosing aspergilloma (table 1). Ages ranged from 29 years spondylitis.4 5 The saprophyte forms a conglomera- to 61 years. There were seven men and four women. tion of fragmented hyphae, fibrin, and inflammatory The chest radiograph was available for review in all cells (called an aspergilloma, fungus ball, or cases and figures 1-5 are representative of the http://thorax.bmj.com/ mycetoma) with the radiological appearance of a group. crescent of air separating the mycetoma from the wall of the cavity.' 6-8 Patients who have old tuber- Clinical manifestations culous cavities with superimposed aspergillomas tend to have recurrent and life threatening haemop- Table 2 summarises the important clinical features tysis,5 '9-4 and this is clearly an important factor to in the 11 patients with aspergilloma associated with be considered in assessing their need for surgery. pulmonary tuberculosis. The duration of illness until Consequently, this study was undertaken to review presentation at the hospital ranged from one week on October 5, 2021 by guest. Protected our experience of the incidence, natural history, to one and half years and the most frequent com- diagnosis, and management of pulmonary aspergil- plaint was of recurrent haemoptysis, usually of one loma seen in residual tuberculous cavities in a chest to two days' duration. Fever, productive cough, clinic serving a rural and urban population where weight loss, and repeated haemoptysis with varying pulmonary tuberculosis is endemic. This represents degrees of anaemia occurred in all patients. Five of the largest published series from a single institution the patients with severe or advanced pulmonary in our geographical zone. tuberculosis presented with dyspnoea and fatigue. There were four cases of finger clubbing. Address for reprint requests: Dr Adebayo 0 Adeyemo, Depart- Diagnosis ment of Surgery, Faculty of Health Sciences, University of Ife, Ile-Ife, Nigeria. Acid fast bacilli were present in the sputum smear of Accepted I June 1984 nine of the 11 patients and the remaining two had 862 Thorax: first published as 10.1136/thx.39.11.862 on 1 November 1984. Downloaded from Management ofpulmonary aspergilloma in the presence ofactive tuberculosis 863 Table 1 Clinical summary and management of11 patients with pulmonary aspergiUoma in the presence ofactive tuberculosis Patient Age (y) Locationof Sputum Management Complications Outcome No and.Sex fungus bl AFB Fungus 1 35 F Right upper lobe + Streptomycin, aminosalocylic acid, isoniazid; Atelectasis Recovery (fig 1) lobectomy 2 55 M Left upper lobe + Streptomycin, aminosalicylic acid isoniazid, Empyema thoracis Recovery clindamycin; lobectomy 3 49 M Left upper lobe + Streptomycin, aminosalicylic acid isoniazid, Wound infection Recovery ampiciliin; lobectomy 4 46 F Left upper lobe + + Streptomycin, ethambutol, isoniazid; refused Exsanguinating Died surgery haemoptysis 5 49 F Left upper lobe + Streptomycin, ethambutol, isoniazid, ampicillin, Empyema thoracis Recovery (fig 2) clindamycin; left pneumonectomy 6 50 M Right upper lobe + Streptomycin, ethambutol, isoniazid; lobectomy Wound infection, Recovery empyema thoracis 7 29 M Left upper lobe + Streptomycin, rifampicin, isoniazid; lobectomy Uneventful recovery 8 47 F Right and left + + Streptomycin, rifampicin, isoniazid; left upper Massive haemoptysis on Died upper lobe lobectomy (1st stage) 6th postoperative (ngs 3 and 4) day 9 32 M Right upper lobe + Streptomycin, aminosalicylic acid; lobectomy Uneventful recovery 10 38 M Left upper lobe + Streptomycin, aminosalicylic acid, isoniazid; Uneventful lobectomy recovery 11 34 M Leftupper lobe + Streptomycin, rifampicin, isoniazid; lobectomy Uneventful (fig 5) recovery AFB-acid fast bacilli. Table 2 Clinical features of1I patients with pulmonary cavities, as shown by chest radiographs (figs 3 and 4) aspergilloma in the presence ofactive tuberculosis taken in 1974 and 1980. The aspergillomas were all located in the upper lobe except in the patient with Presenting manifestations No ofcases bilateral aspergillomas, one of which was located in copyright. Increased productive cough 11 the right middle lobe; eight occurred on the left side Recurrent haemoptysis Weight loss 9 and four on the right. Excessive night sweat 8 Dyspnoea 5 Fatigue 5 Finger clubbing 4 -M acid fast bacilli cultured from the sputum; http://thorax.bmj.com/ A fumigatus was recovered from the sputum in four cases. Histological examination of resected surgical specimens confirmed the diagnosis of pulmonary tuberculosis and aspergilloma in all 11 cases. The skin patch test and serum precipitin (gel diffusion) test were not done because of lack of facilities. Standard posteroanterior chest views were per- formed in all cases. Lateral views and tomography on October 5, 2021 by guest. Protected were obtained when necessary. The hallmark of the radiological diagnosis of pulmonary aspergilloma is the presence of a moon shaped radiolucency adja- cent to a rounded mass within a cavitary lesion on the chest radiograph, and the fungus ball (aspergil- loma) often alters its location as the patient changes position. In three cases the aspergilloma appeared as a smooth homogenous, rather circular mass occupy- ing a small fraction, usually the base, of a thin walled cavity (fig 1). In seven cases the aspergillomas occupied virtually the entire cavity (fig 2). In one Fig 1 Case 1: Posteroanterior chest radiograph ofa treated treated tuberculous patient, bilateral aspergillomas tuberculous patient showing a fungus ball located at the base appeared in previous empty bilateral thin walled ofa thin walled cavity in the right upper lobe. 864 Adeyemo, Odelowo, Makanjuola Thorax: first published as 10.1136/thx.39.11.862 on 1 November 1984. Downloaded from Fig 2 Case 5: Posteroanterior chest radiograph ofa chronic tuberculous patient showing a fungus ball Fig 4 Case 8: Posteroanterior radiograph ofthe same occupying the entire left upper lobe. The left lower lobe is patient, taken six years later (1980). Fungal balls have the seat ofchronic tuberculous changes. appeared in both cavities. The lung fields also show many infitrates. copyright. http://thorax.bmj.com/ on October 5, 2021 by guest. Protected Fig 3 Case 8: Posterioanterior chest radiograph (1974) of a treated case oftuberculosis showing bilateral thin waUled cysts located in the right mid zone and the left upper zone. Fig 5 Case 1: Posteroanterior chest radiograph ofa tuberculous patient showing a fuingus ball in the keft upper lobe. Treatment and outcome combined medical and surgical approach. The medi- Table 1 shows the mode of treatment and its out- cal treatment consisted of antituberculous chemo- come in each case. The mainstay of treatment is a therapy, consisting of daily intramuscular injections Thorax: first published as 10.1136/thx.39.11.862 on 1 November 1984. Downloaded from Management ofpulmonary aspergilloma in the presence ofactive tuberculosis 865 of streptomycin for three months and oral administ- smear in nine cases and from culture in two cases. ration of a combination of isoniazid with either This high incidence of positivity for acid fast bacilli aminosalicylic acid or ethambutol or rifampicin for was due to the fact that all patients still had active 18 to 24 months. Supportive blood transfusion was tuberculosis disease. given to those who had a packed cell volume below Most lesions are unilateral but isolated instances 025. The surgical treatment consisted of either of multiple bilateral aspergillomas have been lobectomy (nine patients) or pneumonectomy (one recorded.8 H 21 Our case of a 47 year old woman patient) whenever the patient was physically fit for (No 8 in table 1) complements the list of the few anaesthesia, since nearly all the lobes habouring the reported cases of bilateral pulmonary aspergilloma aspergilloma had been destroyed by the concurrent in English
Load more

Recommended publications
  • Fungal Infection in the Lung
    CHAPTER Fungal Infection in the Lung 52 Udas Chandra Ghosh, Kaushik Hazra INTRODUCTION The following risk factors may predispose to develop Pneumonia is the leading infectious cause of death in fungal infections in the lungs 6 1, 2 developed countries . Though the fungal cause of 1. Acute leukemia or lymphoma during myeloablative pneumonia occupies a minor portion in the immune- chemotherapy competent patients, but it causes a major role in immune- deficient populations. 2. Bone marrow or peripheral blood stem cell transplantation Fungi may colonize body sites without producing disease or they may be a true pathogen, generating a broad variety 3. Solid organ transplantation on immunosuppressive of clinical syndromes. treatment Fungal infections of the lung are less common than 4. Prolonged corticosteroid therapy bacterial and viral infections and very difficult for 5. Acquired immunodeficiency syndrome diagnosis and treatment purposes. Their virulence varies from causing no symptoms to death. Out of more than 1 6. Prolonged neutropenia from various causes lakh species only few fungi cause human infection and 7. Congenital immune deficiency syndromes the most vulnerable organs are skin and lungs3, 4. 8. Postsplenectomy state RISK FACTORS 9. Genetic predisposition Workers or farmers with heavy exposure to bird, bat, or rodent droppings or other animal excreta in endemic EPIDEMIOLOGY OF FUNGAL PNEUMONIA areas are predisposed to any of the endemic fungal The incidences of invasive fungal infections have pneumonias, such as histoplasmosis, in which the increased during recent decades, largely because of the environmental exposure to avian or bat feces encourages increasing size of the population at risk. This population the growth of the organism.
    [Show full text]
  • Aspergillomas in the Lung Cavities
    ASPERGILLOMAS IN THE LUNG CAVITIES Eastern Journal of Medicine 3 (1): 7-9, 1998. Aspergillomas in the lung cavities SAKARYA M.E.1, ÖZBAY B.2, YALÇINKAYA İ.3, ARSLAN H.1, UZUN K.2, POYRAZ N.1 Departments of Radiology1and Chest Diseases2,Chest Surgery3 School of Medicine, Yüzüncü Yıl University, Van Objective Pulmonary aspergilloma usually arise from All patients showed cavitary lesions due to healed colonization of aspergillus in preexisting lung cavities. tuberculosis except one. Hemoptisis was the most In this study, we aimed to evaluate computed common complaint. Six patients underwent tomograpy (CT) findings in patients with pulmonary thoracotomy. One patient developed empyema after the aspergilloma. operation. Method We have reviewed 9 patients with aspergilloma, Conclusion CT of the chest in the patients with who referred to the hospital between 1991 and 1996, on aspergilloma is an important diagnostic tool in the their tomographic findings. diagnosis of pulmonary aspergilloma. Results The most common involvement site was upper Key words Pulmonary aspergilloma, computed lobe, which suggested the etiology of tuberculosis. tomography. strongly suggested by a positive precipitin test. CT Introduction clearly demonstrated pulmonary aspergilloma The first description of aspergillosis in man was findings. made by Bennett in 1842. The term aspergilloma was first used by Dave almost a century later to describe a Results discrete lesion that classically colonizes the cavities The most common underlying disease was healed of healed pulmonary tuberculosis and other fibrotic pulmonary tuberculosis. The CT appearance in all lung diseases (1). Pulmonary involvement with was consistent with a diagnosis of aspergilloma. Aspergillus fumigatus is varied and largely dependent In two patients with aspergilloma (22%) the on the patient’s underlying pulmonary and immune lesions were bilateral; in two patients, there were status.
    [Show full text]
  • Allergic Bronchopulmonary Aspergillosis: a Perplexing Clinical Entity Ashok Shah,1* Chandramani Panjabi2
    Review Allergy Asthma Immunol Res. 2016 July;8(4):282-297. http://dx.doi.org/10.4168/aair.2016.8.4.282 pISSN 2092-7355 • eISSN 2092-7363 Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity Ashok Shah,1* Chandramani Panjabi2 1Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India 2Department of Respiratory Medicine, Mata Chanan Devi Hospital, New Delhi, India This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. In susceptible individuals, inhalation of Aspergillus spores can affect the respiratory tract in many ways. These spores get trapped in the viscid spu- tum of asthmatic subjects which triggers a cascade of inflammatory reactions that can result in Aspergillus-induced asthma, allergic bronchopulmo- nary aspergillosis (ABPA), and allergic Aspergillus sinusitis (AAS). An immunologically mediated disease, ABPA, occurs predominantly in patients with asthma and cystic fibrosis (CF). A set of criteria, which is still evolving, is required for diagnosis. Imaging plays a compelling role in the diagno- sis and monitoring of the disease. Demonstration of central bronchiectasis with normal tapering bronchi is still considered pathognomonic in pa- tients without CF. Elevated serum IgE levels and Aspergillus-specific IgE and/or IgG are also vital for the diagnosis. Mucoid impaction occurring in the paranasal sinuses results in AAS, which also requires a set of diagnostic criteria. Demonstration of fungal elements in sinus material is the hall- mark of AAS.
    [Show full text]
  • CNS Aspergilloma Mimicking Tumors: Review of CNS Aspergillus
    G Model NEURAD-681; No. of Pages 8 ARTICLE IN PRESS Journal of Neuroradiology xxx (2017) xxx–xxx Available online at ScienceDirect www.sciencedirect.com Original Article CNS aspergilloma mimicking tumors: Review of CNS aspergillus infection imaging characteristics in the immunocompetent population a b,∗ c a Devendra Kumar , Pankaj Nepal , Sumit Singh , Subramaniyan Ramanathan , Maneesh d e e f Khanna , Rakesh Sheoran , Sanjay Kumar Bansal , Santosh Patil a Al wakra Hospital, Hamad Medical Corporation, Doha, Qatar b Metropolitan Hospital Center, New York Medical College, NY, USA c University of Alabama, Alabama, USA d Hamad Medical Corporation, Doha, Qatar e Neurociti Hospital, Ludhiana, Punjab, India f Department of Radiodiagnosis, JN medical College, Karnataka, India a r t i c l e i n f o a b s t r a c t Article history: Background and purpose. – CNS Aspergillosis is very rare and difficult to diagnose clinically and on imaging. Available online xxx Our objective was to elucidate distinct neuroimaging pattern of CNS aspergillosis in the immunocompe- tent population that helps to differentiate from other differential diagnosis. Keywords: Methods. – Retrospective analysis of brain imaging findings was performed in eight proven cases of cen- Central nervous system (CNS) tral nervous system aspergillosis in immunocompetent patients. Immunocompetent status was screened Aspergillosis with clinical and radiological information. Cases were evaluated for anatomical distribution, T1 and T2 sig- Immunocompetent nal pattern in MRI and attenuation characteristics in CT scan, post-contrast enhancement pattern, internal inhomogeneity, vascular involvement, calvarial involvement and concomitant paranasal, cavernous sinus or orbital extension. All patients were operated and diagnosis was confirmed on histopathology.
    [Show full text]
  • Diagnostic Aspects of Chronic Pulmonary Aspergillosis: Present and New Directions
    Current Fungal Infection Reports (2019) 13:292–300 https://doi.org/10.1007/s12281-019-00361-7 ADVANCES IN DIAGNOSIS OF INVASIVE FUNGAL INFECTIONS (O MORRISSEY, SECTION EDITOR) Diagnostic Aspects of Chronic Pulmonary Aspergillosis: Present and New Directions Bayu A. P. Wilopo1 & Malcolm D. Richardson1,2 & David W. Denning1,3 Published online: 25 November 2019 # The Author(s) 2019 Abstract Purpose of Review Diagnosis of chronic pulmonary aspergillosis (CPA) is important since many diseases have a similar appear- ance, but require different treatment. This review presents the well-established diagnostic criteria and new laboratory diagnostic approaches that have been evaluated for the diagnosis of this condition. Recent Findings Respiratory fungal culture is insensitive for CPA diagnosis. There are many new tests available, especially new platforms to detect Aspergillus IgG. The most recent innovation is a lateral flow device, a point-of-care test that can be used in resource-constrained settings. Chest radiographs without cavitation or pleural thickening have a 100% negative predictive value for chronic cavitary pulmonary aspergillosis in the African setting. Summary Early diagnosis of CPA is important to avoid inappropriate treatment. It is our contention that these new diagnostics will transform the diagnosis of CPA and reduce the number of undiagnosed cases or cases with a late diagnosis. Keywords Chronic pulmonary aspergillosis . Diagnostics . Serological test . Lateral flow device . Lateral flow assay . Resource-constrained settings Introduction appeared distinctly jointed in microscopic examinations of sputa and the lining membrane of tubercular cavities in the Chronic pulmonary aspergillosis (CPA) is a fungal infection lungs of a man initially thought to have tuberculosis [3].
    [Show full text]
  • Pulmonary Paracoccidioidomycosis in the Pneumology Unit of General Hospital in Recife (Brasil)
    Boletín Micológico Vol. 10 (1-2): 63-66 1996 PULMONARY PARACOCCIDIOIDOMYCOSIS IN THE PNEUMOLOGY UNIT OF GENERAL HOSPITAL IN RECIFE (BRASIL). IJ Paracoccidioidomicosis pulmonar en la .unidad de neumología de un hospital general en Recife (Brasil)/' . Olian~,M.C. Magalhaes, * Lusinete, A.de Queiroz, * Cristi'na, M. de Sou~a*, Laura,Torres.** *Departamento de Micología, Centro de Ciencias Biol., Universidade Federal de Pernambuco, 50670-420, Recife, PE, Brasil ** Hospital Geral Otavio de Freitas(SANCHO), Recife,PE, Brasil. Palabras clave: Paracoccidioidomicosis pulmonar Keywords: Pulmonary paracoccidioidomycosis SUMMARY RESUMEN In order to determine the presence of fungi in clini­ Para determinar la presencia de hongos en muestras cal sal11ples of the respiratory system, 322 patients with clínicas de vias respiratorias, fueron pesquisados. 322 pneul110pathieswere surveyed. Al! ofthem had been hospi­ pacientes con pneumopatias internos en la unidad de talised in the Pneumology Unit of the Otavio de Freitas neumología del Hospital General Otavio de Freitas, Recife, . General Hospital, Recife, PE, Brazil. Paracoccidioidomy­ PE, Brasil. Se diagno,sticaron 7 casos de paracoccidio­ cosis was diagnosed in 7 male patients (2.1%), and idomicosis(2, 1%), todo~ del sexo masculino y relacionados 6 involvedwith work in the rural zone. In cases there was a a trabajos rurales. En 6 casos se constató " diagno.s.tir:o "diagnostic mistake" between pulmonary tuberculosis and errado" entre tuberculosis pulmonar y Para~oci.­ pull110nary paracoccidioidomycosis; in 1 case the associa­ dioidomicosis pulmonar; en 1 caso fué comprobada la !ion of these two pneumopathies was verified. asociación de estas 2 neumopatías. twoofthem(Londero& Severo, 1981;Rippon, 1982;Wanke, .. INTRODUCTION 1984;Lacazetal.,1991).
    [Show full text]
  • Underlying Conditions in Chronic Pulmonary Aspergillosis Including Simple Aspergilloma
    Eur Respir J 2011; 37: 865–872 DOI: 10.1183/09031936.00054810 CopyrightßERS 2011 Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma N.L. Smith and D.W. Denning ABSTRACT: Chronic pulmonary aspergillosis (CPA) is a condition caused by the ubiquitous AFFILIATIONS fungus Aspergillus fumigatus in non-immunocompromised individuals. Numerous underlying The School of Translational Medicine, University of Manchester, conditions have been associated with CPA. Manchester Academic Health Details of the underlying conditions of 126 CPA patients attending our tertiary referral clinic Science Centre and University from all over the UK were extracted from the clinical notes, and the distribution of these Hospital of South Manchester, underlying conditions was analysed. For those with several underlying pulmonary conditions, one Manchester, UK. was nominated as the primary condition. CORRESPONDENCE Many patients presented with multiple underlying conditions, and a total of 232 underlying D.W. Denning conditions were identified for the 126 patients. Previous classical tuberculosis and non- 2nd Floor Education and Research tuberculous mycobacterial infection were the most common primary underlying conditions Centre Wythenshawe Hospital (15.3% and 14.9%, respectively). Others included allergic bronchopulmonary aspergillosis Southmoor Road (ABPA), chronic obstructive pulmonary condition (COPD) and/or emphysema, pneumothorax Manchester and prior treated lung cancer. Some conditions were found more often as one of multiple M23 9LT underlying conditions, while others were found only as secondary underlying conditions. UK E-mail: [email protected] Tuberculosis, non-tuberculous mycobacterial infection and ABPA remain the predominant risk factors for development of CPA, with COPD, prior pneumothorax or treated lung cancer also Received: relatively common among our referrals.
    [Show full text]
  • Dr. Ansari Systemic Fungal Infections
    Aspergillosis Dr. Ansari Systemic Fungal infections • Primary (endemic, dimorphic) fungal pathogen – Histoplama capsulatum – Coccidioides immitis – Blastomyces dermatitidis – Paracoccidioides Secondary (opportunistic) fungal infections • Aspergillosis • Candidiasis • Cryptococcosis • Mucormycosis • Penicillosis marneffei • Pneumocystis jirovecii pneumonia (PCP) Definition: Aspergillosis: Tissue invasive disease Allergic disease Aspergilloma (fungus ball) Mycotoxicosis: A.flavus and A.parasiticus Otomycosis Onychomycosis Keratitis Mycetoma Animals Agents: Aspergillus Farms Ubiquitous Cellars Exogenous Hay barns Agents: Aspergillus fumigatus (invasive) 90% Fumigatus & Clavatus(allergic) Asp.flavus Asp.terreus Asp.niger A.flavus A.flavus A.niger A.fumigatus Asp.fumigatus Asp.fumigatus Asp.flavus Asp niger Aspergillus terreus Predisposing factors: For invasive aspergillosis neutrophil deficiencies or dysfunction children with chronic granulomatous disease (CGD) Transplant Corticostreoid Pathogenesis: A.fumigatus Fast.dimeter(2-5) Termotolorant hydrophobic Pathogenesis: Aflatoxines Fumagillin Ochratoxine A Gliotoxin Clinical manifestations of Aspergillus: Clinical manifestations: 1-Allergic disease (lung and sinus): Allergic bronchopulmonary aspergillosis(ABPA) Allergic aspergillus sinusitis 2-Aspergilloma (lung and sinus) Clinical manifestations: 3-Invasive disease: Invasive pulmonary aspergillosis (IPA) invasive aspergillus sinusitis Clinical manifestations: 4-Brain 5-Endophthalmitis 6-Cutaneous aspergillosis Allergic disease: 1-Allergic
    [Show full text]
  • Fungal Infections in PIDD Patients
    Funga l Infections in PIDD Patients PIDD patients are more prone to certain types of infections. Knowing which ones they are most susceptible to and how they are most commonly treated can help to minimize the risk. By Alexandra F. Freeman, MD, and Anahita Agharahimi, MSN, CRNP 16 December-January 2014 www.IGLiving.com IG Living! ndividuals with primary immune deficiencies (PID Ds) are (paronychia) or the finger nails and toenails themselves at greater risk for recurrent infections compared with (onychomycosis). Candida can enter the bloodstream and Ithose with normal immune systems. PIDD patients cause more severe infections when the normal skin barriers fre quently have a genetic defect that causes an abnormality are compromised such as with central venous access lines in the number and/or function of one or more compo - (long-term IV access) that are sometimes needed for various nents of the immune system that fights infections. These treatments. These invasive infections usually cause infections can be predominantly viral, bacterial or fungal, fever and more acute illness compared with the more depending on the type of white blood cells affected by the mild infections such as thrush and vaginal yeast infections. specific immune deficiency . For instance, neutrophil Ringworm is also caused by yeasts, including Trichophyton abnormalities lead to recurrent bacterial and mold infections ; and Microsporum species, that cause rashes on the skin or B lymphocytes typically lead to bacterial infections, more scalp. Tinea versicolor is caused by the yeast Malassezia specifically those that antibodies prevent such as furfur and causes a rash usually on the trunk.
    [Show full text]
  • Concurrent Allergic Bronchopulmonary Aspergillosis and Aspergilloma: Is It a More Severe Form of the Disease?
    Eur Respir Rev 2010; 19: 118, 261–263 DOI: 10.1183/09059180.00009010 CopyrightßERS 2010 EDITORIAL Concurrent allergic bronchopulmonary aspergillosis and aspergilloma: is it a more severe form of the disease? A. Shah he mould Aspergillus, a genus of spore forming fungi, lung diseases in which aspergilloma formation has been affects the respiratory system in more ways than one. reported include sarcoidosis [15], hydatidosis [16], pneumato- T The clinical spectrum of Aspergillus involvement of the coele caused by Pneumocystis pneumonia [17], bronchiectasis, lungs ranges from various hypersensitivity manifestations to emphysematous bullae, and sites of prior lobectomies or invasive disease which can be fatal. The inhaled spores hardly pneumonectomies. The time required for the development of affect healthy persons but in asthmatic subjects these spores fungal balls ranges from a few months to more than 10 yrs [18]. are trapped in the viscid secretions found in the airways. Repeated inhalation of Aspergillus antigens triggers allergic The clinical categories of Aspergillus-related respiratory disor- reactions in atopic individuals, which may manifest as ders, for reasons unknown, usually remain mutually exclusive. Aspergillus-induced asthma, allergic bronchopulmonary asper- In spite of similar immunopathological responses, concomitant gillosis (ABPA) and allergic Aspergillus sinusitis (AAS) [1]. occurrence of ABPA and AAS is infrequently reported [19–22]. Saprobic colonisation of airways, cavities and necrotic tissue In this issue of the European Respiratory Review,MONTANI et al. leads to the development of aspergillomas. [23] describe a 50-yr-old female with concomitant ABPA and aspergilloma. Even though chronic lung damage appears to Although ABPA is predominantly a disease of asthmatics, only provide a favourable milieu for aspergilloma formation, the a few asthmatics actually suffer from it.
    [Show full text]
  • Aspergillosis and the Lungs Fungal Disease Series
    American Thoracic Society PUBLIC HEALTH | INFORMATION SERIES Aspergillosis And The Lungs Fungal Disease Series Aspergillosis (As-per-gill-osis) is an infection caused by a fungus called Aspergillus. Aspergillus lives in soil, plants and rotting material. It can also be found in the dust in your home, carpeting, heating and air conditioning ducts, certain foods including dried fish and in marijuana. Aspergillus infection is occurring more often and is now the leading cause of death due to invasive fungal infections in the United States. This is due mainly because there are more people who are living with weakened immune systems that put that them at higher risk of infection. Not everyone who gets aspergillosis goes on to factors. Different forms and their symptoms include: develop the severe form (invasive aspergillosis). ■■ Hypersensitivity Pneumonitis—an allergic reaction What causes Aspergillosis? to the fungus in the lungs. Symptoms can last for Aspergillus enters the body when you breathe in the weeks or months and include: CLIP AND COPY AND CLIP fungal spores (“seeds”). This fungus is commonly • shortness of breath found in your lungs and sinuses. If your immunity (the • coughing ability to “fight off” infections) is normal, the infection ■■ Allergic Bronchopulmonary Aspergillosis (ABPA)— can be contained and may never cause an illness. an asthma-like illness. Symptoms do not improve However, having a weak immune system or a chronic with usual asthma treatment and include: lung disease allows the Aspergillus to grow, invade • coughing your lungs and spread throughout your body. This may • shortness of breath happen if you: • wheezing • have a cancer such as leukemia or aplastic ■■ Invasive Aspergillosis—a rapidly spreading and anemia; potentially life threatening illness.
    [Show full text]
  • Aspergillus Nodules; Another Presentation of Chronic Pulmonary Aspergillosis Eavan G
    Muldoon et al. BMC Pulmonary Medicine (2016) 16:123 DOI 10.1186/s12890-016-0276-3 RESEARCH ARTICLE Open Access Aspergillus nodules; another presentation of Chronic Pulmonary Aspergillosis Eavan G. Muldoon1,4*, Anna Sharman2, Iain Page1,4, Paul Bishop3 and David W. Denning1,4 Abstract Background: There are a number of different manifestations of pulmonary aspergillosis. This study aims to review the radiology, presentation, and histological features of lung nodules caused by Aspergillus spp. Methods: Patients were identified from a cohort attending our specialist Chronic Pulmonary Aspergillosis clinic. Patients with cavitating lung lesions, with or without fibrosis and those with aspergillomas or a diagnosis of invasive aspergillosis were excluded. Demographic, laboratory, and clinical data and radiologic findings were recorded. Results: Thirty-three patients with pulmonary nodules and diagnostic features of aspergillosis (histology and/or laboratory findings) were identified. Eighteen (54.5 %) were male, mean age 58 years (range 27–80 years). 19 (57.6 %) were former or current smokers. The median Charleston co-morbidity index was 3 (range 0–7). All complained of a least one of; dyspnoea, cough, haemoptysis, or weight loss. None reported fever. Ten patients (31 %) did not have an elevated Aspergillus IgG, and only 4 patients had elevated Aspergillus precipitins. Twelve patients (36 %) had a single nodule, six patients (18 %) had between 2 and 5 nodules, 2 (6 %) between 6 and 10 nodules and 13 (39 %) had more than 10 nodules. The mean size of the nodules was 21 mm, with a maximum size ranging between 5–50 mm. No nodules had cavitation radiographically. The upper lobes were most commonly involved.
    [Show full text]