Disease Information for Aspergillosis, bronchopulmonary/hypersn: Definition

  • Aspergillosis refers to several forms of a broad range of illnesses caused by infection with Aspergillus species;

    Aspergillus species are ubiquitous in the environment internationally and occur as a mold found in soil

    Cause a variety of illness from hypersensitivity pneumonitis to disseminated overwhelming infection in immunosuppressed patients; Incidence of invasive aspergillosis is increasing with advances in the treatment of life threatening diseases: aggressive chemotherapy; bone marrow and organ transplantation; Frequently cultured from samples obtained in hospital wards from unfiltered outside air; route via airborne conidia (spores) that are small enough to reach the alveoli on inhalation; Can also invade the nose and paranasal sinuses, external ear, or traumatized skin; The clinical syndrome and pathologic spectrum of Aspergillus lung disease is dependent on the underlying lung architecture, the host’s immune response, and the degree of inoculum; Aspergillus fumigatus is the usual cause; A flavus is the second most important species, particularly in invasive disease of immunosuppressed patients and in lesions beginning in the nose and paranasal sinuses; NON INVASIVE DISEASE OR ALLERGIC ASPERGILLOSIS- Represents a hypersensitivity pneumonitis; Presents as cough, dyspnea, fever, chills, and malaise typically 4 to 8 hr after exposure ; Repeated attacks can lead to granulomatous disease and pulmonary fibrosis; ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS (ABPA)- Symptoms occur most commonly in atopic individuals during the third and fourth decades of life; Hypersensitivity reaction of the airways to Aspergillus fungal antigens present in the bronchial tree, even simple colonization; This provokes an initial type I (immediate hypersensitivity) and a type III reaction (immune complexes), which is most likely responsible for the roentgenographic features and more destructive changes of the bronchi in invasive infection; Although seen in full spectrum of colonization to invasion clinically the allergic reponse is an underdiagnosed pulmonary co-disorder in patients with asthma, bronchiectasis and cystic fibrosis; Manifests commonly as hemoptysis and worsening control in severe chronic asthma patents;DIFFERENTIAL DIAGNOSIS-Tuberculosis; Cystic fibrosis; Lung carcinoma; Eosinophilic pneumonia ; bronchiectasis; Sarcoidosis; Lung abscess; LABORATORY TESTS FOR ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS: Peripheral blood eosinophilia and an elevated total serum IgE level; Skin test with Aspergillus antigenic extract usually is positive but is nonspecific Aspergillus serum precipitating antibody is present in 70% to 100% of cases; Sputum cultures may be positive for Aspergillus spp. but are nonspecific; Sputum culture; Serum precipitating antibody; Chest roentgenograms show a variety of abnormalities from small, patchy, fleeting infiltrates (commonly in the upper lobes) to lobar consolidation; A majority of patients eventually develop central bronchiectasis; [Adapted from Ferri web source 5 minute consult]