Aspergillosis: A lung fungi infection, Treatment and Symptoms

What is Aspergillosis?

Aspergillosis is a disease caused due to filamentous fungi.

Causes of Aspergillosis

Predisposing factors for fungal infection of lung are usually apportunistic in nature.
States of general debility such as malnutrition, diabetes, cachexia of malignant disease, blood dyscrasias and lymphomas.
Local damage to respiratory tract due to previous inflammatory, neoplastic or allergic disease.
Iatrogenic factors are broad spectrum antibiotics, cortico-steroids, cyto-toxic and anti-leukemia drugs also the immunosuppressive drugs.

Who is at risk of suffering from Aspergillosis?

Aspergillus fumigatus is of chief importance and agriculture workers are at special risk. The fungus may infect a lung previously damaged by tuberculosis cavity, unresolved pneumonia, pulmonary infarct or bronchitises.

There are 3 types of broncho-aspergillosis:

Allergic broncho-pulmonary aspergillosis

In individuals with atopic hypersensitivity, high titers of IgE antibody and precipitating IgG antibody to aspergillus results in episodes of intense, usually focal inflammation of medium size bronchi.
On background of asthma, there are signs and symptoms of worsening airflow obstruction, cough that may produce characteristic mucus casts of the bronchi.
Segmental or lobar consolidation may be seen on chest X-ray.
Repeated, poorly controlled episodes eventually cause proximal bronchiectasis.

Treatment of Allergic broncho-pulmonary aspergillosis

This includes cortico-steroids for 4-6 weeks.

Aspergillma (mycetoma)

Cavities from previous tuberculosis or sarcoid disease may become colonized by aspergillus fumigatus.
A ball like fungal mass mixed with inflammatory debris and blood forms the cavity which becomes lined with highly vascular granulation tissue.
Typical symptom is recurring mild episodes of haemoptysis.
The fungal ball may be difficult to see on chest X-ray, but can easily be visualized on the CT-scan with a crescent of surrounding air within lung cavity.
High titers of aspergillus precipitins are usually present.

Treatment of Aspergillma (mycetoma)

It includes lobectomy for individual with severe haemoptysis.

Invasive aspergillosis

On immunocompromised individuals with severe neutropenia or T-lymphocyte deficiency, invasive aspergillus infection of lung parenchyma can produce an acute or sub acute illness.
It may present with fever and local cavitary pneumonia.
Diagnosis can be confirmed by demonstration of fungal hyphae in bronchoscopic or open lung samplings.

Treatment of Invasive aspergillosis

It includes use of anti-fungal drugs like Amphoterin and Itraconazole.