aspergillosis prepared by nawaraj adhikari

Aspergillosis

Presented By : Nawaraj Adhikari

BPH 3rd Batch (3rd Year)

Roll No: 10

Chitwan Medical College(CMC)

• Aspergillosis is the diseases / infection causedby fungi of the genus Aspergillus.

• The majority of cases occur in people withunderlying illnesses such as tuberculosis or chronicobstructive pulmonary disease (COPD), but withotherwise healthy immune systems.

• Most commonly, aspergillosis occurs in the formof chronic pulmonaryaspergillosis (CPA),aspergilloma or allergicbronchopulmonary aspergillosis (ABPA).

9/24/2016Aspergillosis / For BPH 3rd year 2

• Other, non-invasive manifestations include

fungal sinusitis (both allergic in nature and with

established fungal balls), otomycosis (ear

infection), keratitis (eye infection)

and onychomycosis (nail infection).

• In most instances these are less severe, and curable

with effective antifungal treatment.


• People with deficient immune systems such aspatients undergoing hematopoietic stem celltransplantation, chemotherapy for leukemia, or AIDSare at risk of more disseminated disease.

• Acute invasive aspergillosis occurs when the immunesystem fails to prevent Aspergillus spores fromentering the bloodstream via the lungs.

• Without the body mounting an effective immuneresponse, fungal cells are free to disseminatethroughout the body and can infect major organssuch as the heart and kidneys.


Source of infection

Compost

Hay

Cereal

Soil


• Vector:

None

• Vehicle:

Air

• Incubation period:

3 – 21 ( days)


Agent• The most frequently identified pathogen

is Aspergillus fumigatus an ubiquitous organism

that is capable of living under extensive

environmental stress.

• It is estimated that most humans inhale thousands

of Aspergillus spores daily, but they do not affect

most people’s health due to effective immune

responses.

• Taken together, the major chronic, invasive and

allergic forms of aspergillosis account for around

600,000 deaths annually worldwide


Etiology

• Next most commonly isolated species include:

1. A. flavus

2. A. niger

3. A. clavatus

4. A. glaucus

5. A. nidulans

6. A. oryzae

7. A. terreus

8. A. ustus

9. A. versicolor9/24/2016Aspergillosis / For BPH 3rd year 9

Symptoms• A fungus ball in the lungs may cause no symptoms and may

be discovered only with a chest X-ray, or it may cause

repeated coughing up of blood, chest pain, and occasionally

severe, even fatal bleeding. A rapidly

invasive Aspergillus infection in the lungs often causes cough,

fever, chest pain, and difficulty breathing.

• Poorly controlled aspergillosis can disseminate through the

blood stream to cause widespread organ damage. Symptoms

include fever, chills, shock, delirium, seizures and blood clots.

The person may develop kidney failure, liver

failure (causing jaundice), and breathing difficulties. Death

can occur quickly.


• Aspergillosis of the ear canal causes itching and

occasionally pain. Fluid draining overnight from

the ear may leave a stain on the pillow.

Aspergillosis of the sinuses causes a feeling of

congestion and sometimes pain or discharge. It

can extend beyond the sinuses.


Epidemiology

• Aspergillosis affects people with the following:

Weakened immune system

Low white blood cell levels

Lung cavities

Long-term corticosteroid therapy

A hospital stay

Asthma and cystic fibrosis


Epidemiology Cont.

• Invasive aspergillosis affects people who are

immunosuppressed such as:

People who have had bone marrow transplants or solid

organ transplants

People who are taking high doses of corticosteroids

People who undergo chemotherapy for cancer

People who have chronic granulomatous disease

People with advanced AIDS

Leukemia patients

Tuberculosis patients9/24/2016Aspergillosis / For BPH 3rd year 13

Epidemiology Cont.

• Aspergillosis is common in the environment and is

found worldwide

• Most people breathe in aspergillus spores everyday

• It is impossible to completely avoid breathing in

aspergillus spores because they are ubiquitous

• People with compromised immune systems who

breathe in the spores acquire infections


Epidemiology Cont.

• Aspergillosis occurs:

Soil

Air, spores are inhaled

Food-spices and ground pepper

Compost and decaying vegetation

Grains and crops

Fire proofing materials

Bedding, pillows, carpeting

Ventilation and air conditioning systems

Dust


Burden of aspergillosis infections in Nepal

(2015)• There are few reports of serious fungal infections in Nepal

though the pathogenic and allergenic fungi including

Aspergillus species are common in the atmosphere.

• It is estimated 9546 patients (range 2673-13,364) develop

allergic bronchopulmonary aspergillosis annually.

• Based on 26,219 cases of pulmonary tuberculosis, the annual

incidence of new chronic pulmonary aspergillosis (CPA) cases

was estimated at 1678 with a 5 year period prevalence of 5289,

80% of CPA cases.

• Of 381,822 adult asthma cases, it is estimated 9546 patients

(range 2673-13,364) develop allergic bronchopulmonary

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Manifestations

• Respiratory

• Cranial

• Pathologic

• Clinical

• Thoracic Initial CT


Disease Spectrum

• Forms of the disease involve:

oSinuses

oLungs

oPre-existing lung cavity

oPulmonary aspergillosis

oCNS aspergillosis

oSinonasal aspergillosis

oAllergic fungal sinusitis

o Urinary tract fungus balls

oOsteomyelitis

oEndophthalmitis

oEndocarditis

oRenal Abscesses

oCutaneous (Burns, post

surgical wounds, IV

insertion sites)

oOtomycosis

o Exogenous

endophthalmitis


Diagnosis

• Clinical Presentations:

Fever

Cough

Dyspnea

Difficulty breathing

Coughing up blood

Chest Pain


Treatment

• Treatment depends on the symptoms present

Itraconazole

Voriconazole

Surgery

Amphotercin B


Prevention

• Prevention of Aspergillosis involves a reduction of

mold exposure via environmental infection-control.

• Anti-fungal prophylaxis can be given to high-risk

patients. Posaconazole is often given as prophylaxis

in severely immunocompromised patients.


• This disease commonly effects people with a weak

immune system

Avoid medications that may further weaken the

immune system.

Avoid forests, grain stores, rotting vegetation,

and piles of dead leaves.

Hospitals should have good ventilation

Dust control

Adequate air flow rate


Reference

• http://www.ncbi.nlm.nih.gov/pubmed/26449506

• http://www.mycology.adelaide.edu.au/

• http://www.emedicinehealth.com/slideshow_skin_problem

s/article_em.html


http://www.ncbi.nlm.nih.gov/pubmed/26449506

http://www.mycology.adelaide.edu.au/

aspergillosis prepared by nawaraj adhikari

Health & Medicine