Difference between revisions of "Aspergillosis"

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===Allergic Bronchopulmonary Aspergillosis (ABPA)===
 
===Allergic Bronchopulmonary Aspergillosis (ABPA)===
 
*Hypersensitivity reaction to ''A fumigatus''
 
*Hypersensitivity reaction to ''A fumigatus''
*Asthma and cystic fibrosis
+
*[[Asthma]] and [[cystic fibrosis]]
*Cough, mucous plugs, bronchial casts, [[hemoptysis]], wheezing
+
*[[Cough]], mucous plugs, bronchial casts, [[hemoptysis]], [[wheezing]]
 
*+/- Allergic fungal sinusitis
 
*+/- Allergic fungal sinusitis
 
===Chronic Necrotizing Aspergillosis Pneumonia (CNPA)===
 
===Chronic Necrotizing Aspergillosis Pneumonia (CNPA)===
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===Invasive aspergillosis===
 
===Invasive aspergillosis===
 
*[[Neutropenia]] or immunosuppression
 
*[[Neutropenia]] or immunosuppression
*Organ transplantation (bone marrow), leukemia, lymphoma, chemotherapy
+
*Organ [[transplant complications|transplantation]] (bone marrow), [[leukemia]], [[lymphoma]], chemotherapy
 
*Long-term steroid use (ex [[COPD]])
 
*Long-term steroid use (ex [[COPD]])
 
*[[Fever]], cough, dyspnea, pleuritic [[chest pain]], [[hemoptysis]]
 
*[[Fever]], cough, dyspnea, pleuritic [[chest pain]], [[hemoptysis]]
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==Differential Diagnosis==
 
==Differential Diagnosis==
 
*[[Asthma]]
 
*[[Asthma]]
*bronchiectasis
+
*[[Bronchiectasis]]
 
*[[Eosinophilia]]
 
*[[Eosinophilia]]
 
*[[ARDS]]
 
*[[ARDS]]
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**Precipitin Ab test +
 
**Precipitin Ab test +
 
**[[CXR]]/CT: Mass in preexisting cavity, often in upper lobe (crescent of air outlining solid mass)
 
**[[CXR]]/CT: Mass in preexisting cavity, often in upper lobe (crescent of air outlining solid mass)
*Invasive apsergillosis and CNPA
+
*Invasive aspergillosis and CNPA
 
**Visualization of fungi (Silver stain)
 
**Visualization of fungi (Silver stain)
 
**Positive culture from sputum, needle biopsy, or BAL
 
**Positive culture from sputum, needle biopsy, or BAL
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**[[CXR]]: Nodules, cavitary lesions, alveolar infiltrates
 
**[[CXR]]: Nodules, cavitary lesions, alveolar infiltrates
 
**CT chest: Halo sign, screscent of air surrounding nodules, wedge-shaped or pleural-based infiltrates, cavitation, pulmonary infarction
 
**CT chest: Halo sign, screscent of air surrounding nodules, wedge-shaped or pleural-based infiltrates, cavitation, pulmonary infarction
 +
 +
===Special Population: [[Cystic Fibrosis]]===
 +
*Diagnosis: Clinical deterioration; IgE> 1000IU/mL or > 2-4x baseline; + serology; new infiltrate
 +
*Treatment: New radiologic finding and symptoms and change in baseline IgE >500 IU/mL
  
 
==Management==
 
==Management==
 
*Pulmonary consult +/- ID consult
 
*Pulmonary consult +/- ID consult
*ABPA: Oral corticosteroids
+
*ABPA: Oral [[corticosteroids]]
 
**Recurrent chronic, add oral [[itraconazole]] +/- surgical resection of nasal polyp
 
**Recurrent chronic, add oral [[itraconazole]] +/- surgical resection of nasal polyp
 
*Aspergilloma
 
*Aspergilloma
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**Bronchial artery embolization
 
**Bronchial artery embolization
 
*Invasive aspergillosis
 
*Invasive aspergillosis
**Voriconazole DOC
+
**[[Voriconazole]] DOC
**Alternative: Posaconazole, amphotericin B, caspofungin
+
**Alternative: Posaconazole, [[amphotericin B]], [[caspofungin]]
 
**Reduce immunosuppression
 
**Reduce immunosuppression
 
*CNPA
 
*CNPA
**Voriconazole, itraconazole, caspogungin, or amphotericin
+
**[[Voriconazole]], [[itraconazole]], [[caspofungin]], or [[amphotericin b]]
 
**Reduce immunosuppression
 
**Reduce immunosuppression
 
==Special Population: [[Cystic Fibrosis]]==
 
*Diagnosis: Clinical deterioration; IgE> 1000IU/mL or > 2-4x baseline; + serology; new infiltrate
 
*Treatment: New radiologic finding and symptoms and change in baseline IgE >500 IU/mL
 
  
 
==Disposition==
 
==Disposition==

Latest revision as of 20:31, 24 August 2019

Background

  • Primary affects lung
  • Mold: Hyphae that branches 45°
  • Inhalation

Clinical Features

Allergic Bronchopulmonary Aspergillosis (ABPA)

Chronic Necrotizing Aspergillosis Pneumonia (CNPA)

Aspergilloma (Fungus ball)

  • Preexisting cavitary lung disease (Tb, sarcoidosis) or cystic lesion (PCP)
  • Hemoptysis, cough and fever
  • Asymptomatic radiographic abnormality

Invasive aspergillosis

Differential Diagnosis

Causes of Pneumonia

Bacteria

Viral

Fungal

Parasitic

Evaluation

  • ABPA
    • Eosinophilia
    • Skin test + for A. Fumigatus
    • Serum IgE > 1000 IU/dL or > x 2-fold rise from baseline
    • Aspergillus precipitins +
    • Aspergillus radioallergosorbent assay test + and sputum culture
    • CXR: Fleeting pulmonary infiltrates, mucoid impaction, central bronchiectasis
    • CT chest: Bronchiectasis, lobulated masses that are mucus-filled dilate bronchi
  • Aspergilloma
    • Precipitin Ab test +
    • CXR/CT: Mass in preexisting cavity, often in upper lobe (crescent of air outlining solid mass)
  • Invasive aspergillosis and CNPA
    • Visualization of fungi (Silver stain)
    • Positive culture from sputum, needle biopsy, or BAL
    • Galactomannan level
    • CXR: Nodules, cavitary lesions, alveolar infiltrates
    • CT chest: Halo sign, screscent of air surrounding nodules, wedge-shaped or pleural-based infiltrates, cavitation, pulmonary infarction

Special Population: Cystic Fibrosis

  • Diagnosis: Clinical deterioration; IgE> 1000IU/mL or > 2-4x baseline; + serology; new infiltrate
  • Treatment: New radiologic finding and symptoms and change in baseline IgE >500 IU/mL

Management

Disposition

  • Invasive aspergillosis often requires admission
  • Admit if massive hemoptysis
  • ABPA usually managed outpatient

See Also

External Links

References