Aspergillosis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
===Allergic Bronchopulmonary Aspergillosis (ABPA)=== | |||
*Hypersensitivity reaction to ''A fumigatus'' | |||
*Asthma and cystic fibrosis | |||
*Cough, mucous plugs, bronchial casts, [[hemoptysis]], wheezing | |||
*+/- Allergic fungal sinusitis | |||
===Chronic Necrotizing Aspergillosis Pneumonia (CNPA)=== | |||
*Underlying lung disease (steroid-dependent [[COPD]], [[alcoholism]]) | |||
*Subacute [[pneumonia]], resistant to [[antibiotics]] and cavitates | |||
*[[Fever]], cough, night sweats, weight loss | |||
===Aspergilloma (Fungus ball)=== | |||
*Preexisting cavitary lung disease (Tb, sarcoidosis) or cystic lesion (PCP) | |||
*[[Hemoptysis]], cough and fever | |||
*Asymptomatic radiographic abnormality | |||
===Invasive aspergillosis=== | |||
*[[Neutropenia]] or immunosuppression | |||
*Organ transplantation (bone marrow), leukemia, lymphoma, chemotherapy | |||
*Long-term steroid use (ex [[COPD]]) | |||
*[[Fever]], cough, dyspnea, pleuritic [[chest pain]], [[hemoptysis]] | |||
*Rapidly progressive, can be fatal | |||
* Can cause skin infection | *Can cause skin infection | ||
==Differential Diagnosis== | ==Differential Diagnosis== |
Revision as of 01:21, 7 April 2015
Background
- Primary affects lung
- Mold: Hyphae that branches 45°
- Inhalation
- 4 syndromes:
- Allergic Bronchopulmonary Aspergillosis (ABPA)
- Chronic Necrotizing Aspergillosis Pneumonia (CNPA)
- Aspergilloma
- Invasive aspergillosis
Clinical Features
Allergic Bronchopulmonary Aspergillosis (ABPA)
- Hypersensitivity reaction to A fumigatus
- Asthma and cystic fibrosis
- Cough, mucous plugs, bronchial casts, hemoptysis, wheezing
- +/- Allergic fungal sinusitis
Chronic Necrotizing Aspergillosis Pneumonia (CNPA)
- Underlying lung disease (steroid-dependent COPD, alcoholism)
- Subacute pneumonia, resistant to antibiotics and cavitates
- Fever, cough, night sweats, weight loss
Aspergilloma (Fungus ball)
- Preexisting cavitary lung disease (Tb, sarcoidosis) or cystic lesion (PCP)
- Hemoptysis, cough and fever
- Asymptomatic radiographic abnormality
Invasive aspergillosis
- Neutropenia or immunosuppression
- Organ transplantation (bone marrow), leukemia, lymphoma, chemotherapy
- Long-term steroid use (ex COPD)
- Fever, cough, dyspnea, pleuritic chest pain, hemoptysis
- Rapidly progressive, can be fatal
- Can cause skin infection
Differential Diagnosis
- Asthma, bronchiectasis, eosinophilia, pneumonia, ARDS
- Fungal or viral infection, PE, abscess, Tb, sarcoidosis
Workup
- 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 apsergillosis 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
Management
- Pulmonary consult +/- ID consult
- ABPA: Oral corticosteroids
- Recurrent chronic, add oral itraconazole +/- surgical resection of nasal polyp
- Aspergilloma
- Symptomatic (hemoptysis): Oral itraconazole
- Intracavitary CT-guided percutaneous catheter px for amphotericin B
- Surgical resection
- Bronchial artery embolization
- Invasive aspergillosis
- Voriconazole DOC
- Alternative: Posaconazole, amphotericin B, caspofungin
- Reduce immunosuppression
- CNPA
- Voriconazole, itraconazole, caspogungin, or amphotericin
- Reduce immunosuppression
Special Population: Cystic Fibrosis
- Diagnosis: Clinical deterioration; IgE> 1000IU/mL or > 2-4x baseline; + serology; new infiltrate
- Treatment: New radiologic finding and sxs and change in baseline IgE >500 IU/mL
Disposition
- Invasive aspergillosis often requires admission
- Admit if massive hemoptysis
- ABPA usually managed outpatient
See Also
External Links
Sources
- Harman EM, et al. (2014, May 31). Aspergillosis. eMedicine. Retrieved 12/24/2014 from http://emedicine.medscape.com/article/296052-overview