2.  Ubiquitous
 Worldwide
TYPES:
A fumigatus
A flavus
A niger
A terreus
A lentulus

3.  Rapid growth
 Basic morphology:
 Aerial hyphae with conidia; long
conidiophores with terminal vesicles on
which phialides produce biseptal chain
of conidia
 Species variate in these

7.  Fungal conidia formed in abundance
 Aerosolized
 Reach lungs
 Macrophages can engulf & destroy conidia
IMMUNOCOMPROMISED:
Leukaemia, stem cell transplant,
corticosteroids
Macrophages cannot contain inoculum;
Conidia swell, germinate to hyphae in
cavities, BV

8. ALLERGIC FORMS:
1.IgE AB formed to As conidial Ag
 Second exposure: immediate asthama
2. Allergic Bronchopulmonary Aspergillosis
 Conidia germinate,hyphae colonize
bronchial tree; parenchyma spared;


9. Inhaled enter an existing cavity,
germinate to abundant hyphae in
abnormal space as in TB, sarcoidosis,
emphysema
 Asymptomatic
 Cough, dysponea, hemoptysis, fatigue,
weight loss
 Invade nasal sinuses, cornea, nail, ear
canal

10.  Asthama
 Recurrent chest infilterates
 Eosinophilia
 Both type 1 & 3 hypersensitivity reaction
 Permenant lung scarring
3.Extrinsic Allergic Alveolitis:
Normal individuals with massive conidial
exposure

11.  Inhalation; germination
 Acute pneumonic process: mild necrosis to
 Dissemination +/-
RISK: Immuno-compromised:
 AIDS; CD4 count< 50cells/mm
 Stem cell allogenic hemopoietic transplant
 Leukaemia/lymphoma
 Corticosteroid therapy

12. Specimen:
 Sputum
 Lung biopsy
 Resp tract specimen
Microscopy: KOH mount
 calcofluor stain
 histology
 Hyphae: 4um wide, septate,hyaline,
branch dichotomously

13.  Fever, cough, dysponea, hemoptysis
 Hyphae invade BV; lumen & wall to
cause thrombosis, infarction & necrosis
Dissemination to organs
 GIT& Liver
 Kidney
 Brain
FATE: grave without T/M

16.  ID test positive
 AB: no help
 Cell wall galactomannan may help
T/M:
 Itraconazole; posaconazole Amp R in leukamia centres
 Amphotericin B
 Cytokine immuotherapy: interferon/gran-mac colony
Stimu
 Allergic: steroids, disodium chromoglychate
Prevention
 Avoid exposure to conidia in allergic & IC uhospital units