This document provides information on pulmonary aspergillosis caused by the fungus Aspergillus. It discusses the history and taxonomy of Aspergillus. There are four main clinical syndromes of pulmonary aspergillosis: invasive pulmonary aspergillosis, allergic bronchopulmonary aspergillosis, chronic pulmonary aspergillosis, and Aspergillus tracheobronchitis. Invasive pulmonary aspergillosis is difficult to diagnose but the presence of septate hyphae in lung tissue along with a culture of Aspergillus is diagnostic. Voriconazole is now considered the primary treatment for invasive pulmonary aspergillosis.
An approach to Interstitial Lung Disease / Diffuse Parenchymal Lung DiseaseThomas Kurian
YouTube link: https://youtu.be/gPr31qrivUc
An approach to Diffuse Parenchymal Lung disease / Interstitial Lung disease with emphasis on the idiopathic causes.
New technology called Electromagnetic Navigation Bronchoscopy® (ENB) that uses virtual bronchoscopy and real time 3-dimensional CT images that enable me to localize these peripheral lung nodules for diagnosis and treatment. This outpatient procedure is minimally invasive and therefore has a small risk of pneumothorax (2-3%) and its published diagnostic yield rates range from 67% - 86%
An approach to Interstitial Lung Disease / Diffuse Parenchymal Lung DiseaseThomas Kurian
YouTube link: https://youtu.be/gPr31qrivUc
An approach to Diffuse Parenchymal Lung disease / Interstitial Lung disease with emphasis on the idiopathic causes.
New technology called Electromagnetic Navigation Bronchoscopy® (ENB) that uses virtual bronchoscopy and real time 3-dimensional CT images that enable me to localize these peripheral lung nodules for diagnosis and treatment. This outpatient procedure is minimally invasive and therefore has a small risk of pneumothorax (2-3%) and its published diagnostic yield rates range from 67% - 86%
ASPERGILLOSIS, MUCORMYCOSIS AND HISTOPLASMOSIS.pptxMkindi Mkindi
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS
Granulomatous diseases of the larynx- ALL DETAILS ABOUT TB, FUNGAL LARYNGITIS, SARCOIDOSIS, SYPHILIS, LEPROSY, Wegner granulomatosis, rhinoscleroma ARE GIVEN
to differentiate b/w wheezing and stridor....lead to know to make clinical dx for asthma, croup, laryngomalacia, epiglottis...there many noisy breathing....our focus wheezing n stridor....
PNEUMONIA,
DEFINITION
Pneumonia is an infection of the pulmonary parenchyma.
To the pathologist, pneumonia is an infection of the alveoli ,distal airways, and interstitium of the lung that is manifested by increased weight of the lungs, replacement of normal lung’s sponginess by consolidation ,and alveoli filled with white blood cells ,red blood cells and fibrin .To the clinician, pneumonia is a constellation of symptoms and signs in combination with at least one opacity on CXR.
Epidemiology
Between 5 and 10 million cases of infectious pneumonia occur annually in the United States and result in more than 1 million hospitalizations.
Pneumonia is a leading cause of death worldwide, the sixth leading cause of death in the United States, and the most common lethal infectious disease.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
3. HISTORY OF ASPERGILLOSIS
• 1729 – Fungus Aspergillus first identified and
catalogued by Italian biologist/priest Micheli
• Noticed under microscope the fungi looked like an
aspergillum which is used to sprinkle holy water and
named the genus after it.
• 1815 – Aspergillus first observed in birds by Mayer
• 1842 – British physician John Hughes Bennett
discovered first case of pulmonary aspergillosis in
humans.
• Called aspergilloma which means “fungus ball” in the
lungs
4. HISTORY OF ASPERGILLOSIS
• Many early cases of aspergillosis were found in
patients with tuberculosis or high risk
occupations such as pigeon-crammers and wig
combers.
• Some were invasive but most were aspergillomas
• 1953 – Rankin described the ability of Aspergillus
to cause opportunistic infection in
immunocompromised patients
• 1970 – Histopathology and clinical features of
disease described in 98 patients
7. INTRODUCTION
• Aspergillus species are ubiquitous molds
found in organic matter.
• Although more than 100 species have been
identified, the majority of human illness is
caused by Aspergillus fumigatus and
Aspergillus niger and, less frequently, by
Aspergillus flavus.
• The transmission of fungal spores to the
human host is via inhalation
8. INTRODUCTION
• Aspergillus may cause a broad spectrum of
disease in the human host, ranging from
hypersensitivity reactions to direct
angioinvasion.
• Aspergillus primarily affects the lungs, causing
the following four main syndromes
• Pulmonary aspergillosis refers to a spectrum
of diseases that result from Aspergillus
becoming resident in the lung.
9.
10. Spectrum
• The clinical features, course and
prognosis of Aspergillus
infections largely depend on the
degree of immune compromise
of the host, although there is
increasing recognition of the
importance of genetics. The
interplay between the pathogen
and host immune dysfunction
or hyperactivity determines
which clinical syndrome is more
likely to develop
11. EPIDEMIOLOGY
• Aspergillosis is thought to affect more than 14
million people worldwide, with allergic
bronchopulmonary aspergillosis (ABPA, >4
million), severe asthma with fungal
sensitization (>6.5 million), and chronic
pulmonary aspergillosis (CPA, ∼3 million)
being considerably more prevalent than
invasive aspergillosis (IA, >300,000).
12. EPIDEMIOLOGY
• Burden of Serious Fungal Infection in Nigeria,
by R. O Oladele, D. W. Denning, 2010-2014
• a 5 year period prevalence of 60,377 cases of
chronic pulmonary aspergillosis in px with PTB
• Prevalence of asthma in adults is 15.2%,
estimated at 3.7M adult asthmatics of which
94,000 (2.5%) had ABPA and 124,000 severe
asthma with fungal sensitisation (SAFS)
13. INVASIVE PULMONARY ASPERGILLOSIS
• IPA was first described in 1953.
• Due to widespread use of chemotherapy and immunosuppressive
agents, its incidence has increased over the past two decades .
• Of all autopsies performed between 1978 and 1992, the rate of
invasive mycoses increased from 0.4% to 3.1%, as documented by
GROLL et al.
• IPA increased from 17% to 60% of all mycoses found on autopsy
over the course of the study.
• The mortality rate of IPA exceeds 50% in neutropenic patients and
reaches 90% in haematopoietic stem-cell transplantation (HSCT)
recipients.
Groll AH, Shah PM, Mentzel C, et al. Trends in the postmortem epidemiology of invasive fungal infections at a university hospital. J
Infect 1996; 33: 23–32.
14. INVASIVE PULMONARY ASPERGILLOSIS (Risk Factors)
• Alveolar macrophages are the first line of defence
against inhaled Aspergillus conidia.
• In the lungs, pathogen recognition receptors,
such as Toll-like receptors, dectin-1 and
mannose-binding lectin, identify specific fungal
wall components and produce cytokines that
stimulate neutrophil recruitment, the main
defence mechanism against Aspergillus hyphae.
• The major risk factor for IPA is immunodeficiency
which includes neutropenia
15. INVASIVE PULMONARY ASPERGILLOSIS (Risk Factors)
Prolonged neutropenia (<500 cells·mm−3 for >10 days)
Transplantation (highest risk is with lung transplantation and HSCT)
Prolonged (>3 weeks) and high-dose corticosteroid therapy
Haematological malignancy (risk is higher with leukaemia)
Chemotherapy
Advanced AIDS
Chronic granulomatous disease
•HSCT: haematopoietic stem-cell transplantation.
16. INVASIVE PULMONARY ASPERGILLOSIS (Clinical Presentation)
• In most cases, Aspergillus is introduced to the
lower respiratory tract by inhalation of the
infectious spores.
• Less commonly, IPA may start in locations
other than the lungs, such as sinuses, the
gastrointestinal tract or the skin (via
intravenous catheters, prolonged skin contact
with adhesive tapes or burns)
17. INVASIVE PULMONARY ASPERGILLOSIS (Clinical Presentation)
• Symptoms are nonspecific and usually mimic
bronchopneumonia:
– fever unresponsive to antibiotics
– cough, productive of sputum
– dyspnoea
– pleuritic chest pain (due to vascular invasion leading
to thromboses that cause small pulmonary infarcts)
– haemoptysis, which is usually mild, but can be severe.
• IPA is one of the most common causes of haemoptysis
in neutropenic patients, and may be associated with
cavitation that occurs with neutrophil recovery
18. INVASIVE PULMONARY ASPERGILLOSIS (Clinical Presentation)
• Aspergillus infection may also disseminate
haematogenously to other organs, including the
brain.
• This can lead to seizures, ring-enhancing lesions,
cerebral infarctions, intracranial haemorrhage,
meningitis and epidural abscesses.
• Other organs such as the skin, kidneys, pleura,
heart, oesophagus and liver may be less
frequently involved.
19. INVASIVE PULMONARY ASPERGILLOSIS (Clinical Presentation)
• Aspergillus tracheobronchitis (ATB) is
a unique feature of IPA.
• It represents isolated invasion of the
tracheobronchial tree by Aspergillus spp.
• Predisposing factors for ATB are similar to those
for IPA; however, certain patient groups are more
likely to develop this entity.
• These include lung transplantation recipients,
patients with AIDS and cancer patients with
mediastinal involvement and/or treatment.
20. Aspergillus tracheobronchitis (ATB)
• Obstructive ATB is characterised by thick mucus plugs full
of Aspergillus spp. without macroscopic bronchial
inflammation.
• Pseudomembraneous ATB is characterised by extensive
inflammation of the tracheobronchial tree and a
membrane overlaying the mucosa containing Aspergillus
spp.
• Ulcerative ATB is reserved to patients with limited
involvement of the tracheobronchial tree, and is usually
found at the suture line in lung transplantation recipients.
• Pseudomembraneous ATB is the most severe form and
usually presents with cough and dyspnoea. Haemoptysis is
not frequent.
21. Aspergillus tracheobronchitis (ATB)
• The diagnosis of ATB is usually made by the characteristic
findings on bronchoscopy combined with microscopic
analysis of respiratory specimens obtained during the
procedure.
• The outcome of ulcerative ATB is generally favourable with
antifungal therapy.
• On the other hand, the prognosis is poor in patients with
pseudomembranous and obstructive ATB, with mortality
reaching 78%.
• The need for mechanical ventilation is a predictor of high
mortality in these patients .
• High index of suspicion of ATB, early diagnosis and prompt
antifungal therapy may be associated with improved
outcome.
22. INVASIVE PULMONARY ASPERGILLOSIS (Diagnosis)
• The diagnosis of IPA remains challenging.
• Early diagnosis of IPA in severely immunocompromised
patients is difficult, and a high index of suspicion is
necessary in patients with risk factors for invasive
disease.
• The gold standard in the diagnosis of IPA is
histopathological examination of lung tissue obtained
by thoracoscopic or open-lung biopsy.
• The presence of septate, acute, branching hyphae
invading lung tissue along with a culture positive for
Aspergillus from the same site is diagnostic of IPA.
23. INVASIVE PULMONARY ASPERGILLOSIS (Diagnosis)
• The histopathological findings associated with IPA have
been shown to differ according to the underlying host.
In patients with allogeneic HSCT and GVHD, there is
intense inflammation with neutrophilic infiltration,
minimal coagulation necrosis and low fungal burden.
• In neutropenic patients, IPA is characterised by scant
inflammation, extensive coagulation necrosis
associated with hyphal angio-invasion, and high fungal
burden.
• Dissemination to other organs is equally high in both
groups
24. INVASIVE PULMONARY ASPERGILLOSIS (Diagnosis)
• Computed tomography
(CT) of the chest may be
used to identify the halo
sign, a macronodule
surrounded by a
perimeter of ground-
glass opacity, which is an
early sign of invasive
pulmonary aspergillosis
(IPA)
25. INVASIVE PULMONARY ASPERGILLOSIS (Diagnosis)
• Another late
radiological sign is the
air crescent sign,
which appears as a
crescent-shaped
lucency in the region
of the original nodule
secondary to necrosis
26. INVASIVE PULMONARY ASPERGILLOSIS (Diagnosis)
• Other diagnostic tests are:
– Fungal culture, galactomannan (GM) or PCR in
patients with neutropenia
– bronchoalveolar lavage (BAL) to detect
Aspergillus antigens, mainly galactomannan and
(13)-β-D-glucan (both are cellular wall
constituents) as well as PCR
27. INVASIVE PULMONARY ASPERGILLOSIS (Treatment)
• A new broad-spectrum triazole, voriconazole, has been
approved as the initial treatment of invasive
aspergillosis and is currently considered the treatment
of choice in many patients with IPA
• liposomal amphotericin B in the low doses
• azoles target the fungal cell membrane
• Echinocandin derivatives such as caspofungin,
micafungin and anidulafungin are also effective agents
in the treatment of IPA refractory to standard
treatment, or if the patient cannot tolerate first-line
agents
• echinocandins inhibit the (13)-β-D-glucan constituent
of the fungal cell wall
28. INVASIVE PULMONARY ASPERGILLOSIS (Treatment)
• Surgical resection has generally a limited role in
the management of patients with IPA, but it
becomes important in cases with invasion of
bone, burn wounds, epidural abscesses and
vitreal disease.
• It should also be considered in cases of massive
haemoptysis, pulmonary lesions close to the
great blood vessels or pericardium, or residual
localised pulmonary lesions in patients with
continuing immunosuppression
29. CHRONIC NECROTISING ASPERGILLOSIS
• CNA, also called semi-invasive or subacute invasive
aspergillosis, was first described by Gefter et al. and
Binder et al. in 1981.
• It is an indolent, cavitary and infectious process of the
lung parenchyma secondary to local invasion by
Aspergillus species, usually A. fumigatus .
• In contrast to IPA, CNA runs a slowly progressive course
over weeks to months, and vascular invasion or
dissemination to other organs is unusual.
• This syndrome is rare, and the available literature is
based on case reports and small case series.
30. CHRONIC NECROTISING ASPERGILLOSIS (Risk Factor)
• CNA usually affects middle-aged and elderly patients
with altered local defences, associated with underlying
chronic lung diseases such as COPD, previous
pulmonary tuberculosis, thoracic surgery, radiation
therapy, pneumoconiosis, cystic fibrosis, lung infarction
or sarcoidosis.
• It may also occur in patients who are mildly
immunocompromised due to diabetes mellitus,
alcoholism, chronic liver disease, low-dose
corticosteroid therapy, malnutrition, or connective
tissue diseases such as rheumatoid arthritis and
ankylosing spondylitis.
• Mannose-binding lectin polymorphism may play a role
in the pathogenesis of CNA
31. CHRONIC NECROTISING ASPERGILLOSIS (Diagnosis)
• Clinical
– Chronic (>1 month) pulmonary or systemic symptoms, including at
least one of: weight loss, productive cough or haemoptysis
– No overt immunocompromising conditions (e.g. haematological
malignancy, neutropenia, organ transplantation)
• Radiological
– Cavitary pulmonary lesion with evidence of paracavitary infiltrate
– New cavity formation, or expansion of cavity size over time
• Laboratory
– Elevated levels of inflammatory markers (C-reactive protein, plasma
viscosity or erythrocyte sedimentation rate).
– Isolation of Aspergillus spp. from pulmonary or pleural cavity
– Exclusion of other pulmonary pathogens, by results of appropriate
cultures and serological tests, that are associated with similar disease
presentation, including mycobacteria and endemic fungi
32. CHRONIC NECROTISING ASPERGILLOSIS (Treatment)
• Voriconazole has emerged as a primary therapy
for CNA, for mild to moderate disease until
resolution or stabilisation of the clinical and
radiographic manifestations
• while in patients with severe disease, initial
therapy with intravenous amphotericin B or
intravenous voriconazole should be considered.
• Itraconazole an effective alternative to the
relatively toxic amphotericin B
33. CHRONIC NECROTISING ASPERGILLOSIS (Treatment)
• Surgical resection has a minor role in the
treatment of CNA, being reserved for healthy
young patients with focal disease and good
pulmonary reserves, patients not tolerating
antifungal therapy and patients with residual
localised but active disease despite adequate
antifungal therapy.
34. ASPERGILLOMA
• Aspergilloma is the most common and best-
recognised form of pulmonary involvement by
Aspergillus species
• It usually develops in a pre-existing cavity in the
lung.
• The aspergilloma (fungus ball) is composed of
fungal hyphae, inflammatory cells, fibrin, mucus,
and tissue debris.
• The most common species of Aspergillus
recovered from such lesions is A. fumigatus;
however, other fungi, such as Zygomycetes and
Fusarium, may cause the formation of a fungal
ball.
35. ASPERGILLOMA
• Many cavitary lung diseases are complicated
by aspergilloma, including tuberculosis,
sarcoidosis, bronchiectasis, bronchial cysts
and bullae, ankylosing spondylitis, and
neoplasm.
• Of these, tuberculosis is the most common
• The fungus ball may move within the cavity,
but it does not usually invade the surrounding
lung parenchyma or blood vessels, although
exceptions have been noted.
37. ASPERGILLOMA (Clinical Presentation)
• Most patients with aspergilloma are
asymptomatic.
• When symptoms are present, most patients
experience mild haemoptysis, but severe and
life-threatening haemoptysis may occur,
particularly in patients with underlying
tuberculosis.
38. ASPERGILLOMA (Clinical Presentation)
• The source of bleeding is usually the bronchial
blood vessels, and it may be caused by
– local invasion of blood vessels lining the cavity
– endotoxins released from the fungus, or
– mechanical irritation of the exposed vasculature
inside the cavity by the moving fungus ball.
• Less commonly, patients may develop cough,
dyspnoea that is probably more related to the
underlying lung disease and fever that could be
secondary to the underlying disease or bacterial
superinfection
39. ASPERGILLOMA (Diagnosis)
• The diagnosis of pulmonary aspergilloma is
usually based on clinical and radiographic
features along with serological or microbiological
evidence of Aspergillus spp.
• Sputum cultures for Aspergillus spp are positive
only in 50% of cases.
• Serum IgG antibodies to Aspergillus are positive
in most cases but may be negative in patients on
corticosteroid therapy.
• Aspergillus antigen has been recovered from the
BAL fluid of patients with aspergilloma
40. ASPERGILLOMA (Diagnosis)
• Chest radiography is
useful in demonstrating
the presence of a mass in
a pre-existing cavity.
Aspergilloma appears as
an upper-lobe, mobile,
intra-cavitary mass with
an air crescent in the
periphery
42. ASPERGILLOMA (Treatment)
• Treatment is considered only when patients
become symptomatic, usually with haemoptysis.
• Inhaled, intracavitary and endobronchial
instillations of antifungal agents
• CT-guided percutaneous administration of
amphotericin B can be effective for aspergilloma,
especially in patients with massive haemoptysis,
and can lead to resolution within few days
• Itraconazole may be useful in the management of
selected patients with aspergilloma because it
has a high tissue penetration.
43. ASPERGILLOMA (Treatment)
• Surgical resection of the cavity and removal of
the fungus ball is usually indicated in patients
with recurrent haemoptysis, if their
pulmonary function is sufficient to allow
surgery
• Bronchial artery embolisation should be
considered as a temporary measure in
patients with life-threatening haemoptysis
44. ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS
• Allergic bronchopulmonary aspergillosis (ABPA) is
a pulmonary disease that results from
hypersensitivity to Aspergillus antigens, mostly
due to A. fumigatus.
• The majority of cases occur among people with
asthma or cystic fibrosis.
• It is estimated that 2% of asthmatics, and 7–14%
of corticosteroid-dependent asthmatics have
ABPA. Also the incidence of ABPA is higher in
patients with atopy.
• In the case of cystic fibrosis, 1–15% of patients
may develop ABPA.
Patterson K, Strek ME. Allergic bronchopulmonary aspergillosis. Proc Am Thorac Soc 2010; 7: 237–
244.CrossRefPubMedGoogle Scholar
45. ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS
• Observations have suggested that it is crucial to
screen asthmatic patients for sensitisation to
Aspergillus antigens and to monitor these
patients more closely and exclude the presence
of ABPA.
• Among patients with cystic fibrosis, ABPA is more
commonly seen in those who are males, have a
history of asthma or atopy, have lower lung
function or have Pseudomonas in sputum
cultures.
46. ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS
• The pathogenesis of ABPA is not completely
understood. There does not appear to be a
correlation between Aspergillus load in the
environment and the development of ABPA.
• Many immune responses appear to be involved,
including
– Aspergillus-specific IgE-mediated type I
hypersensitivity reactions
– Specific IgG-mediated type III hypersensitivity
reactions
– Abnormal T-lymphocyte responses.
47. ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS (Clinical Presentation)
• ABPA is usually suspected on clinical grounds,
and diagnosis is confirmed by radiological and
serological testing.
• Almost all patients have clinical asthma, and
patients usually present with episodic
wheezing, expectoration of sputum containing
brown plugs, pleuritic chest pain, and fever
53. • Chest computed
tomography image
showing central
bronchiectasis in a
patient with allergic
bronchopulmonary
aspergillosis.
54. ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS (Treatment)
• Treatment of ABPA aims to treat acute
exacerbations of the disease and limit progressive
lung disease and bronchiectasis
• Oral corticosteroids are the main treatment for
ABPA. They suppress the hypersensitivity and
inflammatory response provoked by A.
fumigatus rather than eradicating the organism.
• Treatment with corticosteroids leads to the relief
of bronchospasm, the resolution of radiographic
infiltrates and a reduction in serum total IgE and
peripheral eosinophilia.
55. ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS (Treatment)
• 2 weeks of daily therapy of oral prednisone (0.5
mg·kg−1·day−1), followed by gradual tapering,
has been recommended for new ABPA-related
infiltrates
• Total serum IgE serves as a marker of ABPA
disease activity. It should be checked 6–8 weeks
after the initiation of therapy and then every 8
weeks for 1 year after that to determine a
baseline range for each individual patient
56. ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS (Treatment)
• Adding oral itraconazole to steroids in patients
with recurrent or chronic ABPA may be helpful.
This may allow more rapid resolution of infiltrates
and symptoms, facilitating steroid tapering or
lowering the needed maintenance corticosteroid
dosage.
• Voriconazole has also been tried in the treatment
of ABPA and showed a favourable therapeutic
response
• Case reports have described the beneficial use of
the anti-immunoglobulin E (IgE) monoclonal
antibody omalizumab (Xolair) in patients with
ABPA.
57. Disease Primary treatment Other treatments
Invasive pulmonary
aspergillosis
Voriconazole
Alternative therapy: liposomal
amphotericin B
Continuation therapy:
voriconazole or itraconazole
Salvage therapy: echinocandin or
posaconazole
Chronic necrotising
aspergillosis
Voriconazole
Alternative therapy: itraconazole
Severe cases: intravenous
voriconazole or liposomal
amphotericin B
Consider surgical resection
Aspergilloma Observation
Bronchial artery embolisation
Surgical resection
Consider itraconazole
Allergic bronchopulmonary
aspergillosis
Corticosteroids
Itraconazole or voriconazole as
steroid-sparing agents
58. CONCLUSION
• The various clinical syndromes caused by
Aspergillus can be viewed as a continuous
spectrum of disease whose manifestations are
defined by the interaction between pathogen
and host.
• One form of clinical disease may evolve into
another over time depending on the degree of
immune compromise of the host.
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• https://emedicine.medscape.com/article/296052