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Published in Ken Addley, MCQs, MEQs and OSPEs in Occupational Medicine, 2023
It is a fungus and reproduces up to 55°C and can survive up to 70°C. It can cause an aspergilloma in an immunocompetent person with a lung cavity such as from old tuberculosis. It is ubiquitous. Allergic bronchopulmonary aspergillosis can be treated with oral corticosteroids, sometimes used with anti-fungal medications such as itraconazole.
Pulmonary Immunology
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
Hemant H. Kesarwala, Thomas J. Fischer
Anaphylactic (type I) or immediate hypersensitivity reactions result from antigen binding to preformed IgE antibodies attached to the surface of the mast cell or the basophil. Activation of the mast cell or basophil cause the release of mediators (e.g., histamine) with the production of clinical symptoms such as wheezing, nasal congestion, or vascular collapse. Allergic bronchopulmonary aspergillosis is a disorder typically seen in patients with bronchial asthma. It is characterized by wheezing, low grade fever, eosinophilia, and expectoration of mucus plugs. The airways are colonized by aspergillus and diffusion of the antigen across the mucosa results in specific IgE and IgG being produced. Pathogenesis of this disorder probably involves both immediate (type I) and immune complex (type III) mechanisms. In an experimental model in monkeys it has been shown by Slavin et al. that both IgE and IgG antibody are required for the disease process to develop. Possibly deposition of IgG-immune complexes is facilitated by IgE antibody.31
Aspergillosis
Published in Meera Chand, John Holton, Case Studies in Infection Control, 2018
Aspergillus species may provoke an allergic response in the host, most commonly as allergic bronchopulmonary aspergillosis. This is a chronic condition that, if untreated, may ultimately lead to pulmonary fibrosis. It is classically characterized by central bronchiectasis in the context of asthma or cystic fibrosis, with elevated serum IgE and skin or antibody reactivity to Aspergillus species. An overactive immune response, predominantly driven by Th2 rather than Th1 cells, drives the production of excess interleukins that cause mucus plugging, inflammation of smaller airways, and atelectasis.
The role of precision medicine in bronchiectasis: emerging data and clinical implications
Published in Expert Review of Respiratory Medicine, 2023
Grace Oscullo, David de la Rosa, Marta Garcia Clemente, Rosa Giron, Rafael Golpe, Luis Máiz, Miguel Angel Martinez-Garcia
Bronchiectasis and asthma share functional and clinical features that can lead to the misdiagnosis of both diseases. The association between asthma and bronchiectasis has been well described, especially in uncontrolled or severe asthmatic patients [60]. As with COPD, it is unclear whether there is any causal relationship between bronchiectasis and asthma. Allergic bronchopulmonary aspergillosis is related to the development of both asthma and bronchiectasis, but it is a distinct entity rather than an overlap between the two diseases [61]. It is not clear how asthma can cause bronchiectasis, but eosinophilic inflammation can produce proteolytic enzymes and lead to imbalances between matrix metalloproteinases and tissue inhibitors of metalloproteinases that could cause extracellular matrix degradation and airway damage/dilation [16]. Mucus hypersecretion and plugging could promote chronic bacterial colonization, leading to the vicious circle of infection/inflammation/airway damage. Modifications to airway microbiota may plausibly be associated with a different (neutrophilic) inflammatory phenotype in asthma [62].
Azole resistance in Aspergillus species: promising therapeutic options
Published in Expert Opinion on Pharmacotherapy, 2021
Shirisha Pasula, Pranatharthi H. Chandrasekar
Aspergillus fumigatus can cause a wide variety of pulmonary fungal diseases, including hypersensitivity pneumonitis, acute invasive aspergillosis (IA), chronic pulmonary aspergillosis (CPA), and allergic bronchopulmonary aspergillosis (ABPA) [1]. The triazoles, itraconazole, isavuconazole, posaconazole, and voriconazole are antifungal agents with potent activity against A. fumigatus. Itraconazole and voriconazole are the preferred agents in patients with chronic pulmonary aspergillosis. Voriconazole and isavuconazole have been studied as first-line agents for the treatment of invasive aspergillosis. Posaconazole is mainly used for prophylaxis against invasive fungal infections in patients with hematological diseases [2–4]. There is an increasing global concern for azole resistance creating difficulty in choosing reliable effective antifungal regimen and is associated with increased mortality. This paper reviews epidemiology, mechanisms and detection of azole resistance, and therapeutic options for azole-resistant Aspergillus infections.
Efficacy of nebulized liposomal amphotericin B in the treatment of ABPA in an HIV/HBV co-infected man: Case report and literature review
Published in Journal of Asthma, 2019
Magali Garcia, Gwénaël Le Moal, Jacques Cadranel, France Roblot, Cendrine Godet
A 56-year-old HIV1/HBV co-infected Caucasian man with medical history of asthma and chronic obstructive pulmonary disease (COPD) presented with cough, increasing dyspnea, and general weakness. He had been diagnosed with HIV1/HBV positive 20 years before and treated since 1997. He had a recent CD4 count of 483 cells.mm−3 (17%) and an HIV-1 viral load <50 copies mL−1 under Highly Active Anti Retroviral Therapy (HAART) regimen (darunavir/ritonavir 600/100 mg twice a day, etravirine 200 mg twice a day). He had not been suffering from any opportunistic infection. Laboratory investigations showed an elevated peripheral blood eosinophil count (1.222 cells µL−1), total immunoglobulin (Ig)E (749 IU mL−1), specific anti-Aspergillus fumigatus IgE levels at 28.1 kU.L−1, and the presence of specific anti-A. fumigatus precipitins in the serum (two lines). A thoracic computed tomography (CT) scan revealed left apical condensation with right bronchiectasis associated with bronchocele (Figure 1A). The association of poorly controlled asthma, COPD, and clinical, biological and radiological presentations supported the diagnosis of allergic bronchopulmonary aspergillosis (ABPA).