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Respiratory Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Ian Pavord, Nayia Petousi, Nick Talbot
Aspergillus is ubiquitous and often cultured from the sputum of people in whom it is not pathogenic. There are, however, three distinct patterns of disease: Aspergilloma: A fungal ball forms in a pre-existing lung cavity (e.g. post-TB). It is often aysmptomatic and identified incidently, but it can be associated with haemoptysis due to erosion into vascular structures. This can be massive and life-threatening.Allergic bronchopulmonary aspergillosis (ABPA): An immunological response to Aspergillus causes airway inflammation and an asthma-like illness with episodes of cough, pyrexia and malaise. Yellowish sputum and bronchial plugs may be expectorated. Repeated episodes can lead to proximal bronchiectasis, more common in the upper lobes.Invasive aspergillosis: This involves direct invasion of the fungus into the lung parenchyma. It is uncommon without significant immunocompromise or neutropenia.
Infections
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Aspergilloma is a mass of fungal hyphae growing in a lung cavity that communicates with the airways; it does not invade the lung. The aetiology of the cavity is most commonly previous TB. The condition presents with cough and haemoptysis, and the only curative treatment is to resect the cavity (see also Chapter 8).
Aspergillus spp.
Published in Rossana de Aguiar Cordeiro, Pocket Guide to Mycological Diagnosis, 2019
Reginaldo Gonçalves de Lima-Neto, Patrice Le Pape, Rejane Pereira Neves
Aspergilloma is usually a benign condition when it is present singly. It can remain stable over months, and may not produce symptoms or only produce a mild cough. But, over time, the underlying condition can worsen and possibly cause hemoptysis, wheezing, shortness of breath, and unintentional weight loss. In addition, aspergillomas can cause severe, and sometimes fatal, bleeding in the lungs (Barnes & Marr, 2006; Lee et al., 2004). However, aspergilloma does not produce many laboratory abnormalities that enable easy detection.
Apical fibrobullous lung disease in ankylosing spondylitis: case report and literature review
Published in European Clinical Respiratory Journal, 2022
Ana Catarina da Silva Alfaiate, Vera Maria Rêgo Durão, Joana Seabra Patrício, Maria Paula Pedrosa Silva Duarte
In the case report, the patient developed several lung infections by different microorganisms, namely MTC, MRSA, and AF. Anti-bacillary treatment was performed for 9 months and concluded after confirmation of negative cultures in bronchial wash. Later, voriconazole was started to treat CCPA based on clinical, laboratory, and bronchial wash findings. AFBD, especially with cavitation features, can be erroneously diagnosed as pulmonary TB, particularly in patients under or previously submitted to AS biological treatment [14]. In the reported case, the patient had been under anti-TNF-α therapy for almost 2 years after negative TB screening and was no longer under that medication at the time of first observation. However, low BMI and structural lung disease are also well-known risk factors for the development of active TB. Hemoptysis is the most frequent sign of aspergillus infection. In our medical literature review, the description of hemoptysis in patients with AS and aspergillosis was frequently encountered in the presence of aspergilloma [11,14]. In the reported case, the patient evidenced a mass-like lesion inside the LUL cavity most likely representing an aspergilloma and developed severe bleeding with massive hemoptysis.
Early diagnosis of aspergillosis in asthmatic and rheumatoid arthritis patients by Aspergillus galactomannan antigen assay: a case-control study in Karbala providence
Published in Journal of Asthma, 2022
Ali Abdul Hussein S. Al-Janabi, Roaa Noori Ali
From the results of this study, aspergillosis as indicated by GM was found higher among apparently healthy male individuals than in other patient groups. This could be illustrated by two possible explanations; the first is that individuals had an early development of aspergillosis without a specific symptom and the second is that a GM test may give a false-positive result. In general, individuals with a good immune system are often under the risk of aspergillosis. Patients with either RA or RA and asthma are more susceptible to acquired aspergillosis, especially aspergilloma or fungal ball (13). Aspergillus fumigatus was diagnosed as a causative agent of pleural aspergillosis in healthy individuals without any predisposing factors or lung pathology (14). This was also noticed with invasive aspergillosis caused by Aspergillus niger which was diagnosed in immunocompetent individuals (13). Aspergilloma is usually encouraged to develop when the inhaled fungal spore grows in lung cavities resulting from previous diseases such as TB and sarcoidosis (2). Thus, antibodies against such undetectable infections give a positive result in healthy individuals. Otherwise, ELISA for GM is more specific to detect early invasive aspergillosis with 90% sensitivity and 84% specificity (15). On the other hand, a false-positive result for the GM serological tests was recorded by many studies. These results may be associated with the presence of fungal infections with other than Aspergillus types or may relate to treatment with antibiotics (16). About 12% of invasive aspergillosis gave a false-positive for GM by ELISA (17).
Invasive Aspergillus infection of middle ear in a patient treated with secukinumab, methotrexate, and corticosteroids for psoriasis and psoriatic arthritis
Published in Journal of Dermatological Treatment, 2022
Filip Rob, Lukáš Školoudík, Viktor Chrobok, Jana Dědková, Petra Kašparová, Lucie Podrazilová
Invasive aspergillosis is an opportunistic infection most commonly seen in patients with prolonged neutropenia (e.g. immunosuppressive patients because of solid or bone marrow transplantation). Modern biologic therapies, including TNF-alpha and IL-17 inhibitors, also interfere with neutrophil function. Only sporadic cases of invasive aspergillosis have been reported with infliximab and etanercept treatment in patients with inflammatory bowel disease and rheumatoid arthritis (5). Invasive Aspergillus infection has not been reported with secukinumab or ixekizumab therapy, even in long-term safety studies lasting 5 years (3,6). With our patient, the development of this opportunistic infection could be facilitated by the current therapy with methotrexate. Like treatment with methotrexate (usually a high dose), cases of aspergillosis in transplant patients have been rarely described. If aspergillosis is suspected, an X-ray or CT scan (according to the localization) should be performed. These examinations reveal a fungal mass (aspergilloma) and characteristic signs of invasive aspergillosis. Non-culture-based tests (galactomannan or β(1,3)-glucan test) can also help diagnose the disease. A sputum examination (culture, PCR) can be used in bronchopulmonary aspergillosis, but tissue biopsy is usually necessary to confirm the diagnosis (7).