Aspergillosis prepared by nawaraj adhikari

note for bph student

1. Aspergillosis
PresentedBy:NawarajAdhikari
BPH3
rd
Batch(3
rd
Year)
RollNo:10
ChitwanMedicalCollege(CMC)

2. •Aspergillosisisthediseases/infectioncaused
byfungiofthegenusAspergillus.
•Themajorityofcasesoccurinpeoplewith
underlyingillnessessuchastuberculosisorchronic
obstructivepulmonarydisease(COPD),butwith
otherwisehealthyimmunesystems.
•Mostcommonly,aspergillosisoccursintheform
of chronic pulmonary
aspergillosis(CPA),aspergillomaorallergic
bronchopulmonaryaspergillosis(ABPA).
9/24/2016Aspergillosis / For BPH 3rd year 2

3. •Other,non-invasivemanifestationsinclude
fungalsinusitis(bothallergicinnatureandwith
establishedfungalballs),otomycosis(ear
infection),keratitis(eye infection)
andonychomycosis(nailinfection).
•Inmostinstancesthesearelesssevere,andcurable
witheffectiveantifungaltreatment.
9/24/2016Aspergillosis / For BPH 3rd year 3

4. •Peoplewithdeficientimmunesystemssuchas
patientsundergoinghematopoieticstemcell
transplantation,chemotherapyforleukemia,orAIDS
areatriskofmoredisseminateddisease.
•Acuteinvasiveaspergillosisoccurswhentheimmune
systemfailstopreventAspergillussporesfrom
enteringthebloodstreamviathelungs.
•Withoutthebodymountinganeffectiveimmune
response,fungalcellsarefreetodisseminate
throughoutthebodyandcaninfectmajororgans
suchastheheartandkidneys.
9/24/2016Aspergillosis / For BPH 3rd year 4

5. 9/24/2016Aspergillosis / For BPH 3rd year 5

6. Source of infection
Compost
Hay
Cereal
Soil
9/24/2016Aspergillosis / For BPH 3rd year 6

7. •Vector:
 None
•Vehicle:
 Air
•Incubationperiod:
3–21(days)
9/24/2016Aspergillosis / For BPH 3rd year 7

8. Agent
•Themostfrequentlyidentifiedpathogen
isAspergillusfumigatusanubiquitousorganism
thatiscapableoflivingunderextensive
environmentalstress.
•Itisestimatedthatmosthumansinhalethousands
ofAspergillussporesdaily,buttheydonotaffect
mostpeople’shealthduetoeffectiveimmune
responses.
•Takentogether,themajorchronic,invasiveand
allergicformsofaspergillosisaccountforaround
600,000deathsannuallyworldwide
9/24/2016Aspergillosis / For BPH 3rd year 8

9. Etiology
•Nextmostcommonlyisolatedspeciesinclude:
1.A.flavus
2.A.niger
3.A.clavatus
4.A.glaucus
5.A.nidulans
6.A.oryzae
7.A.terreus
8.A.ustus
9.A.versicolor
9/24/2016Aspergillosis / For BPH 3rd year 9

10. Symptoms
•Afungusballinthelungsmaycausenosymptomsandmay
bediscoveredonlywithachestX-ray,oritmaycause
repeatedcoughingupofblood,chestpain,andoccasionally
severe,even fatalbleeding. A rapidly
invasiveAspergillusinfectioninthelungsoftencausescough,
fever,chestpain,anddifficultybreathing.
•Poorlycontrolledaspergillosiscandisseminatethroughthe
bloodstreamtocausewidespreadorgandamage.Symptoms
includefever,chills,shock,delirium,seizuresandbloodclots.
Thepersonmaydevelopkidneyfailure,liver
failure(causingjaundice),andbreathingdifficulties.Death
canoccurquickly.
9/24/2016Aspergillosis / For BPH 3rd year 10

11. •Aspergillosisoftheearcanalcausesitchingand
occasionallypain.Fluiddrainingovernightfrom
theearmayleaveastainonthepillow.
Aspergillosisofthesinusescausesafeelingof
congestionandsometimespainordischarge.It
canextendbeyondthesinuses.
9/24/2016Aspergillosis / For BPH 3rd year 11

12. Epidemiology
•Aspergillosis affects people with the following:
Weakened immune system
Low white blood cell levels
Lung cavities
Long-term corticosteroid therapy
A hospital stay
Asthma and cystic fibrosis
9/24/2016Aspergillosis / For BPH 3rd year 12

13. Epidemiology Cont.
•Invasiveaspergillosisaffectspeoplewhoare
immunosuppressedsuchas:
Peoplewhohavehadbonemarrowtransplantsorsolid
organtransplants
Peoplewhoaretakinghighdosesofcorticosteroids
Peoplewhoundergochemotherapyforcancer
Peoplewhohavechronicgranulomatousdisease
PeoplewithadvancedAIDS
Leukemiapatients
Tuberculosispatients
9/24/2016Aspergillosis / For BPH 3rd year 13

14. Epidemiology Cont.
•Aspergillosisiscommonintheenvironmentandis
foundworldwide
•Mostpeoplebreatheinaspergillussporeseveryday
•Itisimpossibletocompletelyavoidbreathingin
aspergillussporesbecausetheyareubiquitous
•Peoplewithcompromisedimmunesystemswho
breatheinthesporesacquireinfections
9/24/2016Aspergillosis / For BPH 3rd year 14

15. Epidemiology Cont.
•Aspergillosisoccurs:
Soil
Air,sporesareinhaled
Food-spicesandgroundpepper
Compostanddecayingvegetation
Grainsandcrops
Fireproofingmaterials
Bedding,pillows,carpeting
Ventilationandairconditioningsystems
Dust
9/24/2016Aspergillosis / For BPH 3rd year 15

16. Burden ofaspergillosisinfections in Nepal
(2015)
•TherearefewreportsofseriousfungalinfectionsinNepal
thoughthepathogenicandallergenicfungiincluding
Aspergillusspeciesarecommonintheatmosphere.
•Itisestimated9546patients(range2673-13,364)develop
allergicbronchopulmonaryaspergillosisannually.
•Basedon26,219casesofpulmonarytuberculosis,theannual
incidenceofnewchronicpulmonaryaspergillosis(CPA)cases
wasestimatedat1678witha5yearperiodprevalenceof5289,
80%ofCPAcases.
•Of381,822adultasthmacases,itisestimated9546patients
(range2673-13,364)developallergicbronchopulmonary
aspergillosis.
9/24/2016Aspergillosis / For BPH 3rd year 16

17. Manifestations
•Respiratory
•Cranial
•Pathologic
•Clinical
•ThoracicInitialCT
9/24/2016Aspergillosis / For BPH 3rd year 17

18. Disease Spectrum
•Formsofthediseaseinvolve:
oSinuses
oLungs
oPre-existinglungcavity
oPulmonaryaspergillosis
oCNSaspergillosis
oSinonasalaspergillosis
oAllergicfungalsinusitis
oUrinarytractfungusballs
oOsteomyelitis
oEndophthalmitis
oEndocarditis
oRenalAbscesses
oCutaneous(Burns,post
surgicalwounds,IV
insertionsites)
oOtomycosis
oExogenous
endophthalmitis
9/24/2016Aspergillosis / For BPH 3rd year 18

19. Diagnosis
•ClinicalPresentations:
Fever
Cough
Dyspnea
Difficultybreathing
Coughingupblood
ChestPain
9/24/2016Aspergillosis / For BPH 3rd year 19

20. Treatment
•Treatment depends on the symptoms present
Itraconazole
Voriconazole
Surgery
AmphotercinB
9/24/2016Aspergillosis / For BPH 3rd year 20

21. Prevention
•PreventionofAspergillosisinvolvesareductionof
moldexposureviaenvironmentalinfection-control.
•Anti-fungalprophylaxiscanbegiventohigh-risk
patients.Posaconazoleisoftengivenasprophylaxis
inseverelyimmunocompromisedpatients.
9/24/2016Aspergillosis / For BPH 3rd year 21

22. •Thisdiseasecommonlyeffectspeoplewithaweak
immunesystem
Avoidmedicationsthatmayfurtherweakenthe
immunesystem.
Avoidforests,grainstores,rottingvegetation,
andpilesofdeadleaves.
Hospitalsshouldhavegoodventilation
Dustcontrol
Adequateairflowrate
9/24/2016Aspergillosis / For BPH 3rd year 22

23. Reference
•http://www.ncbi.nlm.nih.gov/pubmed/26449506
•http://www.mycology.adelaide.edu.au/
•http://www.emedicinehealth.com/slideshow_skin_problem
s/article_em.html
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