Aspergillus is one of the most prevalent fungi in the environment. Although these fungi are ubiquitous outdoors, they appear in high concentrations only in hot arid southern climates. The fungi are filamentous in presentation and are usually found in soil and decaying vegetation. They produce abundant airborne spores during dry seasons. There are over 200 species of Aspergillus; however fumigatus is the most pathogenic to humans.
Aspergillus infection is termed aspergillosis. The clinical presentation and severity of the disorder depends upon the species of Aspergillus and the physiological state of the patient. The presence of Aspergillus in sputum may represent recent inhalation of fungal spores rather than a true pathogenic process. When the immune system is suppressed due to factors such as chemotherapy, disruption of normal flora, or underlying debilitating disease; Aspergillus can invade the human body and colonize organs such as the lungs, nasal passages, and the eyes. Yeast Infections Treatment can be used to help with other fungal infections like these.
Aspergillosis may present as three distinct clinical entities— 1) non-invasive bronchial allergic form, 2) invasive or disseminated aspergillosis, and 3) aspergilloma. These may represent various degrees of fungal invasion but not necessarily progressive stages of infection.
Aspergilloma or Fungus Ball
Aspergilloma, represents a saprophytic (any organism that lives on dead organic matter, as certain fungi and bacteria).colonization of preexisting cavities in the lung. Also known as mycetomas or fungus balls, aspergillomas account for approximately 60-75% of cases of pulmonary aspergillosis and frequently require surgery. The aspergilloma lies free in the lung cavities, but can be located anywhere. Many times the fungus ball grows in a part of the lung which had a previous tuberculous infection
Course of Aspergillomas
Aspergillomas usually occur in individuals with pre-existing cavitary lung disease like:
- sarcoidosis
- pulmonary tuberculosis
- lung abscess
- bronchiectasis
- cystic fibrosis
- lung cancer
- chronic obstructive lung disease.
Medical conditions that may predispose to aspergilloma formation include diabetes mellitus, cancers, long term steroid therapy and other immunosuppressed states that increase the individual’s susceptibility to aspergilloma formation. Pulmonary tuberculosis is the most common predisposing cause of aspergillomas. Multiple aspergillomas have also been reported.
CLINICAL PRESENTATION
Individuals with aspergilloma may be asymptomatic, and many times the lung lesion is incidentally discovered by routine chest x-ray. The most common presentation is hemoptysis (coughing up of blood), occurring in 50-80% of patients, and may be alarming and life threatening.
Other less common symptoms include:
-chest pain
- fever
-a chronic productive cough (with a foul taste and odor)
- shortness of breath
- weight loss
- chills
Physical findings of failure to thrive and Blue nails (clubbing) are usually related to the underlying chronic lung disease.
Course of Aspergilloma
Occasionally an aspergilloma will experience natural breakdown and spontaneous resolution. However, most lesions remain with more than 50% giving rise to coughing up of blood (hemoptysis).
The degree of hemoptysis may vary from frequent minor and moderate episodes to a single massive hemorrhage. The risk of massive hemoptysis does not appear to be related to the size or duration of the disease process, the underlying lung disorder, or the presence of previous major episodes of hemoptysis.
Death from massive hemoptysis occurs in 5-30% and can occur in both simple and complex types of aspergillomas.
X-Rays
On a chest x-ray an aspergilloma typically appears as a round density 3-6 cm in
diameter. Changes in the position of the patient cause the density to move within the cavity.
CT scans are useful to determine the boundaries of the fungus ball within the cavity. Calcification along the edges or within the fungus ball may be visible in chronic lesions. Occasionally, an aspergilloma may present as poorly visible cavity or as empty cavities.
End Of Part 1, Part 2 soon to come.
Technorati Tags: Allergies, Aspergilloma, Aspergillus, Fungal Infection, Lung Infection, Yeast Infections Treatment