PHYS 799 Lecture Notes - Lecture 52: Allergic Bronchopulmonary Aspergillosis, Chronic Granulomatous Disease, Bronchoalveolar Lavage
12 Jun 2019
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Document Summary
Aspergillus is ubiquitous environmental fungus, present in decaying organic matter (e. g. compost, soil); filamentous mold; spores (conidia) are the infectious agent. A. fumigatus is most common pathogen; also flavus, niger, terreus. Stages of infection: germination, hyphal extension, tissue invasion/destruction. Typically, aspergillus infection is limited due to immune response; pathology more likely in pts w/neutropenia, chronic granulomatous disease (impaired oxidative burst) Invasive aspergillosis in immunocompromised/neutrophil dysfunction; primary pulm infection (w/fever, respiratory symptoms); disseminated infection. Chronic, minimally invasive aspergillosis due to anatomic abnormality. Aspergilloma fungus ball in lung cavity; due to anatomic abnormality (e. g. cavities formed by lung disease) Allergic bronchopulmonary aspergillosis (abpa) primarily in asthmatics. Biopsy/culture hyphae w/regular septa and acute angle branching. Detection of galactomannan and beta-d-glucan in blood, bronchoalveolar lavage (bal) not specific to aspergillus. Radiology air crescent sign on cxr in pulmonary aspergillosis. Antifungals mold-active azoles (voriconazole, posaconazole, itraconazole), amphotericin b, echinocandins (micafungin, caspofungin) Rapidly growing hyphal molds; broad diameter, few septa; ribbon-like folding.
