000 Aspergillosis Aspergillus Infection

Aspergillus Infection

Types

invasive pulmonary aspergillosis (IPA),
angioinvasive aspergillosis:
chronic pulmonary aspergillosis (CPA), and
allergic bronchopulmonary aspergillosis (ABPA).

Invasive pulmonary aspergillosis (IPA) and angioinvasive aspergillosis are related terms, and they are often used interchangeably to describe a severe form of Aspergillus infection involving the lungs. However, there is a subtle distinction between the two terms:
Invasive Pulmonary Aspergillosis (IPA): a broader term that encompasses Aspergillus infections that invade the lung tissue, causing tissue destruction and inflammation. It includes a spectrum of manifestations ranging from localized invasion to more disseminated and severe forms.

formation of nodules, infiltrates, and, in some cases, cavities within the lung tissue.

Angioinvasive Aspergillosis: is a specific subset of IPA characterized by the invasion of blood vessels by Aspergillus hyphae leading to vascular thrombosis and tissue infarction.

Structures Involved

Bronchi and Bronchioles
Blood Vessels
Alveoli
Pleura

Structural Changes

Invasive Pulmonary Aspergillosis (IPA):
- Nodules
- Infiltrates:
- Cavities
Angioinvasive aspergillosis:
Angioinvasion:
- invade and grow within blood vessels, including arteries and veins.
Vascular Thrombosis:
- tissue ischemia.
Tissue Infarction:
Dissemination:
- systemic infection.
Clinical Consequences:
- may include
  - respiratory distress,
  - organ failure, and a
  - high mortality,
    - (especially in immunocompromised individuals).
Chronic Pulmonary Aspergillosis (CPA):
- Bronchiectasis:
- Chronic Inflammation:
  - fibrosis, scarring, and
- Cavities:
  - cavitation may occur, leading to
  - cystic spaces
Allergic Bronchopulmonary Aspergillosis (ABPA):
- Bronchiectasis:
- Fungal Plugs: Mucus plugs containing Aspergillus hyphae may obstruct the airways, contributing to bronchial changes.
- Parenchymal Infiltrates:

It’s important to note that the structural changes in the lung can vary among individuals, and the severity of the changes depends on factors such as the type of Aspergillus infection, duration of infection, and the individual’s immune response. Imaging studies, such as chest X-rays or CT scans, play a crucial role in visualizing these structural changes and guiding the diagnosis and management of Aspergillus infections.

Aspergillus
Artistically rendered by Ashley Davidoff from original CDC image
TheCommonVein.net

Aspergilloma
- - Fungus ball in the lungs
  - Does not spread
  - Can be asymptomatic
Allergic Bronchopulmonary Pulmonary Aspergillosis
- - allergic response in patients with
    - asthma
    - cystic fibrosis
    - bronchiectasis
Chronic Pulmonary Aspergillosis (CPA)
- - colonize
    - cavities in the lungs,
  - aspergillomas may also be present in the lungs.
Invasive Aspergillosis including Angioinvasive Aspergillosis:
- - serious infection,
  - may be systemic
  - immunocompromised

Aspergillosis is a
- fungal infection of usually the lungs,
- caused by the
  - genus Aspergillus,
    - a common mould that is
    - breathed in
    - does not usually affect most people.
  - most commonly
    - Aspergillus fumigatus and
    - Aspergillus flavus,
- Predisposing factors
  - lung diseases such as
    - asthma,
    - cystic fibrosis
    - tuberculosis,
    - immunocompromised
      - stem cell or organ transplant,
      - steroids
      - chemotherapy
- Pathogenesis
  - acute forms
    - immunocompromised
  - chronic form
    - asthma
    - copd
    - cystic fibrosis,
    - tuberculosis
    - sarcoidosis
      - chronic pulmonary aspergillosis (CPA),
      - aspergilloma, or
      - allergic bronchopulmonary aspergillosis (ABPA).
      - or a combination
        
        eg ABPA and CPA
        
        or aspergilloma can progress to CPA.
Clinical
- Signs and symptoms
  - Aspergilloma – fungus ball in the lungs
    - chest pain
    - hemoptysis
    - cause no symptoms
    - incidental discovery on a chest X-ray, or it may cause repeated coughing up of blood, chest pain, and occasionally severe, even fatal, bleeding.[2] A rapidly invasive Aspergillus infection in the lungs often causes cough, fever, chest pain, and difficulty breathing.

Poorly controlled aspergillosis can disseminate through the blood to cause widespread organ damage.[2] Symptoms include fever, chills, shock, delirium, seizures, and blood clots. The person may develop kidney failure, liver failure (causing jaundice), and breathing difficulties.[2] Death can occur quickly.

In addition to the symptoms, an X-ray or computerised tomography (CT) scan of the infected area provides clues for making the diagnosis. Whenever possible, a doctor sends a sample of infected material to a laboratory to confirm identification of the fungus.[citation needed]

Cause[edit]
Aspergillus 235 mags 3X3 copy

Aspergillosis is caused by Aspergillus, a common mold, which tends to affect people who already have a lung disease such as cystic fibrosis or asthma, or who cannot fight infection themselves.[3] The most common causative species is Aspergillus fumigatus.[18]

Risk factors[edit]

- usually Aspergillus fumigatus
  - aspergilloma (saprophytic/noninvasive aspergillosis
  - allergic bronchopulmonary aspergillosis (ABPA)
  - invasive aspergillosis
  - subacute invasive pulmonary aspergillosis
  - Chronic Aspergillosis
  - airway invasive aspergillosis
    - (or bronchopneumonic aspergillosis)
  - angioinvasive aspergillosis
  - obstructive bronchopulmonary aspergillosisOther described groupings include 6:
    Aspergilloma