Chap 188 -- Aspergillosis

CHAPTER 188 ASPERGILLOSIS -fumigatus- most common cause of aspergillosis -invasion of lung tissue- only in immunocompromised px a) granulocyte <500/ul b) supraphysiologic doses of adrenal Glucocorticoids c) hx tx of cyclosporine -acute, diffuse, self limited pneumonitis -balls of hayphae “aspergilloma” 1) Allergic bronchopulmonary aspergillosis - px w/ preexisting asthma/cystic fibrosis 2) Endobronchial saprophytic pulm. Aspergilloma -chronic productive cough w/ hemoptysis 3) Invasive Aspergillosis -acute, rapidly progressive densely consolidated pulm. Infiltrates --most common among px w/ acute leukemia or tissue transplant -“halo sign’ – edema/hemorrhage -“crescent sign”-cavitation of central core 4) Aspergillus sinusitis a) ball of hyphae in obstructyed paranasl sinus w/o tissue invasion b) chronic fibrosing granulomatous inflammation c) allergic fungal sinusitis 5) Otomycosis -growth on cerumen and detritus w/in the external auditory meatus Dx: sputum /bronchoalveolar lavage x-ray: fungus ball Biopsy-for invasive aspergillosis of lung, paranasal sinuses, bronchi, (+) glactomannan antigen- suggestive only TX: Lobectomy- hemptysis of fungus ball Bead embolization- a temorizing measure Short course adrenal glucocorticoid -Amphotericin B