Aspergillosis
Aspergillosis is a mycosis caused by certain types of mold fungi such as Aspergillus. Aspergillosis occurs with multiple chronic toxic-allergic manifestations.
The content of the article:
Classification of aspergillosis
Causes of aspergillosis
Symptoms of aspergillosis
Skin aspergillosis
Diagnosis of aspergillosis
Treatment of aspergillosis
Aspergillosis
If a person becomes ill with aspergillosis, then most often he is exposed to infection of the bronchopulmonary system and paranasal sinuses. In some cases, aspergillosis affects the skin, visual and central nervous system.
Disseminated aspergillosis may develop in the body of a patient with low immune reactivity.
Laboratory methods play a leading role in the study of aspergillosis:
detailed microscopy;
bacterial seeding;
serological reaction;
PCR;
setting up skin-allergic or inhalation tests.
Treatment of aspergillosis is carried out by the use of antifungal drugs.
Classification of aspergillosis
Depending on the ways of infection with fungi, there are several types of aspergillosis:
endogenous (autoinfection);
exogenous (airborne or alimentary transmission pathway);
transplacental (vertical pathways of infection);
Aspergillosis also differs in the localization of its pathological processes:
bronchopulmonary (including lung aspergillosis);
aspergillosis of ENT organs;
aspergillosis of the skin, eyes and bones;
septic, or generalized aspergillosis.
According to statistics, approximately 90 percent of all cases of aspergillosis are due to primary infection of the respiratory tract, as well as the lungs. About five percent — for infection of the paranasal sinuses. In addition, involvement of other human organs in the pathological process is diagnosed in almost five percent of people susceptible to infection.
Causes of aspergillosis
The causative agents of aspergillosis in the human body are some types of mold fungi Aspergikkus, which have the names:
A.flavus;
A.niger;
A.clavatus;
A.nigulans.
Aspergillus, mold fungi, have several properties:
they are aerobic and heterotrophic;
they can grow at temperatures up to 50 degrees Celsius;
they can be preserved for a long time during freezing and drying.
Under environmental conditions, aspergillus can spread almost everywhere — in water, air, soil.
The most favorable places for the spread and “prosperity” of the aspergillosis virus are:
ventilation and shower systems;
humidifiers and air conditioners;
old books and things;
damp walls and ceilings;
long-stored or spoiled food and waste;
agricultural or indoor plants.
In most cases, human infection with aspergillus occurs through inhalation routes. In other words, by inhaling dust containing mycelium of the fungus. Workers of weaving and paper-spinning enterprises, workers of agricultural facilities, millers and pigeon breeders are most at risk of infection, since pigeons are susceptible to aspergillosis.
A contact route of infection with aspergillosis is also possible through damaged skin or mucous membranes. The path of alimentary infection is not excluded in the case of human consumption of products infected with aspergillus.
Medicine has known cases of auto-infection. There is an activation of fungi located on the skin, the mucous membrane of the respiratory tract or pharynx.
Typical risk factors for aspergillosis include the following:
immunodeficiency;
chronic diseases of the respiratory system (tuberculosis, COPD, bronchial asthma, etc.);
diabetes mellitus;
burns;
dysbiosis;
the use of antibiotics, cytostatics, corticosteroids;
the use of radiation therapy.
Symptoms of aspergillosis
To date, one of the most typical forms of infection is lung aspergillosis. Any initial stages of the disease of bronchopulmonary aspergillosis in most cases are disguised as a clinic for bronchitis or tracheobronchitis.
Let’s define the main first symptoms of aspergillosis:
restless frequent cough with the release of sputum of a grayish color;
spitting blood;
weakness throughout the body;
weight loss.
If the process of aspergillosis spreads to the lungs, a pulmonary form of mycosis, otherwise called aspergillosis pneumonia, develops. In the case of the transition of the disease to the acute phase , the following signs of deterioration of the body are noted:
chills;
cough with copious discharge of purulent-mucous sputum;
chest pain;
active shortness of breath;
in the process of breathing, there is a distinct smell of mold.
Microscopic examination of sputum reveals aspergillus spores and mycelium colonies.
If we talk about infection of the human respiratory system with fungi, the following types of diseases can contribute to infection:
pulmonary fibrosis;
emphysema;
cyst;
lung abscess;
sarcoidosis;
tuberculosis;
histoplasmosis;
hypoplasia;
lung aspergilloma;
mycoses.
In case of untimely treatment, the death of a person may occur due to pulmonary hemorrhage or asphyxia.
The next type of infection is aspergillosis of ENT organs. The disease can occur as:
external or moderate otitis media;
rhinitis;
sinusitis;
pharyngitis;
tonsillitis.
In the case of aspergillosis otitis media, hyperemia, peeling and itching of the external auditory canal occur first of all. Over time, the auditory canal will begin to fill with a loose gray mass containing filaments and fungal spores.
Often there is a spread of aspergillosis to the eardrum, accompanied by sharp stabbing pains.
Ocular aspergillosis can take forms:
conjunctivitis;
ulcerative blepharitis;
nodular keratitis;
dacryocystitis, etc.
Possible complications appear in the form of ulcers in the cornea, glaucoma, vision loss.
Skin aspergillosis
This form of the disease is characterized by:
erythema;
infiltrations;
brown scales;
itching.
With the development of aspergillosis of the skin, the nail plates may partially deform or collapse, changing their usual pink color to brownish-green or dark yellow. It is also quite possible to crumble nails.
Aspergillosis of the gastrointestinal tract can occur in the body under the guise of enterocolitis or erosive gastritis. For this type of aspergillosis , the following symptoms are characteristic:
the smell of mold from the mouth;
constant nausea;
vomiting;
diarrhea.
The generalized form of aspergillosis disease develops in the case of hematogenic dissemination of bacteria from their primary focus to other organs and tissues. In the case of this form of aspergillosis , the following types of diseases occur:
aspergillosis endocarditis;
encephalitis;
meningitis;
abscess of the brain, liver and kidneys;
myocardial abscess;
defeat by aspergillosis of bones, ENT organs, gastrointestinal organs;
aspergillosis sepsis.
The lethal outcome in the septic form of aspergillosis is very high, so timely and proper treatment of the disease can save the patient from death.
Diagnosis of aspergillosis
Depending on one or another form of the course of aspergillosis, the patient is referred for consultation to specialists of the appropriate profile:
pulmonologist;
to an otolaryngologist;
mycologist;
an ophthalmologist.
During the treatment and diagnosis of aspergillosis, the greatest attention is paid to the professional history, as well as the presence or absence of chronic pulmonary pathologies or immunodeficiency. In case of suspicion of bronchopulmonary aspergillosis, a specialized lung X-ray, bronchoalveolar lavage and bronchoscopy with analysis of collected sputum are performed.
The basis for the correct diagnosis of aspergillosis is the conduct of a whole complex of laboratory studies, and the following components serve as the material for the study:
sputum;
water from the bronchi;
scrapings from nails and smooth skin;
discharge from the ear canal and sinuses of the nose;
prints of the surface of the human cornea;
cal et al .
In addition, the aspergillosis virus can be detected using a microscope, PCR, culture examination and serological reaction. It is also possible to conduct medical skin-allergic tests.
As practice shows, differential diagnosis of the disease in lung aspergillosis is carried out exclusively in the presence of inflammatory diseases of bacterial or viral etiology. Aspergillosis of nails and skin has similarities with rubromycosis, epidermophytosis, syphilis, actinomycosis and tuberculosis.
Treatment of aspergillosis
Depending on the nature and severity of the patient’s general condition, as well as the form of development of aspergillosis, treatment can take place both in outpatient and inpatient settings of the appropriate profile. As for antifungal therapy, the treatment is carried out with the following drugs:
amphotericin B;
itraconazole;
voriconazole;
caspofungin;
flucytosine.
All of the above drugs must be taken orally, intravenously or used as inhalation procedures.
If a person has aspergillosis of the skin, mucous membranes or nails, a specialist conducts local treatment of all active foci of the virus, and recommends using enzymes, antiseptics and antifungal agents as medicines. Usually antifungal therapy is carried out for one to two months, and sometimes three.
The most favorable course of the disease is observed with aspergillosis of the skin, as well as aspergillosis of the mucous membranes. It should be noted that the lethal outcome from any form of pulmonary mycosis is approximately 30 percent, and if the disease passes in a person with immunodeficiency, then almost 50 percent.
The septic form of aspergillosis has a much more unfavorable prognosis. There are preventive measures aimed at improving the sanitary and hygienic conditions surrounding any person. The list of the most popular and most effective measures includes the following:
active dust control;
wet cleaning in production;
wearing of personal protective equipment (respirators) by employees of mills, granaries or weaving enterprises;
regular improvement of ventilation conditions in warehouses and workshops;
mycological examination of all representatives from the risk group.
Thus, aspergillosis needs high-quality and timely treatment to get rid of multiple forms of mycoses and other malignant bacteria.
