Presentation Developed By:

Katie Olenick, Jacquie Mohney

& Qazi Omair

Aspergillosis

http://agreenliving.org/tag/about-environment/

Names

• People with Aspergillosis are in three distinct groups • Healthy immune system

• Non-invasive Aspergilloma • Chronic pulmonary Aspergillosis (CPA) • Allergic bronchopulmonary Aspergillosis (ABPA) • Fungal sinusitus (Fungal ball in the sinuses) • Otomycosis (Ear infection) • Keratitus (Eye infection) • Onychomycosis (Nail infection)

Names Con’t

• Damage or nonexistent immune system • Pulmonary Aspergilloma (Lungs) • Endocarditis, Mycarditis (Heart) • Cerebral Aspergillosis (Brain) • Renal Aspergillosis (Kidney) • Odteomyelitis (Bone) • Gastrointestinal tract

• Chronic granulomatous disorder

• Genetic • 8 to 10 out of millions of people

Classification of Taxonomy

• Kingdom (Fungi) • Phylum (Ascomycota) • Class (Ascomycetes) • Order (Eurotiales) • Family (Trichocomacaea) • Genus (Aspergillus) • Species: A. fumigatus, A. flavus, A. niger, A.

nidulans, A. terreus

Aspergillus fumigatus

• Filamentous fungus

• Worldwide

• Airborne saprophytic fungi

• Causes infection

A. flavus

• Produces aflatoxin (most important known microtoxins)

• Imperfect ascomycete (does not produce ascospores- makes asexual spores)

• More common in air than A. fumigatus

A. niger

• Multi-nucleate • Normally haploid • Found in agricultural products

A. nidulans

• Ascomycetes • All are filamentous fungus • Asexual spores (Candida) • Sexual spores (Ascospores) • Develop 9 different cell types

A. terreus

• Filamentous ascomycete • Produce lateral cells termed

aleuriospores

Life Cycle

• Sarophytes

• Production of conidia (asexual spores)

• Primary route of human infection: • Inhalation

• Conidial deposition

http://cmr.asm.org/content/vol22/issue3/images/large/zcm0030922850001.jpeg

Epidemiology

• Most common in individuals with: • Asthma

• Cystic fibrosis

• Organ transplant patients

• Immunosuppressed

• Corticosteroid-induced patients

• Neutropenia

The mortality rate in some groups is ~90%

Pathogenesis

• Innate defenses

• Inflammatory

mediators

• Ex. Beta-D-

glucan

• Risk of the disease

increases with the

combination of: • Impacting proximal

events in conidial

clearance, production of

inflammation, and

killing of invasive forms

• microbial factors

impacting disease

potential http://www.longevity-and-antiaging-secrets.com/images/beta-d-glucan.jpg

•Blood Test •Called ‘aspergillus precipitin test’

•Detects antibodies to aspergillus

•Imaging •Chest x-ray or CT scan

•Lung cavity lesion or fungal ball (aspergilloma)

•Skin Test •Aspergillus Ag injected into skin

•Allergic reaction indicates circulating IgE antibodies specific for aspergillus

http://www.humenhealth.com/aspergillosis/aspergillosis.asp

Pulmonary

Aspergillosis Normal Chest X-Ray

http://www.broadwayradiology.co.nz/39.html

•Sputum microscopic analysis

•Filamentous fungus

•Branching septate hyphae with 45°angle

•Silver stains

http://www.mycology.adelaide.edu.au/Mycoses/Opportunistic/Aspergillosis/

http://www.mycology.adelaide.edu.au/Fungal_Descriptions/Hyphomycetes_(hyaline)/Aspergillus/fumigatus.html http://www.sickhousecenter.com/mold-pictures/

A. Fumigatus (left) A. Flatus (right)

•Sputum culture

•Symptoms

•Cough

•Hemoptysis

•Dyspnea

•Fever

•Weight loss

•Fatigue

http://www.sciencephoto.com/media/250290/enlarge

•Commonly found

•opportunistic infection

•AIDS

•Cancer patients

•Similar to

•lung cancer

•tuberculosis

•other lung infections

•Oral Corticosteroids •Standard treatment for allergic bronchopulmonary

aspergillosis to reduce inflammation

•Will prevent existing asthma or cystic fibrosis from worsening

•Antifungal medication •Standard treatment for invasive pulmonary

aspergillosis

•Historically has been Amphotericin B

•Newer antifungals such as itraconazole and voriconazole are now preferred

•Aspergillomas

•Surgical methods

•Bleeding aspergilloma

•Embolization

http://pathhsw5m54.ucsf.edu/case16/aspergilloma.html

http://www.njmoldinspection.com/mycoses/moldinfections.html

• Male • Weakness • Loss of bladder and

bowel control

• Spinal epidural abcess • Aspergillus fumigatus • Cauda equina syndrome

• Treatment • Surgical drainage • Voriconazole • Intraconazole

http://healthhackz.com/lower-back-pain-vital-details-about-low-back-soreness/

• Increased incidence • Preventative measures • Hedi Chaker Hospital

• Hematology

• Environmental Factors • Invasive Aspergillosis

http://www.inmagine.com/dki073/dki073003-photo

"Aspergillus/aspergillosis Website." The Aspergillus/Aspergillosis Website. Web. 10 July 2011. <http://www.aspergillus.org.uk/secure/veterinary/chap1mammalian.htm>.

Batra, Sumit, Sumit Arora, Hemant Meshram, Geetika Khanna, Shabnam B. Grover, and Vinod K. Sharma. "A Rare Etiology of Cauda Equina Syndrome." J Infect Dev Ctries 5.1 (2011): 79-82. Print.

"CDC - Aspergillosis, General Information - NCZVED." Centers for Disease Control and Prevention. 10 July 2010. Web. 8 July 2011. <http://www.cdc.gov/nczved/divisions/dfbmd/diseases/aspergillosis/>.

Dagenais, T. R. T., and N. P. Keller. "Pathogenesis of Aspergillus Fumigatus in Invasive Aspergillosis." Clinical Microbiology Reviews 22.3 (2009): 447-65. Print.

"Descriptions - Aspergillus Comparative." Broad Institute of MIT and Harvard. Web. 10 July 2011. <http://www.broadinstitute.org/annotation/genome/aspergillus_group/GenomeDescriptions.html>.

Resources Con’t "Diagnosis of Aspergillosis." The Aspergillus/Aspergillosis Website. Web. 8 July

2011. <http://www.aspergillus.org.uk/newpatients/diagnosis.php>.

Harman M.D., Eloise M. "Apergillosis." Medscape Reference. 7 June 2011. Web.

10 July 2011. <http://emedicine.medscape.com/article/296052-overview>.

"Human Aspergillosis - Home Inspection for Mold Relevant to Human Health."

Medical Mycologist Medical Toxicologist Certified Health Investigations for Mold

and Toxins for Health Investigations and Mold Testing with Full Indoor Air Quality

Analysis.NJ NY EMF Lead Radon Electromagnetic Radiation. Web. 10 July 2011.

<http://www.njmoldinspection.com/human_aspergillosis.html>.

Marr, Kieren A. "Epidemiology and Clinical Manifestations of Invasive

Aspergillosis." UpToDate Inc. Ed. Carol A. Kauffman and Anna R. Thorner. 2011.

Web. 8 July 2011. <http://www.uptodate.com/contents/epidemiology-and-

clinical-manifestations-of-invasive-aspergillosis>.

Resources Cont’d