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Aspergillosis
Presented By : Nawaraj Adhikari
BPH 3rd Batch (3rd Year)
Roll No: 10
Chitwan Medical College(CMC)
• Aspergillosis is the diseases / infection causedby fungi of the genus Aspergillus.
• The majority of cases occur in people withunderlying illnesses such as tuberculosis or chronicobstructive pulmonary disease (COPD), but withotherwise healthy immune systems.
• Most commonly, aspergillosis occurs in the formof chronic pulmonaryaspergillosis (CPA),aspergilloma or allergicbronchopulmonary aspergillosis (ABPA).
9/24/2016Aspergillosis / For BPH 3rd year 2
• Other, non-invasive manifestations include
fungal sinusitis (both allergic in nature and with
established fungal balls), otomycosis (ear
infection), keratitis (eye infection)
and onychomycosis (nail infection).
• In most instances these are less severe, and curable
with effective antifungal treatment.
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• People with deficient immune systems such aspatients undergoing hematopoietic stem celltransplantation, chemotherapy for leukemia, or AIDSare at risk of more disseminated disease.
• Acute invasive aspergillosis occurs when the immunesystem fails to prevent Aspergillus spores fromentering the bloodstream via the lungs.
• Without the body mounting an effective immuneresponse, fungal cells are free to disseminatethroughout the body and can infect major organssuch as the heart and kidneys.
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Source of infection
Compost
Hay
Cereal
Soil
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• Vector:
None
• Vehicle:
Air
• Incubation period:
3 – 21 ( days)
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Agent• The most frequently identified pathogen
is Aspergillus fumigatus an ubiquitous organism
that is capable of living under extensive
environmental stress.
• It is estimated that most humans inhale thousands
of Aspergillus spores daily, but they do not affect
most people’s health due to effective immune
responses.
• Taken together, the major chronic, invasive and
allergic forms of aspergillosis account for around
600,000 deaths annually worldwide
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Etiology
• Next most commonly isolated species include:
1. A. flavus
2. A. niger
3. A. clavatus
4. A. glaucus
5. A. nidulans
6. A. oryzae
7. A. terreus
8. A. ustus
9. A. versicolor9/24/2016Aspergillosis / For BPH 3rd year 9
Symptoms• A fungus ball in the lungs may cause no symptoms and may
be discovered only with a chest X-ray, or it may cause
repeated coughing up of blood, chest pain, and occasionally
severe, even fatal bleeding. 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 stream to cause widespread organ damage. Symptoms
include fever, chills, shock, delirium, seizures and blood clots.
The person may develop kidney failure, liver
failure (causing jaundice), and breathing difficulties. Death
can occur quickly.
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• Aspergillosis of the ear canal causes itching and
occasionally pain. Fluid draining overnight from
the ear may leave a stain on the pillow.
Aspergillosis of the sinuses causes a feeling of
congestion and sometimes pain or discharge. It
can extend beyond the sinuses.
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Epidemiology
• Aspergillosis affects people with the following:
Weakened immune system
Low white blood cell levels
Lung cavities
Long-term corticosteroid therapy
A hospital stay
Asthma and cystic fibrosis
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Epidemiology Cont.
• Invasive aspergillosis affects people who are
immunosuppressed such as:
People who have had bone marrow transplants or solid
organ transplants
People who are taking high doses of corticosteroids
People who undergo chemotherapy for cancer
People who have chronic granulomatous disease
People with advanced AIDS
Leukemia patients
Tuberculosis patients9/24/2016Aspergillosis / For BPH 3rd year 13
Epidemiology Cont.
• Aspergillosis is common in the environment and is
found worldwide
• Most people breathe in aspergillus spores everyday
• It is impossible to completely avoid breathing in
aspergillus spores because they are ubiquitous
• People with compromised immune systems who
breathe in the spores acquire infections
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Epidemiology Cont.
• Aspergillosis occurs:
Soil
Air, spores are inhaled
Food-spices and ground pepper
Compost and decaying vegetation
Grains and crops
Fire proofing materials
Bedding, pillows, carpeting
Ventilation and air conditioning systems
Dust
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Burden of aspergillosis infections in Nepal
(2015)• There are few reports of serious fungal infections in Nepal
though the pathogenic and allergenic fungi including
Aspergillus species are common in the atmosphere.
• It is estimated 9546 patients (range 2673-13,364) develop
allergic bronchopulmonary aspergillosis annually.
• Based on 26,219 cases of pulmonary tuberculosis, the annual
incidence of new chronic pulmonary aspergillosis (CPA) cases
was estimated at 1678 with a 5 year period prevalence of 5289,
80% of CPA cases.
• Of 381,822 adult asthma cases, it is estimated 9546 patients
(range 2673-13,364) develop allergic bronchopulmonary
aspergillosis.9/24/2016Aspergillosis / For BPH 3rd year 16
Manifestations
• Respiratory
• Cranial
• Pathologic
• Clinical
• Thoracic Initial CT
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Disease Spectrum
• Forms of the disease involve:
oSinuses
oLungs
oPre-existing lung cavity
oPulmonary aspergillosis
oCNS aspergillosis
oSinonasal aspergillosis
oAllergic fungal sinusitis
o Urinary tract fungus balls
oOsteomyelitis
oEndophthalmitis
oEndocarditis
oRenal Abscesses
oCutaneous (Burns, post
surgical wounds, IV
insertion sites)
oOtomycosis
o Exogenous
endophthalmitis
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Diagnosis
• Clinical Presentations:
Fever
Cough
Dyspnea
Difficulty breathing
Coughing up blood
Chest Pain
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Treatment
• Treatment depends on the symptoms present
Itraconazole
Voriconazole
Surgery
Amphotercin B
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Prevention
• Prevention of Aspergillosis involves a reduction of
mold exposure via environmental infection-control.
• Anti-fungal prophylaxis can be given to high-risk
patients. Posaconazole is often given as prophylaxis
in severely immunocompromised patients.
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• This disease commonly effects people with a weak
immune system
Avoid medications that may further weaken the
immune system.
Avoid forests, grain stores, rotting vegetation,
and piles of dead leaves.
Hospitals should have good ventilation
Dust control
Adequate air flow rate
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Reference
• http://www.ncbi.nlm.nih.gov/pubmed/26449506
• http://www.mycology.adelaide.edu.au/
• http://www.emedicinehealth.com/slideshow_skin_problem
s/article_em.html
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