Description, Causes and Risk Factors:
The presence of the fungus Aspergillus in the tissues or invading tissue (invasive aspergillosis) or colonizing air-containing body cavities.
Alternative Name: Aspergilloma.
Aspergillus is a fungal genus that is found in soil and decaying plant life.
Aspergillosis is caused by several Aspergillus spp , especially A fumigatus and A terreus . It is found worldwide and in almost all domestic animals and birds as well as in many wild species. It is primarily a respiratory infection that may become generalized; however, tissue predilection varies among species. The most common forms are pulmonary infections in poultry and other birds, mycotic abortion in cattle, guttural pouch mycosis in horses, and infections of the nasal and paranasal tissues, intervertebral sites, and kidneys of dogs. Pulmonary and intestinal forms have been described in domestic cats.
Aspergillosis is somewhat rare with HIV. It is more common in cancer patients receiving chemotherapy and in transplant patients receiving immunosuppressive therapy. Most commonly, aspergillosis affects the lungs and sinus.
Symptoms include cough, chest pain, shortness of breath, facial pain, fever, and night sweat.
Tentative diagnosis can be made with clinical signs along with the absence of bacterial infection. A blood test showing an elevation in white blood cell count, mild anemia, and an elevation in the monocytes also supports this diagnosis. X-rays can be taken on any suspect patient. A radiograph can reveal densities or nodules consistent with aspergillomas. Samples of the fungus can also be taken, and cultured in specially prepared culture media. Caution - Apergillus is a common environmental contaminant. PCR and sequence assays to identify the presence of Aspergillus and identify specific strains.
Treatment is with antifungal drugs such as voriconazole, caspofungin, itraconazole or amphotericin B. Voriconazole is usually better than amphotericin B. Some other drugs used for the treatment of tuberculosis or epilepsy reduce the blood levels of voriconazole. Voriconazole can be given orally or intravenously. It is better than amphotericin B, but may require dose modification to maximise success, especially in children, those with liver disease or cirrhosis and possibly the elderly.
Caspofungin can only be given intravenously, and is also partially effective. It has been used as rescue therapy and in combination with other antifungals, with reasonable success.
Amphotericin B has to be given by vein in large doses. In some patients the treatment can damage the kidney and other organs. Newer forms of amphotericin B (Amphotec or Amphocil, Abelcet or AmBisome) are useful, especially when the patient experiences side-effects, as they usually cause fewer side effects, especially less renal dysfunction.
Itraconazole is generally given orally (also in large doses, e.g. at least 400 mg daily), although an intravenous preparation is available now. Itraconazole is often used for follow on therapy.
The earlier treatment is started the better the chances of survival. In patients with low numbers of white cells (infection fighters), recovery of these cells can be important in stopping the growth of the fungus. Sometimes surgery is also required. Overall, a third to a half of patients survive invasive aspergillosis if treated and none survive if they are not treated.
All these conditions can affect children and should be diagnosed and treated in the same way.
A lot of encouraging research is being done at the moment to speed up diagnosis of this invasive aspergillosis and to improve its treatment. Some new antifungal drugs (posaconazole, micafungin and anidulafungin in particular) are in clinical trials at present.
Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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