Aspergillis

Exam Cram

• Aspergillus is a fungal infection that can infects the lung causing Allergic bronchopulmonary aspergillosis (ABPA), Aspergillomas and Invasive Aspergillosis

• Allergic bronchopulmonary aspergillosis presentation: chronic wheeze in response to aspergillus lung infection

• Aspergilloma: presents haemoptysis post TB infection, CXR: dense cavitating lesion

• Invasive aspergillosis: fungal sepsis, presents with fever, unwell, pleurisy, cough/wheeze

Allergic bronchopulmonary aspergillosis (ABPA)

Assessment

History:

• Wheeze, sob, productive cough

• Occupation: farmer

Examination:

• Wheeze

Investigations:

• Blood: aspergillosis precipitants

• CXR: patchy bilateral shadowing

• Spirometry: restrictive

Diagnosis

Diagnostic criteria: clinical

Differentials

• Aspergilloma present with haemoptysis

• Invasive aspergillosis presents with fever

• EGPA: difficult as ABPA also has eosinophilia in asthma, however usually involves other body systems like kidney and neuropathies; pulmonary haemorrhage presents as obstructive

Management

Acute

1. Steroids & Itraconazole

Aspergilloma

Assessment

History:

• Weight loss, lethargy, haemoptysis

• Previous tuberculosis

Examination:

• Crackles around lesion in chest

Investigations:

• Blood: aspergillosis precipitants- IgE and IgG

• CXR: solid lesion- crescent shaped radiolucency

Diagnosis

Diagnostic criteria: chest XR, CT or biopsy

Differentials

• Tuberculosis- serum negative for aspergillosis

• Lymphoma

Management

Acute

• Monitor: watch and wait

• Medical: antifungals- itraconazole or viroconazole

• Surgery

Invasive aspergillosis

Assessment

History:

• Fevers, pleuritic chest pain, dry cough

• < 7d 

• Immunocompromised

Examination:

• Febrile, tachypnoea, tachycardiac

Investigations

• Galactomann +ve

• Aspergillus serology +ve

• Raised IgE

Diagnosis

Diagnostic criteria: symptoms + aspergillosis serology

Management

Acute

1. Voriconazole

2. Amphotericin

Resources and References

Links

• Physiology: Respiratory System, Haematopoietic-Immune

• Pathology: Infective, Allergic

Written in 2024.