Aspergillosis

Introduction to Aspergillosis According to the pathogenicity of pathogenic bacteria, it can be divided into pathogenic fungi and conditional pathogenic fungi. Pathogenic fungi are pathogenic in nature, and pathogenic fungi are low in pathogenicity and usually do not infect normal people, but normal humans are susceptible to infection after extensive exposure or immunocompromised. Aspergillosis refers to a disease caused by a pathogenic fungus that not only invades the skin, mucous membranes, but also invades tissues and internal organs. Fungi are widely distributed in nature, and certain fungi can infect humans and cause disease. Actively treat the primary and remove the cause. Patients with respiratory diseases should avoid exposure to an environment rich in Aspergillus. Wear protective masks when working in an environment contaminated with Aspergillus, such as a bird farm. basic knowledge The proportion of illness: 0.0021% Susceptible people: no specific population Mode of infection: non-infectious Complications: bronchiectasis large hemoptysis

Cause of Aspergillosis

Aspergillus infection (35%):

Aspergillus filamentous fungi, a common conditional pathogenic fungus, causes Aspergillus fumigatus and Aspergillus flavus, which are common in human diseases. Aspergillus is widely distributed in nature, with soil, air, plants, wild or poultry animals and the skin of flying birds. It is also common in farms, horse sheds, cowsheds, barns, etc. It can be parasitic on normal human skin and upper respiratory tract, which is a conditional pathogen.

Resistance decreased (42%):

Normal people have a certain resistance to Aspergillus and do not cause disease. Aspergillosis is mostly secondary. When the body's resistance is reduced, the pathogen can enter the bloodstream and inhale into the respiratory tract, and then enter the blood circulation to other tissues or organs to cause disease. Allergic system inhalation of Aspergillus spores can trigger an IgE-mediated change in response to bronchospasm.

Aspergillosis prevention

Patients with respiratory diseases should avoid exposure to an environment rich in Aspergillus. Wear protective masks when working in an environment contaminated with Aspergillus, such as a bird farm.

Aspergillosis complications Complications, bronchiectasis, hemoptysis

Complicated with bronchiectasis, massive hemoptysis, tachycardia, periosteal perforation, severe cases can be blind. Bronchiectasis and massive hemoptysis often occur during the pathological process of Aspergillus infection in the respiratory system. Tachycardia is caused by cardiovascular disease, endocardial, myocardial, and pericardial lesions, causing abnormal heart function. Sinus can progress to infected bones, bone damage, perforation of periosteum. Bluntness can result from severe aspergillosis.

Symptoms of Aspergillosis Common symptoms High fever, hemoptysis, asthma, granuloma

1. Pulmonary aspergillosis

The most common, mostly occurs on the basis of chronic lung disease. Clinical manifestations are divided into two types:

1 Aspergillus bronchus - pneumonia, a large number of Aspergillus spores caused by acute bronchitis, if the mycelium invaded the lung tissue, it caused a wide range of invasive pneumonia or localized granuloma, can also cause necrosis, suppuration, the formation of multiple small abscesses The onset of symptoms of high fever or irregular fever, cough, shortness of breath, green purulent sputum, chronic cough, hemoptysis and other similar symptoms of tuberculosis. No signs of lungs or coarse wet rales. The lungs were enlarged during X-ray examination, and diffuse patchy shadows and clumps were observed in the lungs.

2 globular pulmonary aspergillosis often occurs on the basis of chronic lung diseases such as bronchiectasis and tuberculosis. The mycelial physique regenerates and accumulates in the lung cavity and forms spherical tumors with fibrin and mucosal cells, and does not invade other lung tissues. . Most patients have asymptomatic or primary symptoms, or have fever, cough, shortness of breath, mucus and purulent sputum, which contain green particles. Because there is a rich vascular network around the microbial ball, it can be repeatedly hemoptysis. The X-ray examination of the lung shows that the Aspergillus oryzae is suspended in the cavity, forming a translucent area of the crescent, which has important diagnostic value.

2, allergic aspergillosis

Allergic system inhaled a large amount of dust containing Aspergillus spores, causing allergic rhinitis, bronchial asthma, bronchitis or degenerative pulmonary aspergillosis. Wheezing, coughing and coughing occur several hours after inhalation, which may be accompanied by fever. Most patients remission in 3-4 days, such as re-inhalation and recurrence of the above symptoms, a large number of eosinophils and hyphae can be detected in the sputum. The culture showed growth of Aspergillus fumigatus, blood eosinophilia (>1.0×10 ⁹ /L), serum IgE>1000 ng/ml.

3, systemic aspergillosis

More common in primary and secondary immunodeficiency. Aspergillus enters the blood circulation from the lung lesions and spreads to multiple organs throughout the body. Leukemia, malignant lymphoma, tumor, chronic lung disease, long-term application of antibiotics and corticosteroids are the causes of this disease. Its clinical manifestations vary with the organs invaded, and clinically, fever, systemic poisoning symptoms and embolism are the most common. Involved in the endometrium, myocardium or pericardium, causing suppuration, necrosis and granuloma, central nervous system involvement caused by meningitis and brain abscess. Digestive system and liver involvement are more common.

Examination of aspergillosis

1. Direct microscopic examination: take sputum, sputum, corneal ulcer secretions, pus, etc. for direct smear examination, visible separation of hyphae and round, dark green spores (diameter 2 ~ 3m) or chrysanthemum-like Aspergillus structure. It is clear that it is dyed with lactic acid phenol cotton blue, and its conidiophores are not colored.

2. Pathological tissue biopsy: The pus of the diseased tissue is taken for biopsy to show Aspergillus hyphae and spores.

3. Fungal culture: The blood and the above specimens were inoculated to the sand castle agar and allowed to grow rapidly at room temperature to 45 °C. Typical Aspergillus colonies are green to dark green, and the coarser conidial stalks are visible under the microscope. The apical stalks are enlarged and conidia are produced on the small stalks. Different strains can be further identified based on colony morphology and microscopic examination.

4. Imaging examination: Chest X-ray films have scattered flaky, nodular or round or oval shadows in the middle and lower parts of the common lung. It can also form voids, sometimes with irregularly distributed fine granular nodular shadows; X-rays of Aspergillus sinus balls show increased radiation density. CT and magnetic resonance examination can detect brain occupying lesions.

5. Blood examination: Eosinophils often increase, and the precipitin test is positive.

6. Skin test: The Aspergillus fumigatus antigen skin test contributes to the diagnosis of allergic aspergillosis.

Diagnosis and identification of aspergillosis

diagnosis

Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.

Differential diagnosis

Identification of allergic bronchopulmonary aspergillosis and allergic aspergillosis. Allergicbronchopulmonary aspergillosis (ABPA) is the most common and characteristic disease of allergic bronchial fungal disease, first reported in the United Kingdom in 1952. Its pathogenic Aspergillus is most commonly found in Aspergillus fumigatus, which is visible in Aspergillus oryzae, A. oryzae, and Aspergillus.

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