Aspergillosis. Case Study
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1 Aspergillosis Fungus Ball Nadia Badar, Brandon Grant, Lauren O Bryon, Rusmieah Samad Aspergillosis is a disease of subcutaneous and deep mycoses caused by aspergillus fungus which usually affects the lungs. is a ball or aspergilloma arranged as a tangled mass of fungus fibers, blood clots, and white blood cells. Figure 1 Case Study "Rapidly Progressive Invasive Pulmonary Aspergillosis in a Diabetic Man." Journal of Infection and Chemotherapy 13 (1): June year-old man diagnosed with hyperglycemia. April 7, 2001 patient visited hospital for persistent cold. 2 days later hospital visitation indicated severe infection. Culture/ Laboratory Work Chest X-ray showed a reticular shadow CT revealed thickening of the walls of the large bronchus and diffuse bronchiolitis. Sputum culture Positive for aspergillus Tuberculin skin test was positive. Case Study Treatment First given cefotiam HCl but high fever and black sputum continued. Non-responsive to antibiotic indicated presence of fungal infection. Treated with itraconazole and Meropenem trihydrate. In addition 1mg of amphotericin B was taken daily and increased to 50mg daily.
2 Case Study Day 10 respiration status deteriorated Chest X-ray and CT showed multiple cavities. Day 25 Respiratory failure led to the patients death Autopsy weight of right lung was 1710 g ~ pounds weight of left lung was 1650g ~ pounds Healthy lungs together weigh 2.5 pounds ~ g Various Species A. fumigatus Most commonly isolated A. flaxus A. niger A. clavatus A. glaucus A. nidulans A. oryzae A. terreus A. ustus A. versicolor Etiological Agents Asperigillosis is commonly found in: Airborne dust Compost heaps Air vents Effects open spaces in the body. Lungs Ear canal Sinus Symptoms Symptoms of allergic aspergillosis may include: Fever Malaise
3 Cough Coughing up blood or brownish mucous plugs Wheezing Weight loss lung obstruction Additional symptoms Chills Headaches Shortness of breath Chest pain Increased sputum production, which may be bloody Bone pain Blood in the urine Decreased urine output Meningitis Sinusitis Endocarditis Vision problems Risk Factors Opportunistic infections Bone marrow or stem cell transplant patients are greatly affected. AIDS patients have increased risk Allergic states or cystic fibrosis 7% of people have allergic response to aspergillus mold. Lung cavities Mold spores grow in healed cavity The larger the cavity the greater chance of developing an infection. Hospital stay Patients with weakened immune system are susceptible. Low white blood count Are more susceptible to invasive aspergillosis Tests Chest x-ray CT scan Sputum stain and culture for Aspergillus Tissue biopsy Aspergillus antigen skin test Aspergillus precipitin antibody Complete blood count Histopathology No special stain is needed because grains are quite visible. Usually stained with the haematoxylin and eosin. Stain is seen in the middle of polymorphonuclear leucocytes. Periodic acid schiff and silver reveal the details of colonies showing the
4 segments on hyphae. GMS stain (figure 5) Characteristics Grains may be circular or oval in shape composed of compact hyphae with or without spores. Treatments Fungus ball May cause no symptoms Can be found by X-ray Usually requires no treatment unless coughing up blood, then surgery is needed. Invasive aspergillosis Treated within weeks of amphotericin B- an antifungal medication given by an IV. Itraconazole or voriconazole can also be used Treatments Endocarditis Can be treated by removing the infected heart valves In addition long-term amphotericin B therapy is needed. Aspergillosis of the ear Scraping out fungus and applying antifungal drugs. Allergic aspergillosis Can not be treated with Antifungal agents Treated with orally taking prednisone Complications Amphotericin B can cause kidney impairment and bad side effects. Invasive lung disease can cause substantial bleeding from the lung. Infection of sinuses can destroy facial bones. Most damaging is the spreading of the infection. Epidemiology and Ecology Noscomial infection Commonly found in the 1980 s
5 Effects immunocompromised patients References Yuko, Komase, Kunishima Hiroyuki, Hiromichi Yamaguchi, Mizuki Ikehara, Takahito Yamamoto, and Toshihito Shinagawa. "Rapidly Progressive Invasive Pulmonary Aspergillosis in a Diabetic Man." Journal of Infection and Chemotherapy 13 (1): June "Aspergillosis." MayoClinic. 3 May June 2007 <mayoclinic.com>. Smith, Scott. "Aspergillosis." MedlinePlus June 2007 < Taccetti, Giovanni, Elena Procopio, Lore Marianelli, and Silvia Campana. "Allergic Bronchopulmonary Aspergillosis in Italian Cystic Fibrosis Patients: Prevalence and Percentage of Positive Tests in the Employed Diagnostic Criteria." European Journal of Epidemiology 16 (2000): June "Aspergillosis." Dr. Fungus. 27 Jan June 2007 <
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