Allergic bronchopulmonary aspergillosis is a chronic disease caused by damage to the respiratory system fungi of the genus Aspergillus, with the formation of lesions in lung tissue. Without proper treatment developed immunosuppressive condition, the probability of a lethal outcome.
Fungi of the genus Aspergillus are widely distributed in soil, air, organic dust. Found in the air of medical institutions, which contributes to the development of nosocomial infections
Allergic bronchopulmonary aspergillosis – what is it?
Allergic bronchopulmonary aspergillosis refers to infection-allergic diseases. Causes a reaction of hypersensitivity Plesneva variety of fungi of the genus Aspergillus.
Infection occurs when a decrease in immune defenses and the development of dysbiosis of the respiratory system. High risk of development of pathological process in patients with bronchial asthma, a history of cystic fibrosis and other pathologies accompanied by decreased immunity. The pathogen is not transmitted from person to person.
Factors contributing to infection:
- lowered immunity;
- heredity – in cases of asthma allergies in the family history;
- diabetes mellitus;
- treatment aggressive cytotoxic drugs;
- chronic dialysis;
- the presence of extensive burn surfaces;
- alcoholism with stable liver problems;
- long and intimate contact with the pathogen;
- pathology of the respiratory system;
- diseases of the blood;
- long-term treatment with drugs group antibiotics;
- carcinoma of the various organs and systems.
Spores get into the lung system with the inhaled air. Deposited on the mucous membrane, sprout, begin to multiply. Waste products of the fungus damage the epithelial cells of the lung and bronchus. Starts the inflammatory process of allergic nature.
In addition, the fungi of the genus Aspergillus affect all systems of the body, reducing its defenses. In severe cases, the pathogen with the flow of blood gets into all body tissues, causing severe systemic mycosis. On the background of infection develops sepsis with a high degree – more than 50% of cases – mortality.
Emit a carriage, colonization, invasion and hypersensitivity reaction on the activity of fungal flora.
Symptoms of aspergillosis
It is important
The peak of the infection falls on the autumn-winter period. The disease begins acutely with elevation of body temperature up to critical values.
Then join the following symptoms:
- chest pain;
- shortness of breath;
- expectoration of purulent sputum;
- the nature of the discharge is viscous, there is the blood;
- feeling short of breath;
- spasms and asthma;
- General weakness and drowsiness;
- weight reduction.
In the chronic course of symptoms can be blurred and appear periodically in the form of cough with slight expectoration and a feeling of lack of air. If aspergillosis is an accompanying disease to the fore the symptoms of the underlying pathology.
Diagnosis and treatment of bronchopulmonary aspergillosis do pulmonologists and an allergist. Further shown examination by an otolaryngologist to exclude infections of ENT-organs. The examination is complex and involves laboratory tests, instrumental studies, conducting allergodil.
During the diagnostic procedures necessary to exclude tuberculosis of the respiratory system, sarcoidosis, other chronic and allergic diseases of the bronchial tubes.
Diagnostics consists of the following steps:
- Review and analysis of the patient’s complaints. Special attention should be taken to the presence of a family history of asthma, a possible contact of fungal flora at work. Detected by the dullness of percussion sound and appearance of moist rales.
- Shows a General analysis of blood – determined by an increased number of eosinophils.
- The cultures to determine the causative agent.
- Sputum smear microscopy allows you to see the spores and the mycelium of the fungus.
- Run scratch tests with an extract of Aspergillus – the result is instant.
- Shown bronchography and CT images visualized on bronchiectasis, “volatile” lung infiltrates.
- Bronchoscopy and bronchoalveolar lavage to determine the presence of Aspergillus in the lavage.
- Biopsy if indicated.
The diagnosis of aspergillosis allergic nature confirmed by the determination of elevated levels of total immunoglobulin E and specific IgE and IgG to Aspergillus fumigatus in serum.
Treatment of aspergillosis long. The task is to arrest the inflammatory process, to achieve the resorption infiltration, reducing the hypersensitivity of the organism to the pathogen, the reduction or complete elimination of the fungal flora in the bronchial system.
Therapeutic tactics is:
- The acute phase within 6 months – is shown taking corticosteroids at the choice of the doctor. This files most often prescribed prednisone. In the initial stages of the disease prescribe therapeutic dosages. After the inflammation subsided, resorption of infiltrates, the normalization of the amount of antibodies in the analyses move to maintenance dosage. Duration of maintenance therapy is at least 4-6 months.
- At the second stage – remission – shown long-term use of antifungals – amphotericin of B or of Itraconazole, Itraconazole. The duration of the course is calculated individually and takes at least 4 weeks and preferably 2 months.
Popular antifungals based on flucanozole on fungi of the genus Aspergillus do not apply.
- With the development of bleeding shows a lobectomy to remove the affected part of the lung.
The duration of therapy is individual and may take from six months to 12 months.
Prophylaxis for patients with reduced immune status is in compliance with hygiene standards, processing facilities drugs-antimicotica. Should be removed from the premises flowers.
To prevent re-infection of the patient is prohibited any agricultural work, communication with animals. The optimal solution is a move in the mountainous terrain.
Sovinskaya Elena, a physician, medical columnist