21.10.2020

Treatment of bronchopulmonary aspergillosis

The main directions of treatment of aspergillosis with lesions of the bronchopulmonary system are anti-inflammatory therapy, a decrease in body sensitization, and a decrease in the activity of aspergillus.

In the acute period of the disease, systemic glucocorticosteroid hormones are prescribed for at least six months (the drug of choice is prednisone). The use of glucocorticosteroids begins in therapeutic dosages and continues until the complete resorption of infiltrates and the normalization of antibody titers, after which they switch to a maintenance dose for another 4-6 months.

After complete relief of the inflammatory process, that is, in the remission stage, antifungal therapy with amphotericin B or traconazole is started for 4-8 weeks.

Allergic bronchopulmonary aspergillosis is an infectious-allergic mold mycosis caused by Aspergillus fungi (usually Aspergillus fumigatus) and manifested by the development of respiratory dysbacteriosis, allergic inflammation of the bronchial mucosa and subsequent pulmonary fibrosis. The disease occurs mainly in patients with atopic bronchial asthma (90% of all cases of aspergillosis), as well as in cystic fibrosis and in persons with weakened immunity.

The disease was first identified and described in the UK in 1952 among patients with bronchial asthma, who had a prolonged rise in body temperature. Currently, allergic bronchopulmonary aspergillosis is more common in people aged 20 to 40 years and is diagnosed in 1-2% of patients with bronchial asthma. The defeat of the respiratory tract with Aspergillus fungi poses a particular danger to persons with congenital and acquired immunodeficiency.

Causes of allergic bronchopulmonary aspergillosis

The causative agent of allergic bronchopulmonary aspergillosis is yeast-like fungi of the genus Aspergillus. In total, about 300 representatives of these microorganisms are known, 15 of which can cause the development of infectious-allergic inflammation when inhaled. In the vast majority of cases, mold mycosis in the bronchi occurs when Aspergillus fumigatus penetrates.

Aspergillis are widespread everywhere; fungal spores are in the air both in summer and in winter. Favorite habitat of these microorganisms – wet, wetlands, soil rich in organic fertilizer, squares and parks with fallen leaves, residential and non-residential premises with high humidity (bathrooms, bathrooms, basements in old houses), the land of indoor plants, cells birds air conditioners.

The main risk factors that facilitate the development of allergic bronchopulmonary aspergillosis are hereditary predisposition (the presence of bronchial asthma and other allergic diseases in relatives), prolonged contact with aspergilli (work on the garden, livestock farms, flour mills), reduction of the body’s defenses immunodeficiency, chronic diseases of the bronchopulmonary system, blood diseases, malignant neoplasms, etc.).

The spores of Aspergillus fungi during inhalation enter the respiratory tract, settle on the mucous membrane of the bronchi, germinate and begin to live. When this occurs, the release of proteolytic enzymes that damage the cells of the bronchial epithelium. The reaction of the immune system to Aspergillin antigens causes the formation of allergy mediators, the synthesis of immunoglobulins E, A and G, the development of an inflammatory process of an allergic nature in the bronchi.

Symptoms of allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis in most cases develops in patients with atopic bronchial asthma, most often in autumn and spring, that is, in cold, wet weather. The disease begins acutely, with chills, fever up to 38-39 degrees, the appearance of chest pain, cough with mucopuric sputum, hemoptysis. At the same time, symptoms of bronchial asthma (feeling of lack of air, repeated attacks of suffocation) become more pronounced.

There are signs of intoxication: general weakness, drowsiness, pale skin, lack of appetite, weight loss, long-term maintenance of low-grade fever, etc.

In the chronic course of allergic bronchopulmonary aspergillosis, the manifestations of the disease can be erased – without signs of intoxication, with a periodic cough with mucous sputum, which can have brownish inclusions, slight shortness of breath during physical exertion, a feeling of lack of air.

If aspergillosis proceeds against the background of immunodeficiency, the clinical picture will present symptoms of the underlying disease (acute leukemia, pulmonary tuberculosis, sarcoidosis, obstructive pulmonary disease, malignant neoplasm of a specific localization).

Diagnosis of allergic bronchopulmonary aspergillosis

The diagnosis of allergic bronchopulmonary aspergillosis is established by an allergistimmunologist and pulmonologist on the basis of a study of the anamnesis, the clinical picture of the disease, laboratory and instrumental studies, allergological tests:

  • Conversation and inspection . Anamnesis of the disease may indicate a hereditary burden of allergic diseases, the presence of atopic asthma in a patient, periodic or prolonged contact with aspergilli in everyday life or in the process of professional activity. Physical examination in about half of patients with allergic broncho-pulmonary aspergillosis is determined by dulling the percussion sound in the upper parts of the lungs and listening to auscultation of moist fine bubbling rales, as well as signs of a general state of dyspnea, pallor of the skin, sweating, subfebrilitet or hyperthermia.
  • Laboratory diagnostic tests . When a laboratory study in the peripheral blood is determined by eosinophilia (more than 20%), sometimes there is leukocytosis and increased ESR. The cytological analysis of sputum revealed the predominance of eosinophils, sputum microscopy can determine the elements of the mycelium Aspergillus. Bacteriological examination of sputum allows to identify the culture of Aspergillus fumigatus with the growth of fungi on nutrient media.
  • Allergological examination . Allergic skin tests are carried out with an extract of aspergillus (a typical reaction of the immediate type is detected). The diagnosis of allergic bronchopulmonary aspergillosis is confirmed when determining elevated levels of total immunoglobulin E and specific IgE and IgG to Aspergillus fumigatus in serum.
  • X-ray diagnostics . During bronchography and computed tomography, proximal bronchiectasis, “volatile” infiltrates in the lungs are detected.

Differential diagnosis of allergic bronchopulmonary aspergillosis is performed with pulmonary tuberculosis, sarcoidosis, chronic obstructive pulmonary disease, eosinophilic pulmonary lesions of a different etiology.

Forecast and prevention of allergic bronchopulmonary aspergillosis

The prognosis depends on the frequency and severity of exacerbations of aspergillosis, the accompanying background. With frequent exacerbations and the presence of other diseases in the history, the quality of life suffers significantly. Prevention of primary invasion allows compliance with the rules of precaution when carrying out agricultural work.

First of all, this concerns persons with asthma and immunodeficiency disorders. For the prevention of recurrence of allergic bronchopulmonary aspergillosis, it is necessary to ensure the maximum reduction in contact with aspergillus, and, if possible, move to a highland area with a dry climate.

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