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Questions and Answers
What is the primary causative factor for allergic bronchopulmonary aspergillosis?
What is the primary causative factor for allergic bronchopulmonary aspergillosis?
What percentage range represents the prevalence of ABPA in patients with cystic fibrosis?
What percentage range represents the prevalence of ABPA in patients with cystic fibrosis?
What is the suggested management for allergic bronchopulmonary aspergillosis?
What is the suggested management for allergic bronchopulmonary aspergillosis?
Which of the following best describes the term 'mycosis'?
Which of the following best describes the term 'mycosis'?
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Chronic pulmonary aspergillosis includes which of the following conditions?
Chronic pulmonary aspergillosis includes which of the following conditions?
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What is a common initial clinical feature of allergic bronchopulmonary aspergillosis?
What is a common initial clinical feature of allergic bronchopulmonary aspergillosis?
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Which treatment may reduce the required dosage of oral glucocorticoids in ABPA management?
Which treatment may reduce the required dosage of oral glucocorticoids in ABPA management?
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What is a potential complication of allergic bronchopulmonary aspergillosis in patients with asthma?
What is a potential complication of allergic bronchopulmonary aspergillosis in patients with asthma?
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Which of the following is NOT a characteristic of chronic pulmonary aspergillosis?
Which of the following is NOT a characteristic of chronic pulmonary aspergillosis?
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What role do human leucocyte antigens (HLAs) play in allergic bronchopulmonary aspergillosis?
What role do human leucocyte antigens (HLAs) play in allergic bronchopulmonary aspergillosis?
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Which statement about the treatment of simple aspergillomas is correct?
Which statement about the treatment of simple aspergillomas is correct?
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What is a common finding in sputum microscopy for patients with simple aspergillomas?
What is a common finding in sputum microscopy for patients with simple aspergillomas?
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Which clinical feature is indicative of acute invasive pulmonary aspergillosis (IPA)?
Which clinical feature is indicative of acute invasive pulmonary aspergillosis (IPA)?
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What radiological feature is classically associated with early invasive pulmonary aspergillosis?
What radiological feature is classically associated with early invasive pulmonary aspergillosis?
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In patients with simple aspergillomas, what is the expected result for skin hypersensitivity testing?
In patients with simple aspergillomas, what is the expected result for skin hypersensitivity testing?
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What role do antifungals play in the treatment of patients with multiple mycetomas?
What role do antifungals play in the treatment of patients with multiple mycetomas?
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What possible systemic complication may arise from invasive pulmonary aspergillosis?
What possible systemic complication may arise from invasive pulmonary aspergillosis?
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Which of the following best describes the progression of simple aspergillomas?
Which of the following best describes the progression of simple aspergillomas?
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What symptom should raise suspicion for acute IPA in an immunocompromised patient?
What symptom should raise suspicion for acute IPA in an immunocompromised patient?
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What is the characteristic finding on imaging for patients developing a fungal ball due to aspergillosis?
What is the characteristic finding on imaging for patients developing a fungal ball due to aspergillosis?
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Study Notes
Respiratory Diseases Caused by Fungi
- Fungi are often harmless saprophytes, but some species can cause disease by infecting tissues, producing toxins, or inducing allergic responses.
- Mycosis is the term for fungal infections.
- Pulmonary fungal diseases are influenced by systemic and local factors.
Factors Predisposing to Pulmonary Fungal Disease
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Systemic factors:
- Haematological malignancies
- HIV
- Diabetes mellitus
- Chronic alcoholism
- Radiotherapy
- Glucocorticoids, cytotoxic chemotherapy, biologic therapies and other immunosuppressant medications
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Local factors:
- Tissue damage from suppuration or necrosis
- Alteration of normal bacterial flora by antibiotic therapy
Classification of Bronchopulmonary Aspergillosis
- Allergic bronchopulmonary aspergillosis (ABPA): a hypersensitivity reaction to germinating fungal spores in the airway, potentially complicating asthma and cystic fibrosis.
- Approximately 1-2% of asthmatics, and 5-10% of cystic fibrosis patients are affected.
- Genetic predisposition (various human leukocyte antigens) plays a significant role.
Allergic Bronchopulmonary Aspergillosis (ABPA)
- ABPA results from hypersensitivity to germinating fungal spores in the airway wall.
- It can complicate conditions such as asthma and cystic fibrosis.
- It's a recognised cause of pulmonary eosinophilia.
Clinical Features of ABPA
- Fever, breathlessness, cough (productive of bronchial casts), and worsening asthmatic symptoms are common early presentations.
- Early diagnosis can be challenging, as radiographic infiltrates may mimic pneumonia. Chest X-rays sometimes show segmental or lobar collapse in patients with stable asthma symptoms.
- Regular therapy with low-dose oral glucocorticoids (prednisolone 7.5-10 mg/day) is typically used to control the disease and prevent progressive tissue damage.
Features of Allergic Bronchopulmonary Aspergillosis (ABPA)
- Asthma (in most cases)
- Proximal bronchiectasis
- Positive skin test to extracts of Aspergillus fumigatus
- Elevated total serum IgE
- Elevated Aspergillus-specific IgE or IgG
- Peripheral blood eosinophilia
- Chest X-ray abnormalities
- Recovery of Aspergillus fumigatus from sputum
Chronic Pulmonary Aspergillosis (CPA)
- Includes various forms such as simple aspergilloma, chronic cavitary pulmonary aspergillosis, chronic fibrosing pulmonary aspergillosis, and Aspergillus nodules.
- These conditions are relatively uncommon and challenging to treat and diagnose.
Simple Aspergilloma
- Cavities formed by previous diseases (such as TB) or damaged bronchi offer favorable environments for inhaled Aspergillus to lodge and grow.
- CT scans often reveal irregular mucosal walls, which eventually collapse to form a fungal ball.
Invasive Pulmonary Aspergillosis (IPA)
- IPA is often a complication of profound neutropenia, frequently caused by immunosuppressive drugs and/or diseases.
- It can lead to severe necrotising pneumonia.
- Involvement of pulmonary vessels can cause thrombosis and infarction; systemic spread may occur to the brain, heart, and other organs.
- Tracheobronchial aspergillosis may result in fungal plaques and ulceration formation.
Risk Factors for Invasive Pulmonary Aspergillosis
- Neutropenia: duration and severity of the condition is crucial
- Solid organ or allogeneic stem cell transplant
- Long-term, high-dose glucocorticoid therapy
- Leukaemia and other haematological malignancies
- Cytotoxic chemotherapy
- Advanced HIV disease
- Severe chronic obstructive pulmonary disease
- Critically ill patients on intensive care units
- Chronic granulomatous disease
Diagnosing IPA
- HRCT scans often show characteristic macronodules which may have a 'halo' of reduced attenuation.
- Aspergillus detection in blood/BAL fluid or tissues, and culture or histology.
- Galactomannan, beta-1,3-D-glucan, and Aspergillus DNA blood tests help diagnosis.
Management of IPA
- Voriconazole is the drug of choice.
- Second-line agents include liposomal amphotericin, caspofungin, posaconazole, and isavuconazole.
- Early diagnosis and aggressive treatment are vital to reduce mortality risks.
- High-efficiency particulate air (HEPA) filter rooms, laminar air flow rooms, and personal protective equipment should be utilized to control the spread of Aspergillus.
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Description
Explore the various respiratory diseases triggered by fungal infections. This quiz delves into the factors that predispose individuals to pulmonary fungal diseases, including systemic and local influences. Gain insights into specific conditions like allergic bronchopulmonary aspergillosis and its implications.
