Aspergillosis - a cosmopolitan mycosis, it struck many species of birds and other animals. Spores of the fungus are found in various environmental objects. A person infected with aerogenic. In humans, the disease often have the professional nature of livestock, weaving, and working hlopchatoobrabatyvayuschih companies, breweries, the staff elevators and silos. Men get sick more often than women. Recorded sporadic cases and occasional outbreaks of the group. Perhaps as a result of activation of endogenous disease Aspergillus flora.
Pathogenesis and pathology of aspergillosis
Aspergillosis usually develops in individuals with reduced immune reactivity induced by concomitant diseases or the use of immunosuppressive and cytotoxic drugs, as well as genetic factors.
Getting in the diseased lung tissue, or on the surface of the skin and mucous membranes, cause the formation of Aspergillus abscesses and fistulas, emitting a thick pus. Pulmonary aspergillosis most frequently seen lesion bronchopulmonary apparatus in the form of bronchitis, pneumonia, mostly in the lower lobe, the formation of Aspergillus - cavities containing pus and draining in the bronchus, necrotizing pneumonia. Perhaps disseminirovanie process from the lungs to other organs. Histological examination reveals a focus of the outer layer, consisting of lymphocytes, plasma cells, and connective tissue elements, the middle layer, submitted zpitelioidnymi and giant cells, and an inner layer - the zone of necrosis, which is found in the filamentous mycelium of Aspergillus. Clinic for pulmonary aspergillosis
Primary pulmonary aspergillosis is rare, second - occurs in debilitated individuals, often in patients with tuberculosis or lung tumors, connective tissue, blood diseases, etc.
The most common variant of the disease - aspergilloma, tumor-localized form of aspergillosis, which is characterized by a cavity that communicated with the bronchus, and performed a mass consisting of filaments of the fungus. In the vast majority of cases occur in aspergilloma cavities sanitized tuberculosis, bronchiectasis, abscess cavities after, pulmonary infarction, etc. aspergilloma located in the upper regions of the lungs, usually on the right.
Common symptoms of the disease characterized by a gradual increase in weakness, anorexia, fever, chills, and often with great sweating. The cardinal symptom is a strong paroxysmal cough with copious sputum containing green flakes (accumulations of mycelium of the fungus) and streaks of blood. Sputum may take the form of bloody dirty liquid, odorless. Periodically, hemoptysis, sometimes significantly. In the absence of bronchopulmonary drainage, the symptoms are absent. In some patients, determined by shortness of breath, having chest pain, physical examination reveals signs of infiltrative or cavitary process in the lung.
Radiologically the secondary aspergilloma is defined beginning thickening of the wall cavity, then sekvestropodobnoe shade, surrounded by crescent-Coated - "airbag", "Corolla", "meniscus", "crescent", etc., which can be displaced when the patient's body position ( "symptom of a rattle"). When filling the cavity of contrast medium of the fungus colony can emerge ("a symptom of a float").
Primary acute pulmonary aspergillosis develops suddenly: there are painful, dry cough, shortness of breath, fever, chills. Soon joined hemoptysis. The lungs are auscultated rales of various sizes. Gradually increasing weakness, anorexia, the patient's condition progressively deteriorated. Radiographs demonstrated a tendency to infiltrate the lung tissue, abscess formation and decay with the formation of cavities increases basal nodes.
In chronic pulmonary aspergillosis hemoptysis observed during the acute process. Number of sputum gradually increases, it becomes a purulent character. During exacerbations marked deterioration, severe shortness of breath, an abrupt rise in temperature, chills and night sweats. Auscultatory defined dry and finely wheezing, percussion - a box of pulmonary tone color and dullness in the case of wall location of the lesion. Clinical and radiological picture resembles pulmonary tuberculosis.
Chronic disseminated pulmonary aspergillosis develops torpidly, with mild exacerbations, proceeds according to the type of chronic pneumonia.
The diagnosis of pulmonary aspergillosis is based on a set of clinical and instrumental signs of the disease and confirmed by the detection of mycelial filaments of the fungus in the sputum, pus, bronchial wash waters, or biopsies of the lungs and other organs and the release of a pure culture of the pathogen. Serological methods are used - RAC, TPHA, precipitin reaction. The differential diagnosis is carried out with TB, bronchiectasis, parasitic cysts, tumors of the lung.
Prevention of pulmonary aspergillosis, with activities that prevent infected material to the skin or mucous membranes.
Treatment of pulmonary aspergillosis by preparations of iodine in the form of oral potassium iodate 3-10%, or intravenous injection of sodium iodate 10% after prior desensitization autovaccine. The positive effect was obtained using nystatin, amphotericin B and its derivatives. Treatment of abscesses - surgical.
Forecast aspergillosis with timely treatment is favorable.