Aspergillosis

Aspergillosis is a disease caused by fungi of the genus Aspergillus with frequent localization in the bronchopulmonary system.

Etiology, pathogenesis. Aspergillus is a widespread saprophyte in nature that produces spores year-round. The disease is caused by inhalation of large quantities of Aspergillus spores, for example when working with moldy rotting hay or compost. In pathogenesis, in addition to the allergenic and hemolytic effects of endotoxin, a major role is played by a decrease in the body’s reactivity in chronic diseases (tuberculosis, suppuration, neoplasms, systemic blood diseases, alcoholism, HIV infection, etc.) or with long-term use of glucocorticoids and cytostatics.

Symptoms, course. Allergic bronchopulmonary aspergillosis occurs in healthy individuals with an initially unchanged immunological status. Characterized by fever, bronchospasm; sputum may have a brown tint, sometimes casts of the bronchi are coughed up; The examination reveals transient pulmonary infiltrates, proximal bronchiectasis, peripheral blood eosinophilia, and increased levels of class E immunoglobulins.

The course can be long-term with repeated exacerbations and the development of severe bronchial asthma; in some cases recovery occurs. Endobronchial pulmonary aspergillosis is characterized by a productive cough, often by hemoptysis. Aspergilloma (colonies of fungal mycelium, freely lying in a tuberculous cavity, in an abscess cavity, bronchiectasis, an area of ​​slowly resolving pneumonia, pulmonary infarction, in the area of ​​a tumor) can be asymptomatic, but cough with odorless sputum, hemoptysis, weight loss are more often observed (up to cachexia), high fever, chest pain, progressive deterioration of the condition.

Aspergillus pneumonia (single or multiple lesions in the middle and lower parts of both lungs) with frequent cavities is observed more often in patients with immunodeficiency. Diagnosis uses data from X-ray examination, sputum culture, and serological methods.

Treatment. Etiotropic therapy for aspergillosis involves the use of fungicidal agents. Amphotericin B is effective. The daily dose (250 units/kg) is administered in 450 ml of a 5% solution of sterile glucose intravenously for 4-6 hours every other day or 2 times a week for 4-8 weeks; inhalation of 50,000 units of amphotericin B in 10 ml of water for injection is carried out 1-2 times a day for 10-14 days.

Amphotericin B has the ability to accumulate and is neuro-, nephro- and hepatotoxic. In the absence of severe immunodeficiency, itraconazole (orungal) 200 mg 2 times a day is also used. For allergic bronchopulmonary aspergillosis, glucocorticoids are used.

The dose of prednisolone in the acute stage or during exacerbation of the disease is 0.5 mg/kg daily until the pulmonary infiltrates disappear. Then, for 3 months, the patient takes 0.5 mg/kg of prednisolone every other day; over the next 3 months, the dose of the drug is gradually reduced until it is completely discontinued. The use of fungicidal drugs (amphotericin B, itraconazole) is possible only in the remission stage, since massive death of the fungus can aggravate the condition of patients.

Surgical treatment is carried out for abscessing aspergillus pneumonia, aspergillomas with severe hemoptysis.

Aspergilosis is one of the most dangerous diseases caused by mold fungi of the genus Aspergillus, which affects the lungs of people with weakened immune systems and poses a threat to life. For this article, I use the information and background on this topic provided on the Samuel Hospital website (http://www.samuelshospital.org/infectious