Aspergillosis

Classification according to ICD-10
B44	Aspergillosis disease caused by Aspergillus fumigatus
ICD-10 online (WHO version 2019)

Aspergillosis of the lungs

Aspergillosis is an infection caused by molds of the filamentous fungus - genus Aspergillus , mostly Aspergillus fumigatus . The sites of the disease are the skin , ears , sinuses, and lungs . The latter is most commonly attacked. Metastases in the heart , kidneys and central nervous system are also rarely formed.

Forms of aspergillosis

Depending on the existing immune situation, five types are distinguished:

1. The aspergilloma . It is a conglomerate of mucus , fungal hyphae and cellular components, which in a preformed cavity, e.g. B. in an old tubercular cavern is to be found. Involvement of the paranasal sinuses , especially the maxillary sinus , is also typical . Aspergillomas usually occur when the immune system is normal.
2. Allergic bronchopulmonary aspergillosis (ABPA). This can be found in the context of a hyperergic immune situation. The cause is a type 1 hypersensitivity reaction to Aspergillus. It mainly affects patients with bronchial asthma .
3. Semi-invasive aspergillosis (necrotizing aspergillosis). It is based on a moderately restricted immune competence , e.g. B. in the context of diabetes mellitus , steroid long-term therapy or COPD .
4. Airway invasive aspergillosis (Aspergillus bronchopneumonia). It occurs in patients with severely reduced immune systems, typically in the context of AIDS or neutropenia . Aspergillus is also found here in the bronchial wall.
5. Angioinvasive aspergillosis. It occurs in patients with pronounced neutropenia <500 / µl, which is mostly the result of chemotherapy , or in the context of multiple myeloma , as well as in therapeutic immunosuppression after organ transplantation or in the context of autoimmune diseases . The small to medium-sized pulmonary arteries are affected here . Endocarditis and infections of the central nervous system can occur.

Aspergillosis was first described as pulmonary aspergillosis by Rudolf Virchow at the end of the 19th century .

Aspergillosis also occurs in animals. It is one of the leading causes of death in parrots kept as pets . A lack of breeding success in storks is often due to aspergillosis (→ aspergillosis in birds ). The sinonasal aspergillosis (SNA) is the second most common cause of chronic nasal discharge in dogs .

diagnosis

X-ray of pulmonary aspergillosis. Arrows mark the "half moon sign".

Pulmonary aspergillosis can manifest itself as an air crescent sign on X-ray and CT . (Half moon sign). The total IgE is usually increased; a specific Aspergillus IgE and specific IgG can usually be detected. The laboratory evidence of the recombinant Aspergillus allergens rAspf4 and rAspf6 is highly specific for ABPA.

treatment

The therapy is designed differently according to the types of manifestation. The allergic bronchopulmonary aspergillosis is treated with corticosteroids and allergen avoidance. Aspergillomas are surgically excised. Aspergillus pneumonia and extrapulmonary aspergillosis are treated systemically with the antimycotics amphotericin B and flucytosine . Fluconazole does not work sufficiently against aspergillus.

For the treatment of invasive aspergillosis, voriconazole or, alternatively, amphotericin B in lipid form (L-Amb) are primarily used . Secondary therapy then takes place with caspofungin , L-Amb, amphotericin B as a lipid complex (ABLC), posoconazole or voriconazole.

See also : fungicide resistance

literature

• JP Latge: Aspergillus fumigatus and aspergillosis . In: Clin. Microbiol. Rev. Vol. 12 (1999), pp. 310-350. PMID 10194462 .
• Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 281 f.

Web links

• Gardeners: Be Cautious Of These Fungal Spores

Individual evidence

1. ^ S. Abramson: The air crescent sign . In: Radiology . tape 218 , no. 1 , January 2001, p. 230-232 , PMID 11152807 .
2. ↑ Hutteger, I: The allergic-bronchopulmonary aspergillosis in cystic fibrosis in monthly. Kinderhlkde 2006, 154, p. 1003 ff.
3. ↑ Marianne Abele-Horn (2009), p. 282.

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !