How to treat pulmonary aspergillosis. Pulmonary aspergillosis: symptoms, diagnosis, treatment

Aspergillosis is a human disease caused by individual species molds from the genus Aspergillus, which manifests itself after involvement of the respiratory system due to allergic changes or destructive infectious process. Aspergillosis is the most common pulmonary mycosis; aspergillus itself is found everywhere. For example, they are isolated from air, soil, distilled water and sulfur sources.

Symptoms of aspergillosis

Today, there are four main forms of bronchopulmonary aspergillosis. For example, light form The disease proceeds as usual, rapidly transient acute tracheobronchitis. If it is allergic bronchial aspergillosis, then it is characterized by transient pulmonary infiltrates, fever, eosinophilia, and bronchospasm. There is sputum that has brown tint, and sometimes casts of the bronchi cough up. The course of the disease itself can be long-term with repeated exacerbations, as well as the development of very severe bronchial asthma. And in some cases, recovery occurs.

If the disease is caused by a type of aspergilloma fungus, the disease may be asymptomatic, but in most cases there is a cough and the production of odorless sputum. In addition, the patient may have hemoptysis, weight loss, very high temperature, severe chest pain and a sharply progressive deterioration in health. If this necrotic form pulmonary aspergillosis, it occurs with quite severe intoxication and fever.

Treatment of aspergillosis

Treatment of this disease, regardless of the type of infection, is a very labor-intensive task. After all, chemotherapy and various antibacterial agents usually do not lead to the expected effect. Others do not help in treatment known to doctors today's methods of combating various infectious diseases. And for this reason in lately When aspergillosis is diagnosed, treatment is carried out using surgical methods. For example, patients undergo a lobectomy with resection of certain affected organs. And if the operation was performed by a competent specialist who followed all established procedures, then the patient tolerates such an intervention without complications and the operation gives good forecasts for the future.

If a person has an advanced form of aspergillosis, then in this case surgical treatment is used using conservative treatment methods. For example, the patient is prescribed amphotericin B, nystatin, oxacillin, erythromycin and antibiotics from the tetracycline group. Plus, the patient takes vitamins for general strengthening treatment. If antifungal drugs are used, the total number of antibodies in a person’s blood increases sharply, but by the end of treatment their number returns to normal. When pulmonary aspergillosis has led to lesions of the skin or mucous membranes, the patient is recommended antimycotic or anti-inflammatory drugs.

Pulmonary aspergillosis

Pulmonary aspergillosis is a very serious diagnosis. Since, due to the development of the disease caused by the mold fungi Aspergillus, aspergillomas begin to form in the human lungs, that is, tumor-like formations that consist of tightly woven fungi. There are also complications such as endocarditis, aspergillus pleurisy, otitis, meningoencephalitis and others. However, at any time, aspergilloma can cause formidable complication- This pulmonary hemorrhage, which can be massive and profuse. And in this case, there is no alternative to surgical treatment. Treatment of aspergillosis conservative methods possibly due to fungal infections of the mucous membranes or skin.

Allergic aspergillosis

Allergic bronchopulmonary aspergillosis is allergic disease lungs, which is very similar to pneumonia. It is characterized by inflammation respiratory tract, lungs, asthma and an increase in the number of eosinophils in the blood.

Calls allergic aspergillosis The body's reaction to mushrooms is the fungus Aspergillus.

Aspergillus is a fungus that reproduces and lives in soil, food, rotting plants, water and dust. If ingested by humans, allergic asthma and increased sensitivity. And other people may have a very complex allergic reaction in their airways and lungs.

And although this fungus practically does not enter the human lungs and does not destroy lung tissue, it usually multiplies in the mucous membrane of the patient’s respiratory tract, and therefore causes recurrent allergic inflammation in the lungs themselves.

As a result, the tiny air bubbles in the lungs become filled with eosinophils. The number of mucus-producing cells may also increase. In advanced forms of the disease, inflammation causes a very persistent expansion of the largest airways. And this condition is called bronchiectasis. As a result, it forms in the lungs fibrous tissue. Therefore treatment of this disease should be carried out in the early stages so as not to aggravate the course of the disease and not cause significant harm to health.

Pulmonary aspergillosis is a pathology of the bronchopulmonary system infectious nature, caused by fungi aspergillus of the genus mold.

Pulmonary aspergillosis is usually represented by aspergilloma (a collection of fungal drusen up to several tens of millimeters in size), as well as bronchitis, pneumonia, inflammation of the pleura and bronchopulmonary aspergillosis of an allergic nature. As a rule, aspergillosis develops against a background of weakened immunity, bronchiectasis, various forms tuberculosis or lung cancer and diseases of the hematopoietic system.

About 30% of patients die from bronchopulmonary aspergillosis (every second of patients infected with the immunodeficiency virus dies).

The immediate cause of this pathology is the entry of the Aspergillus fungus into the human body. So-called conidia (spores) are formed on its growths. They are inhaled by humans from the surrounding air. After expiration incubation period Aspergillus begins to directly affect those organs and tissues in which they are fixed. Conidia can enter a person through food of poor quality or through an open wound.

Aspergillus is extremely common in the environment and is found everywhere. Aspergilli have been isolated from ventilation and air conditioning systems; they are found in baths, showers and bathrooms, in household and personal hygiene items. If the fungus “lives” in the house, then it can be easily activated by, for example, renovating an apartment or moving old furniture. Aspergillus lives in grass, fallen leaves, pots indoor plants, food rots under its influence.

Symptoms of pulmonary aspergillosis

Cough with sputum gray. Sometimes greenish lumps may be found in the sputum.
Discharge of blood when coughing.
Taste of mold in the mouth.
Shortness of breath and pain in chest.
Increased body temperature.
Chills.
Lack of appetite.
Bad dream.
General weakness.

Diagnosis of pulmonary aspergillosis

General analysis blood: increased number of leukocytes, eosinophils, increased erythrocyte sedimentation rate.
X-ray examination lungs: infiltrates, cavities in the pulmonary parenchyma.
Sputum analysis (carried out to detect pathogenic fungus). Diagnostic value has only repeated detection of fungal elements, confirmed serologically.
Immunological reactions with fungal antigens: complement fixation, precipitation, passive hemagglutination and immunoelectrophoresis.
Intradermal tests with Aspergillus allergen.
Biopsy of the affected organ (performed in complex diagnostic cases).

Treatment of pulmonary aspergillosis

Assign antifungal drugs"Amphotericin B", "Amphoglucamine", "Mycoheptin". If the disease occurs in mild form, they use drugs in tablets - “Amphoglucamine” and “Mycoheptin”. Further therapy includes repeated courses over 2-3 weeks with a daily dose of 400-600 thousand units 4 to 6 times a day. If the upper respiratory tract and lungs are affected, inhalation of Amphotericin B in 5 ml of distilled water is indicated. To this solution usually add 2 ml of a 2.4% solution of Euphyllin. It is recommended to carry out inhalations at least twice a day for 1-2 weeks. After week break the course of treatment is repeated. The drug should be administered intravenously by drip, slowly, at the rate of 0.1-1 mg per kilogram of the patient’s body weight at least 2 times a week. The course of treatment is 16-20 infusions.

Aspergilloma is practically not amenable to conservative treatment. If aspergilloma is complicated by repeated hemoptysis and abscess pneumonia, pulmonary resection is resorted to.

Essential drugs

There are contraindications. Specialist consultation is required.

(antifungal antibiotic). Dosage regimen:
- IV administration. Before each infusion set exact weight patient and calculate the dose of the drug. The dose of Amphotericin B is set for each patient individually at the rate of 250 IU/kg body weight. Pre-administer 100 units/kg (to determine individual tolerance). In the future, in the absence side effects and if necessary, the dose can be gradually increased to 1000 units/kg. The drug is administered every other day or 1-2 times a week (due to the risk of accumulation). The duration of the course of treatment depends on the severity and localization of the process, the duration of the disease and is at least 4-8 weeks to avoid relapses. The total dose of Amphotericin B per course of treatment averages 1.5-2 million units (18-20 infusions).
- Inhalation administration. Inhalations are prescribed 1-2 times/day. lasting up to 15-20 minutes. in doses of 50,000 units (10 ml) per inhalation, which corresponds to a daily dose of 1000-2000 units/kg of patient body weight. When using inhalation-only inhalers, single dose reduce to 25,000 units (5 ml). The duration of treatment is 10-14 days and depends on the severity and duration of the disease. If necessary, prescribe repeat course after a 7-10 day break.
Mycoheptin (antifungal antibiotic). Dosage regimen: orally, 0.4-0.6 g (200-300 thousand units) 2 times a day, for 10-14 days. If necessary and well tolerated, the course of treatment is repeated after 7 days.
Amphoglucamine (antifungal antibiotic). Dosage regimen: orally, after meals, for adults and children over 14 years of age, the initial dose is 200,000 units 2 times a day; if the effect is insufficient and is well tolerated, the dose is increased to 500,000 units 2 times a day. Duration of treatment is up to 3-4 weeks. Children under 2 years old - 25,000 units 2 times a day, 2-6 years old - 100,000 units 2 times a day, 6-9 years old - 150,000 units 2 times a day, 9-14 years old - 200,000 units 2 times a day. If necessary and there are no side effects, the course of treatment is repeated after a 5-7 day break.

Consultation with a pulmonologist.
X-ray of the lungs.
General blood test.
General sputum analysis.

A disease caused by a genus of higher mold fungi is called aspergillosis, the treatment of which is discussed in this article. One of the common diseases is pulmonary aspergillosis - the penetration of mold into the human body through the respiratory tract.

Infection also occurs when fungal spores enter, either through gastrointestinal tract and through the respiratory tract. Some species of this genus of mushroom are used to obtain enzymatic preparations, others - human pathogens - are toxic and cause disorders immune system.

This type of fungus has several ways of entering the body:

airborne;
through the oral cavity.

Representatives of this genus have the ability to reproduce in a strong osmotic environment containing carbon bonds and oxygen. Represent an infecting agent of carbon-rich food products containing starch, sugar, glucose - nuts, seeds, grains.

The negative impact of fungal or other pathogens is associated with their reproduction, causing intoxication of the body, tissue damage and disruption of the regulatory mechanisms of the human system.

According to WHO, Aspergillus are pathogens of the third group, i.e. cause serious illnesses humans and animals, however, there are therapeutic and preventive measures to prevent mass destruction.

Aspergillosis - what is it?

Despite the production
importance and widespread In medicine, certain types of Aspergillus are toxic to humans.

The toxicity of a substance determines the degree of danger to a living organism. lethal dose– LD50.

Aspergillosis is a poison that affects the heart and brain of people, produced by certain types of Aspergillus fungus. Toxicity and carcinogenicity depend on the type of Aspergillus.

The most dangerous species for humans:

A. fumigatus;
A. clavatus.

Aerobic fungi are found in the air, on domestic plants, and infect agricultural grain crops. May be contained in the air during repair work, in humid air. The risk of contracting aspergillosis is high, but it is not spread from one person to another.

Risk of infection with Aspergillus spores and development secondary diseases, increased for people with chronic diseases, or with inflammation with decreased immunity.

Specifics of infection

As a rule, the following organs are affected:

bronchi;
skin;
brain;

Symptoms

Symptoms of aspergillosis are similar
for symptoms of colds or other uncomplicated inflammatory processes:

dyspnea;
weakness;
chest pain;
increased body temperature;
cough.

In this case, the symptoms of chronic or primary inflammatory process take on a weighted form.
Such symptoms significantly complicate the diagnosis of infection in the early stages of the disease. Infection occurs against the background of existing lung diseases, bronchitis - cystic fibrosis,.

The main diseases caused by Aspergillus damage are:

Bronchopulmonary.
Acute invasive.
Diffuse invasive.
Aspergilloma.

The mechanism of infection by airborne droplets is the most common, because Aspergillus is found in inhaled air. Almost always, a weakened immune system leads to the development of infectious inflammatory processes.

Forms of pathology

– introduction of Aspergillus spores into a weakened body against the background of asthma, chronic bronchitis. Infection occurs with attacks of suffocation, weakness, weight loss, aches and fever, expectoration of sputum, and sometimes manifests itself in the form of coughing with blood.

The main symptom is shortness of breath, difficulty breathing for a long time.

Define defeat bronchopulmonary system possibly on a fluoroscopic image or sputum microscopy. Treatment of bronchopulmonary aspergillosis allergic nature carried out systemically with medication, using antibiotics, antiseptic, steroid, antifungal drugs.

Invasive pulmonary aspergillosis– characterized by the rapid proliferation of fungal spores on the lung tissue, causing rapid intoxication of the lungs.

Symptoms of the lesion develop acutely and manifest themselves in the form of:

significant increase in temperature;
feverish state;
chest pain;
dry cough

There is a risk of damage to neighboring tissues and organs.

Allergic bronchopulmonary

The disease develops against the background
concomitant, chronic lesions of the bronchopulmonary system and represents allergic reaction organism to introduced Aspergillus.

For example, with bronchial asthma, the symptoms of which intensify. Severe dry cough, suffocation and airway obstruction indicate the development of allergic bronchopulmonary aspergillosis. Diagnosis of a side inflammatory process in the bronchi, diagnosed by X-ray, computed tomography based on indicating symptoms, as prescribed by a doctor.

Skin damage

Aerobic fungus aspergillus
causes disease by infecting an organism with reduced immunity. - one of the types of lesions, characterized by redness skin at the initial stage of development. Subsequently, scaly, characteristic itching appears on the skin.

Septic infection

Is an invasive infection of a weakened body, during which the infection spreads throughout blood vessels, affecting internal organs. An infection called cerebral aspergillosis occurs in a similar way.

Often, damage to the central nervous system occurs due to infection inner ear, . Symptoms of the lesion are nonspecific, there is a risk of late diagnosis. By affecting the central nervous system, the fungus causes encephalitis and meningitis. The prognosis of the disease is unfavorable and death is possible.

Ear infection

Inner ear infection may appear at the stage of skin infection, septic lesion. And also with existing inflammation - otitis media.

The disease causes painful sensations, itching, fluid loss from ears, most often at night.

Diagnostics

Diagnosis of Aspergillus damage in the body is carried out when:

protracted course of primary inflammatory diseases;
specific symptoms.

The course of inflammatory processes during infection with Aspergillus spores is protracted.
Primary symptoms are aggravated by infection, and may occur:

feverish condition;
difficulty breathing is prolonged;
mucous discharge has a greenish tint, profuse, with a characteristic putrefactive odor;
damage to the ENT organs occurs with the presence of airway obstruction;
septic damage to internal tissues and organs occurs with worsening primary symptoms – copious discharge, pain, itching.

Diagnosis of a patient for infection with fungal spores contains:

general blood sampling;
sputum culture;
scraping of mucous membranes.

The level of SOE, the presence of antibodies, and identification of spores are determined.
X-ray of the lungs is performed computed tomography.

Treatment

Treatment of infection
carried out in a hospital setting with severe symptoms - elevated temperature, feverish state, delirium. Prescribed drugs to relieve the inflammatory process, antifungal drugs. If treatment is successful, drugs to stabilize the immune system and vitamin complexes are included.

Treatment regimen:

Antibiotics.
Antibacterial drugs.
Antifungal drugs.
Drugs to enhance immunity - immunosuppressants.
Vitamins.

Since it is necessary to test drugs for an allergic reaction, it is advisable to spend the first few days of treatment in a hospital or under the supervision of the attending physician. The presence of concomitant or chronic diseases complicates the course of treatment.

Prevention of disease

Prevention measures are:

monitoring the progress and treatment of existing diseases;
prevention of seasonal infectious diseases;
strengthening the immune system.

Infection with Aspergillus spores most often represents a complication of an existing disease, aggravated by the symptoms that occur when infected with colonies of the fungus.

Conclusion

Leakage inflammatory disease a long period indicates that the treatment has been selected inaccurately, or the doctor’s instructions are being followed in bad faith.

In this case, the disease becomes chronic nature, and this is fraught with regular outbreaks of exacerbation. And, in turn, can lead to concomitant disease or infection. Aerobic organisms - fungi, bacteria, viruses - are present everywhere, and infection of the body indicates a decrease in the body's natural defenses.
Maintaining the immune system is the main rule for preventing the occurrence of infectious human diseases.

Invasive pulmonary aspergillosis is a lesion of the respiratory system by mold fungi of the genus Aspergillus, which is characterized by the spread of infection through the epithelial barrier and angioinvasion. The disease occurs as severe pneumonia, refractory to antibiotics, with high fever, cough, hemoptysis and chest pain. The diagnosis is made on the basis of histological examination of biopsy material, bronchoscopy data, CT scan of the lungs, detection of aspergillus laboratory methods in sputum and (or) lavage fluid. Treatment includes antifungal drugs, immunomodulators, and surgical resection of affected tissue.

Invasive pulmonary aspergillosis usually occurs in individuals with severe immune disorders and occurs in acute or chronic form. Over the past 20 years, there has been a consistent upward trend in the incidence of this form of mycosis. The number of diagnosed cases increased by approximately 15% during this time period. In terms of frequency of development, invasive aspergillosis ranks first among all aggressive mycotic lesions of the lungs. Affects up to 40% of patients with primary immunodeficiencies, up to 30% of recipients various organs and tissues, up to 25% of patients with hemoblastosis, about 4% of HIV-infected people. Mortality among immunocompromised patients with this pathology is 50% or higher.

Reasons

Invasive pulmonary aspergillosis observed when spores of mold fungi of the genus Aspergillus enter the respiratory system. There are 15 species of Aspergillus that can cause disease when certain conditions arise. Conditionally pathogenic fungi are ubiquitous saprophytes and live in soil and water. Aspergillus spores, along with dust particles, rise into the air in large quantities. A person becomes infected through the airborne route. In most infected people, pathology does not develop due to the barrier functions of the body. Risk factors for the occurrence of an invasive form of the disease include:

Dysfunction of immunocompetent cells. Occurs with a significant decrease in the number of neutrophils and (or) alveolar macrophages or a decrease in their phagocytic activity. Neutropenia is present in a number of hemoblastoses, preparation for organ and hematopoietic cell transplantation, and graft-versus-host disease. Dysfunction immune cells observed in chronic granulomatous disease, progression of AIDS, massive and long-term therapy corticosteroids.
Chronic lung diseases. Invasive aspergillosis is often found in patients suffering from chronic pulmonary pathology. Experts in the field of pulmonology and infectology suggest a local decrease T cell immunity in such patients against the background long-term use inhaled corticosteroids. The occurrence of the disease is facilitated by impaired mucociliary clearance, changes in the architecture of the bronchopulmonary system, and frequent hospitalizations.
The patient's serious condition. An invasive variant of the course of respiratory mycosis is increasingly being detected in critically ill patients in departments. intensive care in the absence of neutropenia and chronic pathologies respiratory organs. Most often, aspergillosis is diagnosed in liver failure, diabetes mellitus and extensive burns.

Pathogenesis

Inhalation of Aspergillus spores healthy person most of them are removed from the respiratory tract due to the work of the mucociliary system. The rest are destroyed and absorbed by cells immune defense. Damage to the bronchial mucosa leads to colonization of the airways by micromycetes. Due to the absolute decrease in the number of alveolar macrophages and neutrophils, killing and phagocytosis of micromycetes does not occur. Fungal spores germinate uncontrollably. Aspergillus hyphae can damage vascular endothelium, causing arterial and venous thrombosis, pulmonary hemorrhages. Further spread of the infection occurs through the hematogenous route and leads to dissemination of the process.

Classification

Invasive pulmonary aspergillosis includes all forms of mycotic lesions of the respiratory tract with germination of its epithelium by fungal hyphae. The division into pulmonary invasion and aspergillosis of the respiratory tract is arbitrary due to the rapid spread of the pathology. An isolated process in the area of the trachea and bronchi is possible only with chronic course disease and local damage to the tracheobronchial tree. Of therapeutic and diagnostic importance is the division of mycosis into acute and chronic form. The following types of invasive pulmonary aspergillosis are distinguished:

Acute invasive. Characterized by nonspecific symptoms pulmonary inflammation, the course resembles severe pneumonia or pulmonary infarction.
Chronic necrotic. It is a slowly progressive process. Leads to the formation of decay cavities in the pulmonary parenchyma.

Symptoms

There are no pathognomonic signs of the acute variant of the disease. The first symptoms of pulmonary aspergillosis are increased body temperature and dry Not productive cough. Fever is accompanied by repeated chills and heavy night sweats. The temperature rises to febrile and hyperthermic values. Its curve is often irregular with morning rises and in the evening a decrease to low-grade or normal levels. In patients receiving corticosteroids, temperature reaction less pronounced. Feverish state persists for 7 or more days, despite antibiotic therapy.

The cough gradually becomes productive. Gray-green sputum is released. When the pulmonary vessels grow with fungal hyphae, an admixture of blood appears in it. Moderate hemoptysis is usually observed, rarely massive pulmonary hemorrhage. Diffuse lesion respiratory system and aspergillus tracheobronchitis are accompanied by mixed shortness of breath. Sometimes patients are bothered by quite intense, aggravated deep breathing pleural pain.

Another form of the invasive process, chronic necrotizing pulmonary aspergillosis, is sluggish and sometimes asymptomatic. Within several months, low-grade fever or moderate fever is detected. Noted general weakness, increased fatigue, loss of appetite, noticeable weight loss. Patients complain of a constant productive cough. The sputum contains gray-green lumps containing aspergillus. Hemoptysis is often observed.

Complications

Invasive aspergillosis of the respiratory tract, spreading hematogenously, causes damage to the central nervous system, organs abdominal cavity, hearts, thyroid gland and spleen. The disseminated process can proceed as mycotic septicemia. Angioinvasion often leads to the development of massive pulmonary hemorrhages and vascular thrombosis, which are the cause of pulmonary and myocardial infarctions. Mortality from complications of pulmonary aspergillosis is 50-90%.

Diagnostics

Timely detection of Aspergillus infestation can improve patient survival. Diagnosis of the disease is difficult due to the lack of pathognomonic symptoms and the similarity of the clinical picture with other serious illnesses lungs. Patients with suspected invasive aspergillosis of the respiratory system are examined by a pulmonologist and an infectious disease specialist. When collecting anamnesis, the presence of risk factors and the body’s response to antibiotic treatment must be taken into account. Physical examination is not very informative. Nonspecific signs of damage to the bronchopulmonary system are determined, such as dry and moist rales, pleural friction noise. Final diagnosis installed using:

X-rays. Invasive aspergillosis is detected late on radiographs, so high-resolution computed tomography is recommended. During the first week of the disease, a CT scan of the lungs reveals multiple nodes with a characteristic halo (halo symptom). Later, as a result of necrosis, a crescent-shaped area of clearing appears in the infiltrate (meniscus symptom).
Bronchoscopy. When performing bronchoscopy in patients with aspergillus tracheobronchitis, changes in the mucous membrane in the form of ulcerations or film deposits are noted. Sometimes multiple endobronchial nodules are detected. Diagnostic value have histological and cytological examination nodes
Biopsies. Histological examination Lung biopsy material is considered the gold standard for diagnosing this form of mycosis. The presence of partitions and mycelium branching at an acute angle, as well as the isolation of Aspergillus culture from lung tissue are reliable criteria for the disease.
Laboratory methods. Molds are determined by microscopy of sputum and bronchial washings. Sowing biological fluids on nutrient media gives culture growth within 3-5 days. Aspergillus antigen - galactomannan is detected in blood serum by the method enzyme immunoassay several days before the appearance of clinical and radiological signs of the disease. In a number of European countries, the galactomannan test is used in patients with hematologic malignancies to detect invasive fungal growth at the preclinical stage. The disadvantage of the study is the frequent false-positive reactions due to low species specificity and absorption of the antigen into the blood from food.

Treatment of invasive pulmonary aspergillosis

If invasive pulmonary mycosis is suspected, treatment should be started immediately. As etiotropic medicines antimycotics are used wide range actions. This group of drugs includes triazoles, polyenes and echinocandins. It is possible to use a combination of two antifungal drugs belonging to different classes. To correct the functions of the immune system, immunomodulators are prescribed. In case of severe neutropenia, granulocyte transfusion is performed. Pulmonary aspergillosis with invasive growth is not always subject to surgical treatment. Resection of parenchyma is performed when there is a risk of fungal mycelium germination large vessels and pericardium, to reduce the volume of fungal masses before prescribing drugs leading to immunosuppression.

Prognosis and prevention

Prognosis for invasive aspergillosis respiratory system always serious. Death occurs in 50% of patients with neutropenia. Mortality from mycosis among recipients bone marrow reaches 90%. Early treatment (up to 10 days from the onset of the disease) ensures recovery in approximately 60% of patients. Regarding primary prevention experimental clinical studies, But preventive measures have not yet been sufficiently developed. To prevent relapse of the disease in people with risk factors, antimycotics of the polyene or triazole series and immunomodulators are successfully used. In order to prevent hospital infection with aspergillosis, the rooms of patients at risk are equipped with supply and exhaust ventilation and an air filtration system, and are reliably isolated during repair work. The amount of aspergillus in the air of such premises should not exceed established standards.

Pulmonary aspergillosis is a fungal disease caused by mold fungi Aspergillus. This is extremely dangerous disease, requiring immediate diagnosis and treatment. Delay may cost the patient his life.

The main cause of pulmonary aspergillosis is the entry of fungi into the body with inhaled air. The spores settle on the walls of the bronchi and lungs and, after the incubation period, begin to affect surrounding tissues. Abscesses and fistulas form on the affected membranes, secreting thick pus. But not all infected people develop the disease. Certain factors are required to activate microorganisms.

The causative agent of the disease is the Aspergillus fungus under a microscope

Decreased immunity

Persons with weakened protective forces organisms are most susceptible to pathology. Provoking factors are AIDS and others immunodeficiency states, diabetes mellitus, alcoholism, drug addiction. Immunity is also reduced due to long-term use of antibiotics, cytostatics and corticosteroids. The risk of the disease is increased among patients who have undergone surgery or chemotherapy.

Chronic diseases of the respiratory system

Pathogenic fungi love to settle on already affected tissues. The pathology is often diagnosed in people suffering from bronchial asthma, chronic bronchitis and cystic fibrosis. Patients with oncology, tuberculosis or pulmonary obstruction are also at risk.

Heavy contamination

Even if a person is absolutely healthy and everything is in order with his immune system, he can also get pulmonary aspergillosis if he often and in large quantities inhales fungal spores. Usually this is a professional problem, and it concerns workers of mills, spinning mills and poultry farms, plumbers, farmers, and brewers. Even pharmacists, librarians and mushroom pickers are at risk.

Routes of infection

Aspergillus is widespread. They live in air, soil and water, even distilled water. Fungi feel comfortable in ventilation and water pipes. There are a lot of them in baths, bathrooms and swimming pools.

On the street, microorganisms are found in the ground, rotting grass, and water bodies. There are more colonies indoors. They live in furniture and under wallpaper. They are easy to activate during renovation or when rearranging old furniture.

Among household items increased danger represent old books, clothing and bedding, as well as air conditioners and humidifiers. This list also includes pots with indoor plants. Occasionally, fungi are found in food. This is especially true for stale vegetables and bulk products: cereals, flour, tea, etc.

In terms of the prevalence of Aspergillus in the air, the first places among the countries are occupied by Sudan and Saudi Arabia. Tourists visiting this region often fall ill. But microorganisms can only be obtained from environment. The pathology is not transmitted from person to person.

Classification of the disease

There are four clinical forms diseases. They differ in symptoms and developmental characteristics. Each requires special diagnosis and treatment and carries a certain danger to the body.

Invasive pulmonary aspergillosis

Occurs when fungi penetrate through epithelial tissue respiratory tract. Common among patients with reduced immunity. Recently, cases of morbidity have been reported among people who are not at risk: patients and hospital staff. On early stages lesions are small compactions on the pleura associated with blood vessels. Gradually they turn into cavities filled with pus. The process causes tissue death.

Chronic necrotizing aspergillosis

Accounts for 5% of all cases of pulmonary aspergillosis. Occurs predominantly in middle-aged men. Does not always depend on the level of immunity and can develop due to high content fungi in the air or against the background of other respiratory tract pathologies. When the disease occurs, a cavity forms on the wall of the lung, surrounded by inflamed tissue.

Aspergilloma

Otherwise called “mushroom ball”. It is a mass of aspergillus. Colonies grow in cavities formed by other diseases: tuberculosis, cancer, pneumonia, etc. The disease does not depend on immune status patient. In 10% of cases, all symptoms disappear without a trace even without treatment.

Allergic bronchopulmonary aspergillosis

Diagnosed in patients with a predisposition to allergies. Allergic pulmonary aspergillosis is often detected in children with impaired immune systems. The reaction occurs to fungi and their metabolic products. No tissue destruction is noted. The disease is chronic, with periods of remission followed by exacerbations.

Symptoms of pulmonary aspergillosis in humans

The clinical picture depends on the type of disease. In the invasive form, a high temperature rises and lasts for several days. Patients develop a dry cough and hemoptysis. They complain of shortness of breath and chest pain. In persons with very weak immunity There may be no symptoms even for late stages life-threatening.

Necrotizing aspergillosis is characterized by a sluggish course with periodic exacerbations. Patients develop a cough with sputum. Blood is released in small quantities. Fever occurs rarely. There is weakness and weight loss.

Aspergilloma on initial stages doesn't show itself at all. As the disease progresses, a cough appears and the temperature rises slightly. Most patients experience hemoptysis at least once. In case of complications, pulmonary hemorrhage is possible.

With the allergic nature of the disease, attacks of suffocation occur, severe cough and chest pain. Breathing is difficult, wheezing. Mucus and brown lumps appear in the sputum. Body temperature rises.

TO general symptoms include weakness, sleep disturbance, lack of appetite. A characteristic feature pathology is the taste of mold in the mouth.

Diagnostics

First of all, if aspergillosis is suspected, the medical history is studied and the patient is interviewed. It is necessary to find out living and working conditions, identify the presence hazardous conditions labor. The presence of diabetes mellitus and other chronic diseases in the anamnesis. The duration and duration of taking antibiotics and other potent drugs is specified.

Laboratory tests include blood tests to evaluate white blood cell and eosinophil counts. Serology helps check for the presence of antibodies. Examination of sputum allows you to determine the type of pathogen.

Bronchoscopy reveals deformations of the trachea and bronchi, and identifies foci of inflammation. During the procedure, plaque from tissues is taken for analysis. An X-ray of the lungs is also performed.

MSCT, or multispectral computed tomography, is the main method for identifying lesions. Damaged areas in pulmonary aspergillosis have specific type, which can only be fully assessed using high-resolution equipment.

Required differential diagnosis aspergillosis with tuberculosis, sarcoidosis, destructive pneumonia, cancer. You may need to consult a TB doctor and oncologist. All patients in mandatory are sent to see an otolaryngologist.

Treatment methods

The duration and features of treatment for pulmonary aspergillosis depend on the type and severity of the disease and the state of the immune system. Mild forms are cured on an outpatient basis in a week and a half. In difficult cases, therapy is delayed for a year. The indication for hospitalization is hemoptysis.

Drug treatment

Patients are prescribed antifungal antibiotics. They use drugs in the form of tablets, inhalations and injections. Taking corticosteroid hormones is also indicated to eliminate blockage of the bronchi with mucus. Required for allergies antihistamines. Asymptomatic aspergilloma and allergic form in the remission stage they do not require treatment.

Surgical treatment

Indicated in the presence of bleeding and combined with conservative treatment. Sanitation of the affected areas is mandatory. In some cases it is removed part of the lung or the entire organ. At respiratory failure As a temporary measure, ligation of the bronchial artery is used.

Possible complications

The most common complication is pulmonary hemorrhage. It is also possible to develop profuse suppuration and subsequent deformation of the bronchi. In some cases, fungal spores penetrate the blood vessels, and the infection spreads through the bloodstream throughout the body and affects various organs.

In a chronic course it develops cor pulmonale. With this pathology, the right parts of the organ expand and enlarge. The condition threatens disability. Fatalities are common.

Forecast

In mild forms the prognosis is favorable. Proper treatment leads to full recovery. In the absence of proper therapy, the disease enters the chronic stage.

Invasive aspergillosis without treatment almost always ends in the death of the patient within a month after infection. Even timely medical care sometimes it doesn't help. The mortality rate from this form of the disease reaches 50%. Most fatal outcome patients with immunodeficiency and patients taking large doses glucocorticosteroids before diagnosing the pathology.

Prevention

It is important for people with reduced immunity to be regularly tested for Aspergillus carriage. When working in hazardous industries, they need to wear a respirator. And if fungi are detected in the tests, a change of work is required.

Immunocompromised patients treated in hospital should regularly disinfect the area and ensure air filtration. It is prohibited to keep indoor plants in the ward.

It is recommended to avoid agricultural work and contact with animals. You should not eat stale foods or blue cheeses. If possible, stay in damp and dusty areas should be avoided. In your home, it is important to periodically clean the ventilation, air conditioners and humidifiers.

An important activity is to strengthen the immune system. Useful vitamin complexes, exercise classes and walks fresh air. Should be treated promptly infectious diseases and do not take antibiotics or other strong medications unless necessary. It is strongly recommended to stop using alcohol and drugs.

Pulmonary aspergillosis – insidious disease. You can get it anywhere. Although in most cases the body successfully copes with fungi, but with a weakened immune system, the risk of disease increases significantly. The lower protective functions, the more severe the pathology.