Aspergillosis

Aspergillosis
Dr.Pratima Sharma
MD, Microbiology & Infectious
disease
Introduction
• Aspergillus is a member of the phylum Ascomycota.
• Aspergillus is common and widespread in nature
including soil, plant debris, wood, decomposing
organic matter and in air.
• There are over 185 known species, about 20 of which
are known to be harmful to humans and other animals.
• Pathogenic and allergenic species of Aspergillus - A.
fumigatus, A. flavus and A. niger
• Aspergillus species most commonly invade the
respiratory tract, followed by GI tract,brain, heart , skin
and sinuses- resulting into human Aspergillosis
• It is commonest opportunistic fungal disease after
candidiasis
• Also responsible for toxic manifestations like
alfatoxicosis.
Morphology of Aspergillus
 Aspergillus gets its name from its shape ”an aspergillum” a device
used for sprinkling holy water
 Aspergillus Species vary in color, size, growth rate and microscopic
characteristics
 But all species have hyphae that are septate and hyaline.
 Hyphae and conidia are separate.
 Aspergillus species can reproduce both sexually and asexually,
although asexual reproduction seems to be the more common.
Clinical Manifestation
 Aspergillus primarily affects the lungs, causing 4 main syndromes:
1. Allergic bronchopulmonary aspergillosis (ABPA)
2. Chronic necrotizing Aspergillus pneumonia
3. Aspergilloma
4. Invasive aspergillosis.
 Aspergillus may hematogenously disseminate beyond the lung, potentially
causing endophthalmitis, endocarditis in patients who are severely
immunocompromised
 Aspergillus is second to Candida species as a cause of fungal endocarditis.
 Superficial infection of external ear(otomycosis),eye(mycotic keratitis) and
paranasal sinuses
 Clinical manifestations also depend on the species involved:
 A. fumigatus accounts for most of the cases of acute pulmonary and allergic
aspergillosis.
 A.flavus is more common in hospitals and causes more sinus, skin and
ocular infections than A. fumigatus.
 A. niger can cause invasive infection but more commonly colonizes
respiratory tract and causes otitis externa.
ABPA is a syndrome occurring in asthmatic persons and
patients with CF that results from a hypersensitivity
reaction to Aspergillus colonization of the tracheobronchial
tree.
• This syndrome may cause fever and pulmonary infiltrates
that are unresponsive to antibacterial therapy.
• Patients often have a cough and produce mucous plugs,
which may form bronchial casts.
• They may have hemoptysis.
• ABPA may occur in conjunction with allergic
fungal sinusitis, with symptoms including chronic
sinusitis with purulent sinus drainage
 Aspergilloma may manifest as an
asymptomatic radiographic
abnormality in a patient with
preexisting cavitary lung disease due to
sarcoidosis, tuberculosis, or other
necrotizing pulmonary processes.
• In the lungs-compact mass of fungal
mycelia surrounded by dense fibrous
wall ( )
• Solitary and vary in size(approx 10cm
in diameter)
• Either asymtomatic or have moderate
degree of cough and sputum production
• 40-60% experience hemoptysis, which
may be massive and life threatening
 Invasive aspergillosis
• fever, cough, dyspnea, pleuritic chest pain , hemoptysis in
patients with prolonged neutropenia or immunosuppression.
• Observed in patients who have received lung, heart, and
other solid organ transplants
• Also observed in patients with COPD on long-term
corticosteroid therapy.
• Radiographic and CT scan images may reveal characteristic
patterns, including nodules, cavitary infiltrates, and focal
infiltrates.
• Uncommon, indolent pulmonary infection

• Commonaly seen in patients with pre-existing respiratory
disease such as COPD,bronchiectasis,pneumoconiosis and in
immunocompromised people
• Patients present with fever, productive cough, weight loss
usually mimicking tuberculosis
Laboratory diagnosis
• Specimens: Sputum, ET aspirate, BAL and lung
biopsies
KOH (10%) mount or
histopathological staining of specimens reveals
characteristic narrow septate hyaline hyphae with
acute angle branching
SDA media at 25°C, require 1-3 weeks for growth.
– colony begins as a dense white mycelium which later
assumes a variety of colors, according to species, based on
the color of the conidia.
– Identification is done based on macroscopic and
microscopic(LPCB) observation
 hyaline septate hyphae from which conidiophores arise which
end at vesicles.
 Vesicles are either tubular or globular in shape.
 From vesicle, finger-Like projections of conidia producing cells
arise called phialldes or sterigmata.
 Phialides are arranged either in one or two rows, first row is
called metulae.
 Conidia arise from vesicles either on their entire surface or
only on the upper half
: ELISA detecting Aspergillus specific
galactomannan antigen in patient's sera or urine is
useful for establishing early diagnosis
 Detection of serum antibodies is very useful for chronic

invasive aspergillosis and aspergilloma, where the
culture is usually negative.
 Titer falls rapidly following clinical improvement.
 In allergic syndromes such as ABPA and severe asthma,
specific serum IgE levels are elevated.
 Positive skin test to various antigen extracts of

Aspergillus indicates hypersensitivity response and is
usually positive for various allergic type of aspergillosis.

Aspergillosis

Uploaded by

Copyright:

Available Formats

Aspergillosis

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Aspergillosis

Uploaded by

Copyright:

Available Formats

Aspergillosis

• Uncommon, indolent pulmonary infection

 Detection of serum antibodies is very useful for chronic

 Positive skin test to various antigen extracts of

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.