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{{Aspergillosis}}
{{Aspergillosis}}
==Overview==
==Overview==
Apergillosis may be classified according to the clinical syndrome it causes into allergic bronchopulmonary aspergillosis, allergic ''Aspergillus'' sinusitis, aspergilloma, chronic pulmonary aspergillosis, invasive aspergillosis, or cutaneous aspergillosis.
==Classification==
==Classification==
Apergillosis may be classified according to the clinical syndrome it causes into the following:
Apergillosis may be classified according to the clinical syndrome it causes into the following:
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*Invasive aspergillosis
*Invasive aspergillosis
*Cutaneous aspergillosis
*Cutaneous aspergillosis
 
<br>
The table below distinguishes between the different types of aspergillosis:
The table below distinguishes between the different types of aspergillosis:<ref name=CDC> Definition of Aspergillosis -  Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/fungal/diseases/aspergillosis/definition.html Accessed on Feb 8 2016</ref>


{| {{table}}
{| {{table}}
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| align="center" style="background:#f0f0f0;"|'''Characteristics'''
| align="center" style="background:#f0f0f0;"|'''Characteristics'''
|-
|-
| Allergic Bronchopulmonary Aspergillosis (ABPA)||
| '''Allergic Bronchopulmonary Aspergillosis (ABPA)'''||
*Immune-modulated pulmonary disease due to hypersensitivity to ''A. fumigatus'' (not an infection)
*Immune-modulated pulmonary disease due to hypersensitivity to ''A. fumigatus'' (not an infection)
*Clinical features include persistent dry cough, wheezing, symptoms of asthma exacerbation or bronchiectasis
*Clinical features include persistent dry cough, wheezing, symptoms of asthma exacerbation or bronchiectasis
Line 25: Line 26:
*Treatment with anti-fungal agents, steroids, and asthma control<ref name=Agarwal>{{cite journal| author=Agarwal R, Chakrabarti A, Shah A, Gupta D, Meis JF, Guleria R et al.| title=Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. | journal=Clin Exp Allergy | year= 2013 | volume= 43 | issue= 8 | pages= 850-73 | pmid=23889240 | doi=10.1111/cea.12141 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23889240  }}</ref>
*Treatment with anti-fungal agents, steroids, and asthma control<ref name=Agarwal>{{cite journal| author=Agarwal R, Chakrabarti A, Shah A, Gupta D, Meis JF, Guleria R et al.| title=Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. | journal=Clin Exp Allergy | year= 2013 | volume= 43 | issue= 8 | pages= 850-73 | pmid=23889240 | doi=10.1111/cea.12141 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23889240  }}</ref>
|-
|-
| Allergic ''Aspergillus'' Sinusitis / Rhinosinusitis||
| '''Allergic ''Aspergillus'' Sinusitis / Rhinosinusitis'''||
*Immune-modulated sinus disease (not an infection)
*Immune-modulated sinus disease (not an infection)
*Clinical features of recurrent or resistant sinusitis, such as increased sinus drainage, stuffiness, headache, and facial tenderness, eosinophilic secretions
*Clinical features of recurrent or resistant sinusitis, such as increased sinus drainage, stuffiness, headache, and facial tenderness, eosinophilic secretions
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*Treamtent includes de-obstruction, nasal drainage, oral steroids, immunotherapy against allergens, and allergy control<ref name=glass>{{cite journal| author=Glass D, Amedee RG| title=Allergic fungal rhinosinusitis: a review. | journal=Ochsner J | year= 2011 | volume= 11 | issue= 3 | pages= 271-5 | pmid=21960761 | doi= | pmc=PMC3179194 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21960761  }} </ref>
*Treamtent includes de-obstruction, nasal drainage, oral steroids, immunotherapy against allergens, and allergy control<ref name=glass>{{cite journal| author=Glass D, Amedee RG| title=Allergic fungal rhinosinusitis: a review. | journal=Ochsner J | year= 2011 | volume= 11 | issue= 3 | pages= 271-5 | pmid=21960761 | doi= | pmc=PMC3179194 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21960761  }} </ref>
|-
|-
| Aspergilloma (Fungus Ball)||
| '''Aspergilloma (Fungus Ball)'''||
*An ''Aspergillus'' mass ccolonizes locally in either the lungs or the sinuses
*An ''Aspergillus'' mass ccolonizes locally in either the lungs or the sinuses
*May occur with chronic pulmonary aspergillosis
*May occur with chronic pulmonary aspergillosis
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*Treatment includes surgical resection<ref name=lee>{{cite journal| author=Lee SH, Lee BJ, Jung DY, Kim JH, Sohn DS, Shin JW et al.| title=Clinical manifestations and treatment outcomes of pulmonary aspergilloma. | journal=Korean J Intern Med | year= 2004 | volume= 19 | issue= 1 | pages= 38-42 | pmid=15053042 | doi= | pmc=PMC4531547 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15053042  }} </ref>
*Treatment includes surgical resection<ref name=lee>{{cite journal| author=Lee SH, Lee BJ, Jung DY, Kim JH, Sohn DS, Shin JW et al.| title=Clinical manifestations and treatment outcomes of pulmonary aspergilloma. | journal=Korean J Intern Med | year= 2004 | volume= 19 | issue= 1 | pages= 38-42 | pmid=15053042 | doi= | pmc=PMC4531547 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15053042  }} </ref>
|-
|-
| Chronic Pulmonary Aspergillosis||
| '''Chronic Pulmonary Aspergillosis'''||
*Invasion of ''Aspergillus'' in the pulmonary for > 3 month
*Invasion of ''Aspergillus'' in the pulmonary for > 3 month
*May occur with aspergillomas (single or multiple)
*May occur with aspergillomas (single or multiple)
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*Treatment includes systemic and intracavitary anti-fungal agents<ref name=denning>{{cite journal| author=Denning DW, Riniotis K, Dobrashian R, Sambatakou H| title=Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review. | journal=Clin Infect Dis | year= 2003 | volume= 37 Suppl 3 | issue=  | pages= S265-80 | pmid=12975754 | doi=10.1086/376526 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12975754  }} </ref>
*Treatment includes systemic and intracavitary anti-fungal agents<ref name=denning>{{cite journal| author=Denning DW, Riniotis K, Dobrashian R, Sambatakou H| title=Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review. | journal=Clin Infect Dis | year= 2003 | volume= 37 Suppl 3 | issue=  | pages= S265-80 | pmid=12975754 | doi=10.1086/376526 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12975754  }} </ref>
|-
|-
| Invasive Aspergillosis||
| '''Invasive Aspergillosis'''||
*Severe infection among immunocompromised individuals (e.g. transplant recipients or neutropenic patients)
*Severe infection among immunocompromised individuals (e.g. transplant recipients or neutropenic patients)
*Associated with high mortality rate
*Associated with high mortality rate
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*Treatment includes anti-fungal agents<ref name=nryn>{{cite journal| author=Naaraayan A, Kavian R, Lederman J, Basak P, Jesmajian S| title=Invasive pulmonary aspergillosis - case report and review of literature. | journal=J Community Hosp Intern Med Perspect | year= 2015 | volume= 5 | issue= 1 | pages= 26322 | pmid=25656673 | doi=10.3402/jchimp.v5.26322 | pmc=PMC4318821 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25656673  }} {{cite journal| author=Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW et al.| title=Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 6 | pages= 408-15 | pmid=12167683 | doi=10.1056/NEJMoa020191 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12167683  }} </ref>
*Treatment includes anti-fungal agents<ref name=nryn>{{cite journal| author=Naaraayan A, Kavian R, Lederman J, Basak P, Jesmajian S| title=Invasive pulmonary aspergillosis - case report and review of literature. | journal=J Community Hosp Intern Med Perspect | year= 2015 | volume= 5 | issue= 1 | pages= 26322 | pmid=25656673 | doi=10.3402/jchimp.v5.26322 | pmc=PMC4318821 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25656673  }} {{cite journal| author=Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW et al.| title=Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 6 | pages= 408-15 | pmid=12167683 | doi=10.1056/NEJMoa020191 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12167683  }} </ref>
|-
|-
| Cutaneous Aspergillosis||
| '''Cutaneous Aspergillosis'''||
*Infection of the skin
*Infection of the skin
*Invasion may be either primary through a skin lesion (e.g. surgical or burn wound or catheter site) or secondary to a distant organ to the skin  
*Invasion may be either primary through a skin lesion (e.g. surgical or burn wound or catheter site) or secondary to a distant organ to the skin  
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Diagnosis is by biopsy of the lesion, evaluation of other primary sources (e.g. CT scan for pulmonary lesiosn) is necessary
Diagnosis is by biopsy of the lesion, evaluation of other primary sources (e.g. CT scan for pulmonary lesiosn) is necessary
*Treatment includes anti-fungal agents with or without surgery<ref name=van>{{cite journal| author=van Burik JA, Colven R, Spach DH| title=Cutaneous aspergillosis. | journal=J Clin Microbiol | year= 1998 | volume= 36 | issue= 11 | pages= 3115-21 | pmid=9774549 | doi= | pmc=PMC105285 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9774549  }} </ref>
*Treatment includes anti-fungal agents with or without surgery<ref name=van>{{cite journal| author=van Burik JA, Colven R, Spach DH| title=Cutaneous aspergillosis. | journal=J Clin Microbiol | year= 1998 | volume= 36 | issue= 11 | pages= 3115-21 | pmid=9774549 | doi= | pmc=PMC105285 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9774549  }} </ref>
|-
|
|}
|}
==References==
==References==

Revision as of 17:54, 8 February 2016

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Overview

Apergillosis may be classified according to the clinical syndrome it causes into allergic bronchopulmonary aspergillosis, allergic Aspergillus sinusitis, aspergilloma, chronic pulmonary aspergillosis, invasive aspergillosis, or cutaneous aspergillosis.

Classification

Apergillosis may be classified according to the clinical syndrome it causes into the following:

  • Allergic bronchopulmonary aspergillosis
  • Allergic Aspergillus sinusitis
  • Aspergilloma
  • Chronic pulmonary aspergillosis
  • Invasive aspergillosis
  • Cutaneous aspergillosis


The table below distinguishes between the different types of aspergillosis:[1]

Clinical Syndrome Characteristics
Allergic Bronchopulmonary Aspergillosis (ABPA)
  • Immune-modulated pulmonary disease due to hypersensitivity to A. fumigatus (not an infection)
  • Clinical features include persistent dry cough, wheezing, symptoms of asthma exacerbation or bronchiectasis
  • Common among patients with asthma
  • Recurrent pulmonary infiltrates on chest imaging
  • May result in development of bronchiectasis, cchronic pulmonary aspergillosis, or aspergilloma
  • Treatment with anti-fungal agents, steroids, and asthma control[2]
Allergic Aspergillus Sinusitis / Rhinosinusitis
  • Immune-modulated sinus disease (not an infection)
  • Clinical features of recurrent or resistant sinusitis, such as increased sinus drainage, stuffiness, headache, and facial tenderness, eosinophilic secretions
  • Non-invasive
  • Common in healthy young adults
  • Diagnosed using Bent and Kuhn diagnostic criteria (see criteria here)
  • Unilateral, asymmetric involvement of sinues with bone erosions on imaging
  • Treamtent includes de-obstruction, nasal drainage, oral steroids, immunotherapy against allergens, and allergy control[3]
Aspergilloma (Fungus Ball)
  • An Aspergillus mass ccolonizes locally in either the lungs or the sinuses
  • May occur with chronic pulmonary aspergillosis
  • Clinical features vary from an asymptomatic course to fatal hemoptysis
  • Common among individuals with prior history of lung diseases, including tuberculosis
  • Chest CT in prone position shows movable fungus ball
  • Treatment includes surgical resection[4]
Chronic Pulmonary Aspergillosis
  • Invasion of Aspergillus in the pulmonary for > 3 month
  • May occur with aspergillomas (single or multiple)
  • Clinical features include weight loss, chronic dry cough, dyspnea, and hemoptysis
  • On Imaging, 1 of 3 patterns is characteristic: multiple cavities (chronic cavitary pulmonary aspergillosis - CCPA), fibrosis (chronic fibrosing pulmonary aspergillosis - CFPA), or slowly enlarging single cavity with a subacute course (chcronic necrotizing pulmonary aspergillosis - CNPA)
  • Treatment includes systemic and intracavitary anti-fungal agents[5]
Invasive Aspergillosis
  • Severe infection among immunocompromised individuals (e.g. transplant recipients or neutropenic patients)
  • Associated with high mortality rate
  • May progress to involve other non-pulmonary organs
  • Non-specific clinical features make diagnosis difficult, may mimic asthma or bronchitis
  • Classical triad of fever, pleuritic chest pain, and hemoptysis
  • Focal nodules and infiltration common on imaging
  • Treatment includes anti-fungal agents[6]
Cutaneous Aspergillosis
  • Infection of the skin
  • Invasion may be either primary through a skin lesion (e.g. surgical or burn wound or catheter site) or secondary to a distant organ to the skin
  • Common among immunocompromised individuals

Clinical features usually include fever, change in wound morphology. Lesions are cocmmonly macules, papules, nodules, or plaques. Other lesions may also occur Diagnosis is by biopsy of the lesion, evaluation of other primary sources (e.g. CT scan for pulmonary lesiosn) is necessary

  • Treatment includes anti-fungal agents with or without surgery[7]

References

  1. ↑ Definition of Aspergillosis - Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/fungal/diseases/aspergillosis/definition.html Accessed on Feb 8 2016
  2. ↑ Agarwal R, Chakrabarti A, Shah A, Gupta D, Meis JF, Guleria R; et al. (2013). "Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria". Clin Exp Allergy. 43 (8): 850–73. doi:10.1111/cea.12141. PMID 23889240.
  3. ↑ Glass D, Amedee RG (2011). "Allergic fungal rhinosinusitis: a review". Ochsner J. 11 (3): 271–5. PMC 3179194. PMID 21960761.
  4. ↑ Lee SH, Lee BJ, Jung DY, Kim JH, Sohn DS, Shin JW; et al. (2004). "Clinical manifestations and treatment outcomes of pulmonary aspergilloma". Korean J Intern Med. 19 (1): 38–42. PMC 4531547. PMID 15053042.
  5. ↑ Denning DW, Riniotis K, Dobrashian R, Sambatakou H (2003). "Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review". Clin Infect Dis. 37 Suppl 3: S265–80. doi:10.1086/376526. PMID 12975754.
  6. ↑ Naaraayan A, Kavian R, Lederman J, Basak P, Jesmajian S (2015). "Invasive pulmonary aspergillosis - case report and review of literature". J Community Hosp Intern Med Perspect. 5 (1): 26322. doi:10.3402/jchimp.v5.26322. PMC 4318821. PMID 25656673. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW; et al. (2002). "Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis". N Engl J Med. 347 (6): 408–15. doi:10.1056/NEJMoa020191. PMID 12167683.
  7. ↑ van Burik JA, Colven R, Spach DH (1998). "Cutaneous aspergillosis". J Clin Microbiol. 36 (11): 3115–21. PMC 105285. PMID 9774549.
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