Aspergillosis classification: Difference between revisions
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*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 | ||
*Common among patients with asthma | *Common among patients with [[asthma]] | ||
*Recurrent pulmonary infiltrates on chest imaging | *Recurrent pulmonary infiltrates on chest imaging | ||
*May result in development of bronchiectasis, | *May result in development of [[bronchiectasis]], chronic pulmonary aspergillosis, or aspergilloma | ||
*Treatment with | *Treatment with [[Antifungal drug|antifungal agents]], [[steroids]], and [[Asthma medical therapy|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> | ||
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| '''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, [[Eosinophilia|eosinophilic secretions]] | ||
*Non-invasive | *Non-invasive | ||
*Common in healthy young adults | *Common in healthy young adults | ||
*Diagnosed using Bent and Kuhn diagnostic criteria (see criteria [[Aspergillosis diagnostic criteria|here]]) | *Diagnosed using Bent and Kuhn diagnostic criteria (see criteria [[Aspergillosis diagnostic criteria|'''here''']]) | ||
*Unilateral, asymmetric involvement of sinues with bone erosions on imaging | *Unilateral, asymmetric involvement of sinues with bone erosions on imaging | ||
*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> | ||
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*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 | ||
*Clinical features vary from an asymptomatic course to fatal hemoptysis | *Clinical features vary from an asymptomatic course to fatal [[hemoptysis]] | ||
*Common among individuals with prior history of lung diseases, including [[tuberculosis]] | *Common among individuals with prior history of lung diseases, including [[tuberculosis]] | ||
*Chest CT in prone position shows movable fungus ball | *Chest CT in prone position shows movable fungus ball | ||
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*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) | ||
*Clinical features include weight loss, chronic dry cough, dyspnea, and hemoptysis | *Clinical features include [[weight loss]], [[Ccough|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) | *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 | *Treatment includes systemic and intracavitary [[Antifungal drug|antifungal 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> | ||
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| '''Invasive Aspergillosis'''|| | | '''Invasive Aspergillosis'''|| | ||
*Severe infection among immunocompromised individuals (e.g. transplant | *Severe infection among immunocompromised individuals (e.g. [[transplant recipient]]s or [[neutropenia|neutropenic patients]]) | ||
*Associated with high mortality rate | *Associated with high mortality rate | ||
*May progress to involve other non-pulmonary organs | *May progress to involve other non-pulmonary organs | ||
*Non-specific clinical features make diagnosis difficult, may mimic asthma or bronchitis | *Non-specific clinical features make diagnosis difficult, may mimic asthma or bronchitis | ||
*Classical triad of fever, pleuritic chest pain, and hemoptysis | *Classical triad of [[fever]], [[pleuritic chest pain]], and [[hemoptysis]] | ||
*Focal | *Focal [[nodule]]s and [[infiltration]] common on imaging | ||
*Treatment includes | *Treatment includes [[Antifungal drug|antifungal 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> | ||
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| '''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 wound|surgical]] or [[burn wound]] or at [[catheter site]]) or secondary to a distant organ to the skin | ||
*Common among immunocompromised individuals | *Common among immunocompromised individuals | ||
Clinical features usually include fever, change in | *Clinical features usually include [[fever]], change in lesion morphology. Lesions are cocmmonly [[macule]]s, [[papule]]s, [[nodule]]s, or [[plaque]]s. 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 | *Diagnosis is by biopsy of the lesion, evaluation of other primary sources (e.g. CT scan for pulmonary lesiosn) is necessary | ||
*Treatment includes | *Treatment includes [[Antifungal drug|antifungal 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 17:58, 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) |
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| Allergic Aspergillus Sinusitis / Rhinosinusitis |
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| Aspergilloma (Fungus Ball) |
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| Chronic Pulmonary Aspergillosis |
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| Invasive Aspergillosis |
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| Cutaneous Aspergillosis |
|
References
- ↑ Definition of Aspergillosis - Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/fungal/diseases/aspergillosis/definition.html Accessed on Feb 8 2016
- ↑ 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.
- ↑ Glass D, Amedee RG (2011). "Allergic fungal rhinosinusitis: a review". Ochsner J. 11 (3): 271–5. PMC 3179194. PMID 21960761.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ van Burik JA, Colven R, Spach DH (1998). "Cutaneous aspergillosis". J Clin Microbiol. 36 (11): 3115–21. PMC 105285. PMID 9774549.