DISCUSSION
PULMONARY ASPERGELLOSISThere are more than 250 species of aspergillus, among them being:
– A.fumigatus
– A.flavus
– A.terreus
– A niger.
They are acquired through respiratory route. They are increased in damp cellars, potted plants, and dusty environments They rarely cause a disease in normal host. Risk of infection is increased with defects of macrophage or neutrophil.
INVASIVE PULMONARY ASPERGELLOSIS (IPA)
IPA is a major cause of morbidity and mortality in the immunocompromised host (ICP). Invasion usually involves the pulmonary, sinus, cerebral and coetaneous sites.
The
hallmark of IPA is angio-invasion IPA
take many forms including:
–
Acute necrotizing Broncho-pneumonia
–
Hemorrhagic pulmonary infarction
–
Lung
abscess
–
Lobar
pneumonia
–
Solitary
nodulesa
–
Bronchitis,
and pleural effusion.
Abassi et al clinical inf dis 99
EPIDEMIOLOGY
OF IPA
Incidence:
–
6.8% among malignancy. A.H.Groll et al mycosis 42,1999
–
8%
among AML. M. Cornet et al 02,J of hospital infection 2002
–
Incubation
periods : unknown
–
Average
hospitalization: in USA in 1996, 17.3 days, cost $62,426,000. Erik
J .Dubach et al clinical inf dis 2000
–
Transmission by direct inoculation of skin abrasion or wounds is less
likely. Person to person spread does not occur!
Highest risk:
–
Hematological malignancies, organ transplants, HIV? Rapid neutrophil
recovery might be a risk factor for sever pulmonary complication "hemoptysis"
G.Todeschini et al, Eur J clin investigation 99
–
BMT 32%, hematologic disease 29%, solid organ transplants 9%, AIDS 8%
Patterson Thomas et al Med 2000( Baltimore), 2000
Clinical signs:
Non specific but always include fever (refractory fever to broad spectrum
antibiotic therapy). Hemoptysis is not un common.
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