Aspergillosis - diseases of fungal etiology, the causative agents of which are mold fungi Aspergillus. They can affect not only the skin, but also the mucous membranes of the internal organs.
The degree and depth of penetration of pathogenic fungi can also be different. Due to such features of this type of mycosis, its study is carried out not only by specialists in the field of dermatology, but also pulmonologists, ophthalmologists, otolaryngologists, etc.
In recent years, the incidence of this pathology has increased by 20%. HIV-infected patients, people with immunodeficiency, injecting drug users are most affected. People who take antibiotics uncontrollably, as well as cancer patients undergoing immunosuppressive medication, are also at risk of aspergillosis infection. As a complication, the disease can develop after organ transplantation.
What it is?
Aspergillosis is a term for a group of mycoses caused by aspergillus molds. The most common diseases of this etiology are allergic bronchopulmonary aspergillosis, aspergilloma, invasive pulmonary aspergillosis.
Many people daily inhale aspergillus with the air, but the disease manifests itself only in persons with weak immunity. This type of mycosis can lead to severe complications, including death, in patients with acute leukemia, as well as in patients undergoing hematopoietic cell transplantation.
Most often, in the blood of infected people, the fungus Aspergillus fumigatus is detected.
Causative Agent and Routes of Infection
Aspergillus mold fungi that cause aspergillosis are very heat resistant. The optimal condition for their reproduction is a wet environment. Most often, the disease is provoked by Aspergillus fumigatus fungi, less often Aspergillus vlavus. Aspergillus niger is extremely rare in the body of patients.
Fungi of this kind can be identified in residential areas, as well as on the surface of spoiled food. Throughout their life, aspergillis secrete a large number of allergens that provoke powerful allergic reactions. Often there is a lesion of the lungs, which leads to the development of bronchopulmonary aspergillosis. Some types of aspergillus secrete endotoxins, which cause intoxication of the body.
These fungi are resistant to dry conditions and may be present in dust particles. The effect of formaldehyde solution and carbolic acid is detrimental to aspergillus.
The mechanism of infection is airborne disease, and the direct transmission occurs by air and dust. But there are certain groups of people who, due to their professional characteristics, are prone to this disease. It:
- employees of agro-industrial complexes;
- spinning and weaving workers;
- patients with immune suppression undergoing inpatient treatment.
Infection with aspergillosis is also possible if they are already present in the human body, or are on its skin. The main factor predisposing to the development of aspergillosis is immunodeficiency. Against this background, there are often different types of mycoses, most of which are just occupied by aspergillosis.
A person infected with Aspergillus does not pose a danger to others: no such cases of disease transmission have been recorded. There is also no data on the presence of seasonal outbreaks of pathology among the population.
After suffering aspergillosis, the patient develops immunity. However, it does not differ in persistence, therefore, in patients with immunodeficiency states, relapses of this type of mycosis are possible.
Impact on the human body
The infection penetrates primarily through the upper respiratory tract. At first, the aspergillas are located on the surface of the mucous membranes, but gradually deepen, causing the formation of sores.
Features of the impact of the disease on the human body are as follows:
- Even in an absolutely healthy person, inhaling large amounts of aspergillus can trigger the development of interstitial pneumonia. With this disease, aspergillus is formed - specific granulomas containing purulent exudate and formed from giant epithelial cells. They have a spherical shape, and in their purulent contents are the hyphae of pathogenic fungi. Usually aspergillomas are localized in the tissues of the upper pulmonary regions, and this is clearly visible on the radiograph. Fungi can be found in the bronchi, pulmonary cavities, cysts, and foci of bronchiectasis. Aspergillus does not penetrate directly into the lung tissue, therefore this form of the disease is called non-invasive aspergillosis.
- Aspergillosis most often develops on the background of immunodeficiency. There are cases of the development of pathologies of internal organs, mucous membranes and skin. As an example, abscess or lung cancer, tuberculosis - a pathology in which the development of pulmonary aspergillosis occurs. In recent decades, this fungal disease is increasingly common in patients with HIV and AIDS.
- There is also an invasive form of aspergillosis, in which damage to the internal organs occurs. In the overwhelming number of cases, it is manifested in persons with immunodeficiency. In 90% of patients, 1 of 3 features that are directly related to the manifestation of such aspergillosis are detected:
- treatment of GCS;
- taking cytostatics;
- the level of granulocytes in the blood is less than 500 units.
In invasive aspergillosis, the fungi invade the tissues of the internal organs along with the bloodstream. First, they affect the lungs, then - the pleura and lymph nodes, and subsequently settle in other organs. Aspergillomas with purulent contents in this case are localized in the affected area of the internal organ. In place of granulomas, abscesses often form, resembling in their characteristics a septic process. In this case, mortality is almost 50%.
Aspergillus - the most powerful allergens that can lead to the development of intense allergic reactions. In this scenario, primarily affected branches of the bronchopulmonary tree with the attendant symptoms of this process.
Symptoms of aspergillosis
Pulmonary form of aspergillosis is manifested by the following symptoms:
- cough with a grayish secretion;
- bronchial obstruction;
- frequent bouts of weakness;
- losing weight
With the progression of fungal infection, pneumonia develops. It is characterized by the occurrence of such symptoms:
- atypical fever;
- cough with mucopurulent secretion;
- severe shortness of breath;
- chest pains;
- moldy smell from the oral cavity.
In the study of sputum spore mold fungi Aspergillus are detected.
If a patient with aspergillosis suffers from other diseases of the respiratory system (chronic bronchitis, pneumonia, tuberculosis or lung cancer), the addition of aspergillosis can only aggravate the situation. In parallel, an encapsulated lesion formed by mucus, fibrin, cellular elements, and aspergillus hyphae may begin to form in the tissues of the patient's organ. In such a situation they talk about aspergilloma of the lungs. This situation threatens to open massive pulmonary hemorrhage, as well as asphyxia. Both complications are equally dangerous for the life of the patient, so they require immediate medical intervention.
With the defeat of aspergilli ENT organs can develop:
- external or average otitis;
- fungal tonsillitis or pharyngitis;
With the development of aspergillus otitis, patients suffer from:
- itching in the outer part of the auditory canal;
- peeling skin of the ear;
- the appearance of a friable discharge of a grayish tint in the auditory process (microscopic examination of these secretions reveals aspergillus hyphae);
- sharp pricking pains in the ear (they appear only if the pathological process affected the eardrum).
Aspergillus infection can also affect the paranasal sinuses, provoking the development of fungal sinusitis, ethmoiditis, frontal sinusitis. It is also possible to attach the infection to the visual apparatus, which is fraught with:
- nodular keratitis;
- ulcerative blepharitis;
- ulceration on the surface of the cornea;
Cutaneous aspergillosis is accompanied by:
- the formation of infiltrates;
- mild pruritus;
- the appearance of scales brown.
With the defeat of nail fungi, they acquire a brownish-greenish or yellowish shade in the affected area. Also, the nail plate becomes thin, begins to crumble and exfoliate.
In some cases, aspergillosis affects the gastrointestinal tract. This violation is accompanied by symptoms of gastritis and enterocolitis, namely:
- severe pain in the stomach or intestines;
- the appearance of mold odor from the mouth;
Generalized aspergillosis is characterized by the spread of fungi from the tissues of the primary focus (for example, the lungs) to other organs. Against this background, the development is possible:
- brain abscess;
- hepatitis A;
- pathologies of the digestive tract;
- bone lesions;
- otorhinolaryngological diseases, etc.
When Aspergillus penetrates the blood, Aspergillus sepsis develops, at which the risk of death is significantly increased.
Based on the patient's complaints, the doctor can make a preliminary diagnosis. But it requires mandatory verification, since the tactics of therapy will directly depend on it. In almost 100% of cases, aspergillosis is “in absentia” placed in patients taking drugs that suppress immunity.
To confirm or deny the presence of the disease help:
- general clinical analysis of blood (with aspergillosis, an increase in ESR, eosinophilia and leukocytosis);
- serological antibody test;
- test for determining the level of immunoglobulin E;
- sputum bakposev;
- microscopic examination of scrapings from mucous membranes;
- fence sampling and study.
Additionally possible to:
- CT scan;
- aspiration biopsy;
- bronchopulmonary lavage.
It is important to differentiate aspergillosis from other mycoses, oncological processes, tuberculosis or lung abscess. The sooner the diagnosis is made and clarified, the more successful the treatment will be.
Aspergillosis treatment can occur on an outpatient or inpatient basis. The choice of therapeutic tactics and methods depends on the form of the disease, the severity of its course, the presence or absence of complications, the localization of the lesion of the pathological process and some other factors. The treatment process is organized by a specialized specialist after the affected organ is identified.
If we talk about antifungal therapy, it is carried out through the use of:
- Amphotericin B;
Such preparations are intended for oral administration, injection or inhalation.
Aspergillosis, as already noted, can affect not only the internal organs, but also the skin, mucous membranes and nail plates. If the patient has been diagnosed with such a form of the pathological process, then the doctor should carry out a thorough treatment (reorganization) of any and all foci of the infectious-inflammatory process. To do this, it is recommended to use antibacterial, antiseptic, antimycotic medication.
Antifungal therapy continues, usually for 1 to 2 months. However, everything is purely individual, and sometimes the doctor has to extend the course of treatment for up to 3 months.
The most favorable in terms of future projections is the form of the disease is aspergillosis of the skin and mucous membranes. But pulmonary mycosis in 30% of cases is fatal. In immunocompromised patients, the mortality rate is even higher, at almost 50%.
In septic form of aspergillosis, the prognosis is even more unfavorable than in other types of the disease.
Patients who are at risk should be guided by certain rules. Their observance will help prevent the development of aspergillosis by preventing its pathogen from entering the body. For this it is important:
- maintain an optimal level of humidity in the house;
- fight mold in residential areas;
- carefully monitor the cleanliness of the bathrooms and toilets, because it is in these rooms that high humidity is most often observed, and mold appears;
- constantly monitor the cleanliness of the refrigerator, as this is another favorite place for mold fungus. It is necessary not only to wash the shelves and departments of the refrigerator, but also to regularly clean it from spoiled food.
Prevention, like the treatment of aspergillosis, should be comprehensive and versatile - only this way it is possible to prevent a disease that can not only harm health, but also threaten human life.