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Saturday, March 06, 2010

ASPERGILLOSIS

Aspergillosis is the name given to a wide variety of diseases caused by fungi of the genusAspergillus. The most common forms are allergic bronchopulmonary aspergillosis, pulmonaryaspergilloma and invasive aspergillosis. Most humans inhale Aspergillus spores every day. Aspergillosis develops mainly in individuals who are immunocompromised, either from disease or from immunosuppressive drugs, and is a leading cause of death in acute leukemia andhematopoietic stem cell transplantation. Conversely, it may also develop as an allergic response. The most common cause is Aspergillus fumigatus.

SYMPTOMS
A fungus ball in the lungs may cause no symptoms and may be discovered only with a chest x-ray. Or it may cause repeated coughing up of blood and occasionally severe, even fatal, bleeding. A rapidly invasive Aspergillus infection in the lungs often causes cough, fever, chest pain, and difficulty breathing.
Aspergillosis affecting the deeper tissues makes a person very ill. Symptoms include fever, chills, shock, delirium, and blood clots. The person may develop kidney failure, liver failure (causing jaundice), and breathing difficulties. Death can occur quickly.
Aspergillosis of the ear canal causes itching and occasionally pain. Fluid draining overnight from the ear may leave a stain on the pillow. Aspergillosis of the sinuses causes a feeling of congestion and sometimes pain or discharge.
In addition to the symptoms, an x-ray or computerised tomography (CT) scan of the infected area provides clues for making the diagnosis. Whenever possible, a doctor sends a sample of infected material to a laboratory to confirm identification of the fungus.

DIAGNOSIS
On chest X-ray and computed tomography pulmonary aspergillosis classically manifests as an air crescent sign. In hematologic patients with invasive aspergillosis the galactomannan test can make the diagnosis in a noninvasive way.

TREATMENT
The drugs amphotericin B, caspofungin, flucytosine, itraconazole, voriconazole are used to treat this fungal infection. For severe cases of invasive aspergillosis a combination therapy of voriconazole and caspofungin is suggested as a first line treatment.

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