Aspergillosis

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Definition

Aspergillosis refers to several forms of disease caused by a fungus in the genus Aspergillus. Aspergillosis fungal infections can occur in the ear canal, eyes, nose, sinus cavities, and lungs. In some individuals, the infection can even invade bone and the membranes that enclose the brain and spinal cord (meningitis).

Description

Aspergillosis is primarily an infection of the lungs caused by the inhalation of airborne spores of the fungus Aspergillus. Spores are the small particles that most fungi use to reproduce. Although virtually everyone is exposed to this fungus in their daily environment, it rarely causes disease. When Aspergillus does cause disease, however, it usually occurs in those individuals with weakened immune systems (immunocompromised) or who have a history of respiratory ailments. Because it does not present distinctive symptoms, aspergillosis is generally thought to be underdiagnosed and underreported. Furthermore, many patients with the more severe forms of aspergillosis tend to have multiple, complex health problems, such as AIDS or a blood disorder like leukemia, which can further complicate diagnosis and treatment.

Once considered particularly rare, the incidence of reported aspergillosis has risen somewhat with the development of more sophisticated methods of diagnosis and advances made in other areas of medicine, such as with the increased use of certain chemotherapeutic and corticosteroid drugs that are extremely useful in treating various types of cancer but that decrease the individual's immune response, making them more susceptible to other diseases like aspergillosis.

Our advanced ability to perform tissue and organ transplants has also increased the number of people vulnerable to fungal infections. Transplant recipients, particularly those receiving bone marrow or heart transplants, are highly susceptible to Aspergillus, which may be circulating in the hospital air.

Aspergillosis can be a serious, potentially deadly threat for two primary reasons:

• Aspergillosis usually occurs in those individuals who are already ill or have weakened immune systems, such as patients who have undergone chemotherapy for cancer.
• None of the currently available antifungal drugs are reliably effective against Aspergillus.

— Jill S. Lasker

Dictionary: as·per·gil·lo·sis  (ăs'pər-jə-lō'sĭs)

An infection or disease caused by fungi of the genus Aspergillus.

[ASPERGILL(US) + –OSIS.]

An infection caused by a fungus of the genus Aspergillus.Most commonly affects the ear but is capable of causing inflammatory, granulomatous lesions on or in any organ.

Aspergillosis. (Neville/Damm/Allen/Bouquot, 2002)

A disease caused by species of Aspergillus, marked by inflammatory granulomatous lesions in the skin, ear, orbit, nasal sinuses, lungs, and sometimes bones and meninges. Abortion due to fungal placentitis is common in cows and occurs also in mares and sows. Subacute pulmonary involvement may be accompanied by lesions at all levels in the respiratory tract. Congenital infection of the fetus, especially manifested by dermatitis, is a rare accompaniment. A gastroenteritis with ulceration in the esophagus and forestomachs occurs in calves. Rarely osteomyelitis, intestinal and central nervous system involvement have been recorded in dogs, the most frequent site of infection being the nasal cavity. See also brooder pneumonia.

• avian a. — principal manifestation is as pneumonia but systemic invasion, dermatitis, osteomyelitis, ophthalmitis, encephalitis also occur. Species involved are A. fumigatus, A. flavus.
• disseminated a. — in dogs, a disseminated disease characterized by signs of generalized infection, lymphadenopathy, diskospondylitis, and lameness, paresis or paraplegia. A. terreus is the most common etiologic agent and German shepherd dogs are predisposed. Cats with disseminated aspergillosis usually have concurrent immunosuppressive disease.
• nasal a. — a localized form of aspergillosis, involving the nose, ears and paranasal sinuses. In dogs, there is usually a unilateral or bilateral serosanguinous nasal discharge and a characteristic depigmentation and ulceration of skin adjacent to the external nares.

Aspergillosis
Classification & external resources

Histopathologic image of pulmonary invasive aspergillosis in a patient with interstitial pneumonia. Autopsy material. Grocott's methenamine silver stain.
ICD-10	B44.
ICD-9	117.3
MedlinePlus	001326
eMedicine	med/174
MeSH	D001228

Aspergillosis is the name given to a wide variety of diseases caused by the genus of fungi Aspergillus. The most common forms are allergic bronchopulmonary aspergillosis, pulmonary aspergilloma and invasive aspergillosis. Compromised immune systems often allow Aspergillus to colonize.

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—rarely—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.^[1]

Treatment

The drugs amphotericin B, caspofungin, flucytosine, itraconazole, voriconazole ^[2] are used to treat this fungal infection.

Notable Outbreaks

Aspergillosis has been the culprit in several recent rapid die-offs among waterfowl. From December 8-14, 2006 over 2,000 Mallards died in the Burley, Idaho area, an agricultural community approximately 150 miles southeast of Boise. Moldy waste grain from the farmland and feedlots in the area is the suspected source. A similar aspergillosis outbreak killed 500 mallards in Iowa in 2005. Moldy grain was the cause in that case.

Mallards and other ducks are particularly susceptible to Aspergillosis as they will often resort to poor food sources during bad weather.

Albeit relatively rare in humans, aspergillosis is a common and dangerous infection in birds, particularly in pet parrots and parakeets.

While there is no connection between Aspergillosis and the H5N1 strain of Avian Influenza (commonly called "bird flu"), the rapid die-offs it causes can spark fears of a bird-flu outbreak in the communities where the die-offs occur. There is no outwardly visible sign off the fungal infection as the cause; laboratory analysis is the only way to prove or disprove bird-flu or Aspergillosis.

References

1. ^ Curtis A, Smith G, Ravin C (Oct 1979). "Air crescent sign of invasive aspergillosis.". Radiology 133 (1): 17-21. PMID 472287. 
2. ^ Herbrecht R, Denning D, Patterson T, Bennett J, Greene R, Oestmann J, Kern W, Marr K, Ribaud P, Lortholary O, Sylvester R, Rubin R, Wingard J, Stark P, Durand C, Caillot D, Thiel E, Chandrasekar P, Hodges M, Schlamm H, Troke P, de Pauw B; Invasive Fungal Infections Group of the European Organisation for Research and Treatment of Cancer and the Global Aspergillus Study Group. (Aug 8 2002). "Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis.". N Engl J Med 347 (6): 408-15. PMID 12167683. 

External links

• Aspergillus - aspergillus.org.uk
• Aspergillosis -doctorfungus.org
• USGS National Wildlife Health Center - www.nwhc.usgs.gov

Mycoses (B35-B49, 110-118)
Tinea: Dermatophytosis	Tinea barbae/Tinea capitis - Tinea unguium/Onychomycosis - Tinea manuum - Athlete's foot - Tinea corporis - Tinea cruris
Tinea: Other superficial mycoses	Tinea versicolor - Tinea nigra - White piedra
Dimorphic fungi	Coccidioidomycosis - Histoplasmosis - Blastomycosis - Paracoccidioidomycosis - Sporotrichosis
Other	Candidiasis (Oral candidiasis) - Chromoblastomycosis - Aspergillosis - Cryptococcosis - Phycomycosis/Mucormycosis - Mycetoma (Eumycetoma, Maduromycosis, Actinomycetoma) - Lobo's disease - Pneumocystis pneumonia

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