B.NAVEEN KUMAR*, Dr.Hindustan Abdul ahad, G.Chaitanya, S.MohammedShaibaz
Balaji College of Pharmacy, Anantapur.
E-mail: [email protected]
The term “aspergillosis” refers to illness due to allergy, airway or lung invasion, cutaneous infection, or extrapulmonary dissemination caused by species of Aspergillus, most commonly A. fumigatus, A. flavus, and A. terreus. Aspergillus species are ubiquitous in nature, and inhalation of infectious conidia is a common event. However, tissue invasion is uncommon and occurs most frequently in the setting of immunosuppression associated with receipt of therapy for hematologic malignancies or hematopoietic cell or solid organ transplantation. The diagnosis of invasive aspergillosis will be reviewed here. The epidemiology, clinical manifestations, and treatment of invasive aspergillosis are discussed separately; the diagnosis of invasive aspergillosis in HIV-infected patients, as well as the diagnosis of other syndromes caused by Aspergillus spp, is also presented elsewhere.
Aspergillosis is an infection caused by a fungus called Aspergillus. There are several different kinds of aspergillosis. One kind is allergic bronchopulmonary aspergillosis (also called ABPA), a condition where the fungus causes allergic respiratory symptoms, such as wheezing and coughing, but does not actually invade and destroy tissue in the body. Another kind of aspergillosis is invasive aspergillosis, a disease that usually affects people with weakened immune systems. In this condition, the fungus invades and damages tissues in the body. Invasive aspergillosis most commonly affects the lungs, but Aspergillus can spread throughout the body and also cause infection in other organs.
The different kinds of aspergillosis can cause different symptoms.
Symptoms of allergic bronchopulmonary aspergillosis (ABPA) may include:
Fever (in rare cases)
Symptoms of invasive aspergillosis may include:
Shortness of breath
Aspergilloma, or “fungus ball”
Other symptoms may develop if the infection spreads beyond the lungs. When invasive aspergillosis spreads outside of the lungs, it can cause symptoms in almost any organ. If you have symptoms that you think are related to aspergillosis, contact your doctor.
Aspergillus is common in the environment, so most people breathe in the fungal spores every day. It is probably impossible to completely avoid breathing in some Aspergillus spores. For people with healthy immune systems, this does not cause harm, and the immune system is able to get rid of the spores. But for people with weakened immune systems, breathing in Aspergillusspores can lead to infection. Studies have shown that invasive aspergillosis can occur during building renovation or construction. Outbreaks of Aspergillus skin infections have been traced to contaminated biomedical devices. Aspergillosis cannot be spread from person to person or between people and animals.
Aspergillus species are frequently inhaled into the airways, but because of effective conidial clearance in the majority of individuals, disease usually does not result. Because we inhale conidia constantly, culture isolation of Aspergillus species from the airway does not necessarily indicate disease. Thus, the diagnosis of invasive aspergillosis is based upon both isolating the organism (or markers of the organism) and the probability that it is the cause of disease. The latter is a function of the host’s risk factors for disease (eg, immune status) and the clinical presentation. Demonstration of hyphal elements invading tissues (from biopsy of any affected site, such as the lung or skin) represents a proven diagnosis.
Given the above issues, the diagnosis of invasive aspergillosis is often referred to within a scale of certainty: possible, probable, or proven. These definitions have been developed in order to maintain consistency in clinical and epidemiologic studies, not to drive therapeutic decision making.
Aspergillosis requires treatment with antifungal medication prescribed by a doctor. Voriconazole is currently the first-line treatment for invasive aspergillosis. There are other medications that can be used to treat invasive aspergillosis in patients who cannot take voriconazole or who have not responded to voriconazole. These include itraconazole, lipid amphotericin formulations, caspofungin, micafungin, and posaconazole. Whenever possible, immunosuppressive medications should be discontinued or decreased.