Disease is usually chronically with various allergic reactions or toxic effects. The causative agent of aspergillosis strongly enough widespread in the environment - they are in the ground and in the water and in the air, and is able to reproduce in humans and in animals.
Due to the fact that the first hit takes the respiratory system, the major of aspergillosis symptoms begin to appear just on the part of the respiratory system. Sometimes the fungus enters the body with the blood and lymph, quickly spreading to all organs. This type of disease is characterized by high mortality - about 80%.
What it is?
Aspergillosis - a fungal infection caused by certain types of mold fungi Aspergillus types. Aspergillosis occurs with multiple chronic toxic and allergic manifestations.
If a person falls ill aspergillosis, most often it is exposed to infection bronchopulmonary system and paranasal sinuses. In some cases, aspergillosis affects the skin, visual and central nervous system.
The causes of aspergillosis
Infecting agents belong to the genus Aspergillus, and the greatest value in human pathology have A. Flavus and A. Niger, but can meet other species, for example, A. The Nidulans or A. Fumigatus. We can say that these types of morphologically fungi consist of the same type mycelium having a width of 4-6 microns. Aspergillus, usually possess a sufficiently high biochemical activity, thus can form a variety of enzymes.
Pathogens pulmonary aspergillosis are widespread in nature. Most often they are found in hay, flour, soil and grain, as well as dust. The organism usually exciter dust falls through the air. By inhalatory it reaches the mucous membranes are located on the upper respiratory tract. It is quite possible infection through the skin, which is often changed other pathological process.
Reduced immune defense plays a leading role in the development of aspergillosis. This disease can be complicated by a variety of pathological processes in the skin, internal organs and mucous membranes.
Classification
Aspergillosis is distinguished by its localization of pathological processes:
- bronchopulmonary (including pulmonary aspergillosis);
- aspergillosis otolaryngology;
- Aspergillosis of the skin, eyes, and bones;
- sepsis, or generalized aspergillosis.
Depending on the fungal infection pathways are several types of aspergillosis:
- endogenous (self-infection);
- Exogenous (or airborne alimentary transmission path);
- transplacental (vertical path of infection);
According to statistics, about 90 percent of all cases of the disease aspergillosis accounts for primary infection of the respiratory tract and lungs. About five percent - infection of the paranasal sinuses. Furthermore, involvement in the pathological process of other human organs is diagnosed in nearly five per cent of people exposed to infection.
pulmonary aspergillosis
Pulmonary aspergillosis is a serious diagnosis. Since due to the development of the disease, which is caused by fungi, Aspergillus, in human lungs begin aspergilloma formed, that is, tumor formation, which consist of tightly woven fungi. Yet there are also complications such as endocarditis, Aspergillus pleurisy, otitis, meningoencephalitis and others.
However, at any time aspergilloma can cause serious complication - a pulmonary hemorrhage, which can be massive and profuse. And in this case there is no alternative to surgical treatment. Treatment aspergillosis conservative methods may fungus in lesions of mucous membranes or skin.
The symptoms of aspergillosis in humans
Since the first takes the brunt of the respiratory system, the main symptoms aspergillosis a person begin to show it on the part of the respiratory system. In the third case the fungus enters the body through the blood and lymph and spreads to all organs. In this type of aspergillosis high mortality rate - about eighty percent. The most rare - cutaneous aspergillosis.
If the fungus settled on the surface and does not penetrate into the mucous membrane, as it happens at traheobronhite, aspergilloma, the Patients report at the following symptoms: chronic cough with sputum, sometimes with blood when strained coughing. Most often in such cases, there is pathology of the lung.
In response to the penetration of spores produce human body tissue specific inflammatory reaction. Two types of the most common inflammation - serous desquamative and fibro-purulent. In sero-desquamative inflammation Aspergillus causes exfoliation of the epithelium, gastric membranes, pulmonary exuding (plasma and blood elements). In the second type - fibro-purulent - Aspergillus causes release of fluid to fibrin (clot protein) and purulent component. The most severe reaction to aspergillosis - granuloma formation in the lungs.
Otherwise aspergillosis gives sharp picture - in the lungs produce dense infiltration, which disintegrates. With bloodstream infection occurs and other organs. At the beginning of acute aspergillosis is characterized by the phenomenon of neutropenia, which is reflected in the sudden weakness, nasal bleeding, fever, chills sharp, strong sweating, tachycardia, sharp decrease pressure. In this case, the blood showed a decrease of neutrophils, which hinder the body to produce an inflammatory response in the focus of aspergillosis. Therefore, when neutropenia diagnose aspergillosis is often impossible - all the indicators would seem normal. However, the experience of doctors know that this might signal the beginning aspergillosis, so more research is appointed. Most often Aspergillus colonize the nasal sinuses. At the same time there are red pockets, after the collapse of tissues, they lose their color, then turn black. This process is very swift - usually spreads to the eye sockets, facial tissue, in the cerebral side. Typical symptoms of this condition - congestion, pain in the nasal area, sinus infections, swelling of the mucous membrane. The sinuses are filled with pus, but they do not break.
Often allergic aspergillosis joins asthma. In this case, patients report asthma attacks, increased blood eosinophils, dark areas on X-ray examination, the presence of antibodies in serum (galaktoman). To clarify the diagnosis of sputum analysis is taken. In more than half of the patients at sowing find aspergillus. In this case, make a secondary crop for diagnosis (as conidia could accidentally hit).
Diagnostics
Aspergillosis in adults requires careful and comprehensive diagnosis, which, above all, necessary to identify the types and degrees of severity of this disease.
The first step in establishing the correct diagnosis has been the clinician, which asked people, based on the predominant symptom. The doctor should:
- learn the history of the disease and a history of the patient's life - it can point out some etiologic factors;
- carry out a detailed survey of the patient - to find out first-time occurrence and degree of intensity of expression of symptoms. This will enable the clinician to determine the severity of the disease;
- perform a thorough physical examination, which, depending on the situation, may include ophthalmologic eye examination, palpation the front wall of the abdomen to study the state of the skin and nail plates, as well as listening to the lungs using phonendoscope.
Diagnostics aspergillosis includes the exercise:
- chest X-ray;
- biopsy;
- bronchoscopy;
- spirometry;
- CT.
Laboratory tests will also vary depending on the nature of the course of infection. In most cases, they include:
- study of discharge from the nasal sinuses or the external auditory meatus;
- microscopic examination of feces;
- CBC - may indicate the occurrence of an allergic or inflammatory process;
- sputum is coughed up - to detect particles Aspergillus;
- blood chemistry;
- scraping a skin or nail plate;
- an imprint on the surface of the cornea;
- PCR.
Such measures will not only help make the correct diagnosis, but also to make a differential diagnosis of this disease.
aspergillosis treatment
Regardless of the type of aspergillosis in humans, the treatment is very time-consuming task. Chemotherapy and antibacterial agents do not lead to the desired effect, as well as all other known methods of doctors combating infectious diseases.
For this reason, in recent years in the diagnosis of aspergillosis, treatment is based on the use of surgical methods. Patients underwent lobectomy with resection of the affected organs. If the operation was carried out by a competent person in compliance with all established procedures - interference tolerated without complications and gives good predictions for the future.
When running forms pulmonary aspergillosis surgical treatment is used in conjunction with conservative methods. Aspergillosis patients administered amphotericin B, oxacillin, nystatin, erythromycin, tetracycline antibiotics group. At the same time a person takes vitamins. It is also recommended that patients with aspergillosis restorative treatment.
When using antifungal drugs the number of antibodies in the blood increases dramatically, but by the end of the treatment, it bounces back. If pulmonary aspergillosis leads to lesions of the skin and mucous membranes, patients are recommended antimycotic and anti-inflammatory agents.
Prediction and prevention
The most favorable for aspergillosis is observed in skin and mucous membranes. Mortality from pulmonary forms of athlete's foot is 20-35%, and in immunosuppressed persons - up to 50%. Septic form of aspergillosis has a poor prognosis.
Measures to help prevent infection aspergillosis include measures to improve the sanitary conditions: the fight with the dust in the workplace, the wearing of employees mills granaries, vegetable stores, weaving companies of personal protective equipment (respirators), improved ventilation of shops and warehouses, regular mycological examination of persons from groups risk.
