Aspergillosis

Aspergillosis is a disease caused by fungi of the genus Aspergilles with a frequency of localization in the bronchopulmonary system.

Etiology, pathogenesis. Aspergillus - widely spread in nature saprophytes, year round spitting out spores. The disease is inhaled by a large number of aspergillus spores, for example when working with moldy rotting hay, compost. In pathogenesis, in addition to allergic and hemolytic effects of endotoxin, an important role is played by a decrease in the reactivity of the organism in long-term and chronic diseases (tuberculosis, suppuration, neoplasms, systemic blood diseases, alcoholism, etc.) or with prolonged use of immunosuppressive drugs.

Symptoms, course. There are 4 forms of bronchopulmonary aspergillosis. The mild form proceeds as a rapidly transiting acute tracheobronchitis. Allergic bronchial aspergillosis is characterized by transient pulmonary infiltrates, iosinophilia, fever, bronchospasm; Sputum may have a brown tinge, sometimes bronchial bronchitis; The course can be prolonged with repeated exacerbations and development of severe bronchial asthma; In some cases recovery occurs. Aspergilloma (colonies from the mycelium of the fungus lying freely in the tubercular cavern, abscess cavity, bronchiectasis, a site of slowly resolving pneumonia, a lung infarction, in the tumor region) can be asymptomatic, but more often there is cough with sputum secretion without odor, hemoptysis, weight loss (Up to cachexia), high fever, chest pain, progressive deterioration of the condition. The necrotic form of pulmonary aspergillosis proceeds with pronounced intoxication, fever.

Diagnostics uses data from X-ray examination, sputum culture, and serological methods.

Treatment. Effective amphotericin B. Daily dose (250 U / kg) is administered in 450 ml of a 5% solution of sterile glucose IV drip for 4-6 hours every other day or 2 times a week for 4-8 weeks; Inhalation 50 000 ED amphotericin B in 10 ml of water for injection is produced 1 to 2 times a day for 10 to 14 days. The antifungal effect of the drug is enhanced when combined with rifampicin. Amphotericin B has the ability to cumulate, neuronephro- and hepatotoxic.