Aspergillosis

Aspergillosis - the illness caused by various kinds of musty mushrooms of sort Aspergillus. Proceeds with a primary lesion of lungs is more often, streets with immunodeficiencyies accepts serious septic (generalised) flow.

Aetiology. Originators - various kinds of sort Aspergillus. The greatest value in a pathology of the human have A. niger, A. flavus, there are also other kinds (A. fumigatus, A. nidulans). Morphologicallies consist of the same mycelium (width 4-6 microns), are sometimes found "heads" with conidiums. At sowing on medium Saburo quickly grow, forming flat colonys, at first white, slightly nappy or velvety, then accept bluish, brown, yellowish and other coloration (depending on a kind); thus their surface becomes farinaceous, powderlike. Aspergillis possess the big biochemical activity, form various enzymes (proteolytic, saccharolytic, lipolytic), and some kinds contain endotoxins at which introduction by an experimental animal paralyses educe and there comes their  destruction. Possess allergenic action. From disinfectants on aspergillis solutions of Acidum carbolicum and formalin most activly react.

Epidemiology. Aspergillis eurysynusic in the nature. They can be found in bedrock, grain, a flour, hay (especially mildewed), in a dust of premises where skins are treated, a wool, hemp. Aspergillis even in a dust of medical institutions that caused an intrahospital becoming infected were found. The originator inpours into an organism, as a rule, through air with a dust. From professional bunches workers of agriculture, workers of the weaver's and textile enterprises are more often amazed. Disease at the relaxed persons can arise and as an endogenous infection contamination as on a mucosa of fauces of healthy humans aspergillis are sometimes found. For last years the aspergillosis at persons with various immunodeficiencyies became an actual problem. In particular, at 20%таких patients mycoses educe, and among the last more than 70 % are necessary on an aspergillosis. Intrahospital infestations of immunodeficient patients by a dust containing aspergillis (air - a dust transmission of infection) are observed. Cases of infestation of the human from sick humans it is not observed.

Pathogenesis. The originator aerogenic by gets on mucosas of the top respiratory tracts. There can come a becoming infected through a skin usually variated by any other pathological process. The leading part in an aspergillosis pathogenesis is played by depression of a host defence of an organism. The aspergillosis complicates various pathological processes of a skin, mucosas, an internals. In particular, pulmonary forms of an aspergillosis arose against a bronchoectatic disease, abscesses of a lung, a pulmonary tuberculosis, a cancer of lungs, a chronic bronchitis, etc. last years the aspergillosis began to be observed especially often at persons with immunodeficiencyies (congenital immunodeficiency disorders, the persons receiving antitumoral chemotherapy, immunodepressants, and also a HIV - infected). It meets much more often, than other deep mycoses. At the relaxed persons with a mushroom lungs in the beginning are amazed, then the pleura, lymph nodes are involved in process. Aspergillis can be brought by a blood flow in other organs, forming there specific granulomas which usually abscess. From pulmonary the aspergillosis turns in generalised (septic) and is frequent (over 50 %) comes to an end with  destruction of the patient. To salvage it is possible those patients at whom have remained in any measure of function of immune system. At massive inhalation of spores of aspergillis persons with normal immune system can have the acute diffusive pneumonia which is coming to an end with self-recover.

Symptoms and flow. The incubation interval precisely is not established. Aspergillis can amaze any organs and tissues. It is possible to carry following forms to clinical implications:

1. bronchopulmonary aspergillosis
2. generalised (septic) aspergillosis
3. ENT aspergillosis - organs
4. eye aspergillosis
5. skin aspergillosis
6. aspergillosis of bones
7. other forms of an aspergillosis (a lesion of mucosas of a mouth, genitals, mycotoxicoses and so forth)

Bronchopulmonary aspergillosis can show in the beginning as an aspergillar bronchitis or a tracheobronchitis. In the beginning aspergillis are in blankets of a mucosa of bronchuses, then process extends more deeply, superficial and deeper ulcerations are formed. Disease proceeds chronically, the patient is disturbed by the general delicacy, tussis with abjection of grey colour of a sputum, sometimes with blood streaks. In a sputum lumps in which aspergillis contain can be found. Process usually progresses, grasps lungs, the aspergillar pneumonia educes. The pulmonary form of a mycosis can be acute and chronic. At acute forms the body temperature, a fever of usually irregular type raises, repeated cold fits quite often become perceptible, there is a tussis with an abundant viscous mucopurulent or bloody sputum. At some patients the sputum contains zelenovato-grey lumps in which at microscopy clumps of a mycelium and mushroom spores are found. There are a dyspnea, stethalgias, night sweats, delicacy, a weight loss accrues. At auscultation finely bubbly wet rhonchuses, sometimes a pleural rub become perceptible. In blood a leukocytosis (to 20х10⁹/l), the eosinophilia, an ESR is enlarged. At a X-ray inspection inflammatory infiltration in the form of the oval or roundish infiltrates inclined to disintegration is found. Round formed lumens the wide infiltrative shaft is visible.

Chronic forms of a pulmonary aspergillosis are usually secondary and accumulate on various lesions of lungs (bronchiectasias, caverns, abscesses). The clinical picture develops of symptoms of a basic disease and the lesions caused by an aspergillar infection contamination. Sometimes patients note an odour of a mould from a mouth, in a sputum there can be the virescent lumps consisting of clumps of a mushroom. Filling of the lumens resulting a basic disease, an original shade in the form of a ball with an air layer between a shade of a ball and lumen sides is characteristic. This layer of gas is taped in the form of an original crescent lumen ("aura"). The lethality at a pulmonary aspergillosis fluctuates from 20 to 37 %.

Septic (generalised) forms of an aspergillosis educe against sharp oppression of immunodefence (sick of AIDS, etc.). This form is characterised by hematogenous diffusion of aspergillis with formation of metastasises in various organs and tissues. Lesions of a gastrointestinal tract (a nausea, vomiting, an odour of a mould from a mouth, the liquid foamy chair containing a considerable quantity of aspergillis), brain abscesses, specific uveites, plural lesions of a skin in the form of original knots can be observed. Changes of a respiratory organs with which usually and the aspergillar sepsis begins are observed also. At sick of AIDS aspergillosis signs are combined with implications of a basic disease and opportunistic infection contaminations (a pneumocystosis, a Kaposi's sarcoma, cryptosporiodosis, a candidiasis, a generalised herpetic infection contamination, etc.). On this background the aspergillar sepsis, or a generalised aspergillosis, leads to a lethal outcome.

Aspergillosis of ENTs-organs shows in the form of an outside and average otitis, after operations on an intrinsic ear, an aspergillosis with a lesion of a mucosa of a nose and adnexal lumens, a larynx aspergillosis. There can be an aspergillar lesion of a skin and fingernails. The professional aspergillosis can educe at the persons having contact to disputes of various kinds aspergilli (weaving mills, shpagatno-spinning, effecting of malt, etc.). The aspergillosis proceeds at them in the form of a chronic bronchitis, sometimes with bronchospasm symptoms is more often.

Flow of an aspergillosis at sick of AIDS. The aspergillosis is the most frequent mycosis educing against an immunodeficiencyy. It arises or in the end preAIDS, more often already at the developed clinical semiology of AIDS. The becoming infected comes exogenously air-dust by, that can descend and during stay in medical unit. Disease educes quickly, in the beginning in the form of a pulmonary aspergillosis which then passes in the septic (generalised) form and is accompanied by a lesion of many organs and systems. Proceeds hardly.

Diagnosis and the differential diagnosis. At aspergillosis recognition epidemiological preconditions (a trade, presence of the illnesses relaxing immunodefence, etc.) are considered . From lesions of bronchuses and lungs diagnostic value has long disease, formation of characteristic infiltrates with the subsequent disintegration, character of a sputum, a leukocytosis, an eosinophilia. As diagnosis acknowledgement originator abjection (from a sputum, a stuff taken from bronchuses, biopsy samples of the struck organs) serves. From blood aspergillis are excreted was very rarely even at generalised forms of an aspergillosis. Diagnostic value has appearance of antibodies to the originator, taped by means of serological tests. Dermal assays with a specific aspergillar antigen can be used only at it is rather benign a proceeding mycosis at persons with normal immune system. It is necessary to consider, that at a HIV-infected already in a stage preAIDS reactions of hypersensitivity of the slowed down type become negative. On clinical and radiological data the aspergillosis is necessary for differentiating with other mycoses (a nocardiosis, a histoplasmosis, a candidiasis), and also with a pulmonary tuberculosis, abscesses of lungs, neoplasms, a chronic bronchitis.

Treatment. Treatment of a pulmonary and generalised aspergillosis represents a difficult problem. The chemotherapy is a little effective. To therapy of a pulmonary aspergillosis with the circumscribed infiltrate last years successfully apply surgical methods (a lobectomy with a resection of the struck fields of a lung). At the majority of patients operation proceeds without complications and gives good long-term results (relapses it is not observed). At process diffusion on many organs surgical methods are used in a complex with conservative treatment. Prescribe iodine preparations inside in accruing doses. Use potassium Iodidum (or sodium): in the beginning 3 % solution, then 5 and 10 % solution on 1 table spoon 3-4 times a day; 10 % iodine tincture in milk from 3 to 30 drops 3 times a day. From Antimycosis antibiotics Amphotericinum B. A preparation apply intravenously in 5 % glucose solution (50 000 Unit Amphotericinum B in 450 ml of solution of a glucose), introduce driply within 4-6 hours. Daily dose 250 UNITS/KG prescribe from calculation the Preparation introduce 2-3 times a week. Duration of a course depends on the clinical form of an aspergillosis and fluctuates from 4 till 8 weeks (at a HIV-infected more longly). At pulmonary forms of an aspergillosis inhalations of solutions of Sodium iodidum, nystatin of sodium salt (10000 Unit in 1 ml), 0,1 % solution diamond green (5 ml) are shown. At stratification of a consecutive infection (usually staphylococcal) it is possible to apply Oxacillinum (on 1 gramme 4 times a day) or erythromycin (on 0,25 gramme 4 times a day). Antibiotics of tetracycline bunch and Levomycetinum are contraindicative, as they promote occurrence of aspergillosises. Prescribe vitamins and fortifying treatment.

At treatment of aspergillar lesions of a skin and mucosas use a locally antiinflammatory and antimycosis preparations.

The forecast. At pulmonary forms the lethality compounds 20-35 % (at persons with the immunodeficiencyies which have been not bound to a HIV-infection,-nearby 50 %). At the generalised (septic) form the forecast unfavorable. At an aspergillosis of a skin and mucosas the forecast congenial.

Preventive maintenance and actions in the locus. Struggle against a dust and a traumatism on effecting. Wearing of oxygen breathing apparatuses by workers on mills, granaries, vegetable storehouses, the weaver's enterprises. In medical institutions for persons with immunodeficiencyies it is possible to reduce considerably frequency of an exogenous becoming infected an aspergillosis by clearing of air arriving in chambers by special air filters. For the prevention of secondary (pulmonary) aspergillosises important early recognition and basic disease treatment.