Aspergillosis
Aspergillosis | |
---|---|
Infectious disease | |
Complications | Bleeding, systemic infection[1] |
Causes | Aspergillus fungal infection |
Frequency | 14 million |
Aspergillosis is a
Aspergillosis occurs in humans, birds and other animals. Aspergillosis occurs in chronic or acute forms which are clinically very distinct. Most cases of acute aspergillosis occur in people with severely compromised immune systems such as those undergoing
Other, noninvasive manifestations include fungal
The most frequently identified pathogens are Aspergillus fumigatus and Aspergillus flavus, ubiquitous organisms capable of living under extensive environmental stress. Most people are thought to inhale thousands of Aspergillus spores daily but without effect due to an efficient immune response. Invasive aspergillosis has a 20% mortality at 6 months.[13] The major chronic, invasive, and allergic forms of aspergillosis account for around 600,000 deaths annually worldwide.[10][14][15][16][17]
Signs and 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, chest pain, and occasionally severe, even fatal, bleeding.[2] A rapidly invasive Aspergillus infection in the lungs often causes cough, fever, chest pain, and difficulty breathing.[citation needed]
Poorly controlled aspergillosis can disseminate through the blood to cause widespread organ damage.[2] Symptoms include fever, chills, shock, delirium, seizures, and blood clots. The person may develop kidney failure, liver failure (causing jaundice), and breathing difficulties.[2] 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. It can extend beyond the sinuses.[18]
Cause
Aspergillosis is caused by Aspergillus, a common mold, which tends to affect people who already have a lung disease such as cystic fibrosis or asthma, or who cannot fight infection themselves.[3] The most common causative species is Aspergillus fumigatus.[19]
Risk factors
People who are
Normally the mucociliary clearance mechanism of the airways of the lungs removes inhaled particles. However, in those with underlying lung diseases, such as cystic fibrosis or bronchiectasis, this mucociliary clearance mechanism is impaired and aspergillus spores (which are 2-5 μm in diameter) are able to colonize the airways and sinuses.[13]
Diagnosis
On
On
In those with suspected pulmonary aspergillosis,
-
Angioinvasive pulmonary aspergillosis
-
Angioinvasive pulmonary aspergillosis (closeup)
-
Aspergillus vesicle (HE stain)
Prevention
Prevention of aspergillosis involves a reduction of mold exposure via environmental infection-control. Antifungal prophylaxis can be given to high-risk patients. Posaconazole is often given as prophylaxis in severely immunocompromised patients.[29]
Screening
A systematic review has evaluated the diagnostic accuracy of polymerase chain reaction (PCR) tests in people with defective immune systems from medical treatment such as chemotherapy.[30] Evidence suggests PCR tests have moderate diagnostic accuracy when used for screening for invasive aspergillosis in high risk groups.[30] CT and MRI are vital to diagnosis, however it is always highly recommended to under go a biopsy of the area to confirm a diagnosis.[31][32][33]
Treatment
The current medical treatments for aggressive invasive aspergillosis include
Epidemiology
Aspergillosis is thought to affect more than 14 million people worldwide, with allergic bronchopulmonary aspergillosis (ABPA) infecting about 4 million, severe asthma with fungal sensitization affecting about 6.5 million, and chronic pulmonary aspergillosis infecting about 3 million people, considerably more than invasive aspergillosis which affects about 300,000 people.
Society and culture
During the COVID-19 pandemic 2020/21, COVID-19-associated pulmonary aspergillosis was reported in some people who had been admitted to hospital and received longterm steroid treatment.[43]
Animals
While relatively rare in humans, aspergillosis is a common and dangerous infection in birds, particularly in pet
In the United States, aspergillosis has been the culprit in several rapid die-offs among waterfowl. From 8 December until 14 December 2006, over 2,000 mallards died near
While no connection has been found between aspergillosis and the H5N1 strain of avian influenza (commonly called "bird flu"), rapid die-offs caused by aspergillosis can spark fears of bird flu outbreaks. Laboratory analysis is the only way to distinguish bird flu from aspergillosis.[citation needed]
In dogs, aspergillosis is an uncommon disease typically affecting only the nasal passages (nasal aspergillosis). This is much more common in dolicocephalic breeds. It can also spread to the rest of the body; this is termed disseminated aspergillosis and is rare, usually affecting individuals with underlying immune disorders.[citation needed]
In 2019, an outbreak of aspergillosis struck the rare kākāpō, a large flightless parrot endemic to New Zealand. By June the disease had killed seven of the birds, whose total population at the time was only 142 adults and 72 chicks. One fifth of the population was infected with the disease and the entire species was considered at risk of extinction.[44]
See also
- Other ways in which aspergillus can cause disease in mammals:
References
- ^ "Aspergillosis". mayoclinic.org. Mayo Clinic. Retrieved June 5, 2022.
- ^ ISBN 978-0-12-820703-1.
- ^ a b "ICD-11 - ICD-11 for Mortality and Morbidity Statistics". World Health Organization. Retrieved 29 May 2021.
- ^ "Aspergillosis | About". www.cdc.gov. 10 May 2021. Retrieved 1 June 2021.
- ^ ISBN 978-1-119-64706-5.
- ISBN 978-0-7020-6830-0.
- ^ "Invasive pulmonary aspergillosis | Aspergillus & Aspergillosis Website". The Aspergillus Website. Archived from the original on 26 July 2020. Retrieved 28 June 2019.
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