Aspergilloma

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Aspergilloma
Other namesMycetoma, fungus ball, moldy lungs
Aspergillomas complicating tuberculosis.jpg
Aspergillomas complicating tuberculosis: multiple aspergillomas within large cavitary lesions of tuberculous origin.
Specialty Infectious disease
Causes Aspergillus fungal infection
Diagnostic method Chest x-ray show tumour like opacity. Serology can be helpful. Fungal hyphae seen on KoH mount and sputum culture grows fungus
Frequency
  • Patients with CPA: 25%
  • Global 5-year period prevalence: 18 in 100,000

An aspergilloma is a clump of mold which exists in a body cavity such as a paranasal sinus or an organ such as the lung. By definition, it is caused by fungi of the genus Aspergillus . [1]

Contents

Signs and symptoms

People with aspergillomata typically remain asymptomatic until the condition is fairly advanced; in some cases even for decades. Diagnosis is often made as a result of an incidental finding on a chest X-ray or CT scan that may be performed as part of the workup for another unrelated condition. However, a small percentage of aspergillomata invade into a blood vessel which can result in bleeding. Thus, the most common symptom of associated with aspergillomata is coughing up blood (hemoptysis). This may result in life-threatening hemorrhage, though the amount of blood lost is usually inconsequential.[ citation needed ]

Aspergillomata can also form in other organs. They can form abscesses in solid organs such as the brain or kidney, usually in people who are immunocompromised. They can also develop within body cavities such as the sphenoid or paranasal sinuses, [2] the ear canal, and rarely on surfaces such as heart valves.[ citation needed ]

Cause

Histopathology of aspergilloma, H&E staining Aspergilloma histology.jpg
Histopathology of aspergilloma, H&E staining

The most common organ affected by aspergilloma is the lung. Aspergilloma mainly affects people with underlying cavitary lung disease such as tuberculosis, sarcoidosis, bronchiectasis, cystic fibrosis and systemic immunodeficiency. Aspergillus fumigatus , the most common causative species, is typically inhaled as small (2 to 3 micron) spores. The fungus settles in a cavity and is able to grow free from interference because critical elements of the immune system are unable to penetrate into the cavity. As the fungus multiplies, it forms a ball, which incorporates dead tissue from the surrounding lung, mucus, and other debris. [3]

Diagnosis

Diagnosis of aspergilloma is by serum IgE levels which are usually raised in this condition.

Treatment

Most cases of aspergilloma do not require treatment.[ citation needed ] Treatment of diseases which increase the risk of aspergilloma, such as tuberculosis, may help to prevent their formation. In cases complicated by severe hemoptysis or other associated conditions such as pleural empyema or pneumothorax, surgery may be required to remove the aspergilloma and the surrounding lung tissue by doing a lobectomy or other types of resection and thus stop the bleeding. There has been interest in treatment with antifungal medications such as itraconazole and voriconazole with some reports showing aspergilloma eradication. [4]

Although most fungi—and especially Aspergillus—fail to grow in healthy human tissue, significant growth may occur in people whose adaptive immune system is compromised, such as those with chronic granulomatous disease, who are undergoing chemotherapy, or who have recently undergone a bone marrow transplantation. Within the lungs of such individuals, the fungal hyphae spread out as a spherical growth. With the restoration of normal defense mechanisms, neutrophils and lymphocytes are attracted to the edge of the spherical fungal growth where they lyse, releasing tissue-digesting enzymes as a normal function. A sphere of the infected lung is thus cleaved from the adjacent lung. This sphere flops around in the resulting cavity and is recognized on x-ray as a fungus ball. This process is beneficial as a potentially serious invasive fungal infection is converted into surface colonization. Although the fungus is inactivated in the process, surgeons may choose to operate to reduce the possibility of bleeding. Microscopic examination of surgically removed recently formed fungus balls clearly shows a sphere of dead lung containing fungal hyphae. Microscopic examination of older lesions reveals mummified tissue which may reveal faint residual lung or hyphal structures. [5]

Related Research Articles

<span class="mw-page-title-main">Ascomycota</span> Division or phylum of fungi

Ascomycota is a phylum of the kingdom Fungi that, together with the Basidiomycota, forms the subkingdom Dikarya. Its members are commonly known as the sac fungi or ascomycetes. It is the largest phylum of Fungi, with over 64,000 species. The defining feature of this fungal group is the "ascus", a microscopic sexual structure in which nonmotile spores, called ascospores, are formed. However, some species of Ascomycota are asexual and thus do not form asci or ascospores. Familiar examples of sac fungi include morels, truffles, brewers' and bakers' yeast, dead man's fingers, and cup fungi. The fungal symbionts in the majority of lichens such as Cladonia belong to the Ascomycota.

<span class="mw-page-title-main">Mold</span> Wooly, dust-like fungal structure or substance

A mold or mould is one of the structures that certain fungi can form. The dust-like, colored appearance of molds is due to the formation of spores containing fungal secondary metabolites. The spores are the dispersal units of the fungi. Not all fungi form molds. Some fungi form mushrooms; others grow as single cells and are called microfungi.

<span class="mw-page-title-main">Hemoptysis</span> Medical symptom consisting of bloody mucus from coughing

Hemoptysis or haemoptysis is the discharge of blood or blood-stained mucus through the mouth coming from the bronchi, larynx, trachea, or lungs. It does not necessarily involve coughing. In other words, it is the airway bleeding. This can occur with lung cancer, infections such as tuberculosis, bronchitis, or pneumonia, and certain cardiovascular conditions. Hemoptysis is considered massive at 300 mL. In such cases, there are always severe injuries. The primary danger comes from choking, rather than blood loss.

<span class="mw-page-title-main">Pleurisy</span> Disease of the lungs

Pleurisy, also known as pleuritis, is inflammation of the membranes that surround the lungs and line the chest cavity (pleurae). This can result in a sharp chest pain while breathing. Occasionally the pain may be a constant dull ache. Other symptoms may include shortness of breath, cough, fever, or weight loss, depending on the underlying cause.

<i>Aspergillus fumigatus</i> Species of fungus

Aspergillus fumigatus is a species of fungus in the genus Aspergillus, and is one of the most common Aspergillus species to cause disease in individuals with an immunodeficiency.

<span class="mw-page-title-main">Zygomycosis</span> Medical condition

Zygomycosis is the broadest term to refer to infections caused by bread mold fungi of the zygomycota phylum. However, because zygomycota has been identified as polyphyletic, and is not included in modern fungal classification systems, the diseases that zygomycosis can refer to are better called by their specific names: mucormycosis, phycomycosis and basidiobolomycosis. These rare yet serious and potentially life-threatening fungal infections usually affect the face or oropharyngeal cavity. Zygomycosis type infections are most often caused by common fungi found in soil and decaying vegetation. While most individuals are exposed to the fungi on a regular basis, those with immune disorders (immunocompromised) are more prone to fungal infection. These types of infections are also common after natural disasters, such as tornadoes or earthquakes, where people have open wounds that have become filled with soil or vegetative matter.

<span class="mw-page-title-main">Hemothorax</span> Blood accumulation in the pleural cavity

A hemothorax is an accumulation of blood within the pleural cavity. The symptoms of a hemothorax may include chest pain and difficulty breathing, while the clinical signs may include reduced breath sounds on the affected side and a rapid heart rate. Hemothoraces are usually caused by an injury, but they may occur spontaneously due to cancer invading the pleural cavity, as a result of a blood clotting disorder, as an unusual manifestation of endometriosis, in response to pneumothorax, or rarely in association with other conditions.

<span class="mw-page-title-main">Pulmonary hemorrhage</span> Medical condition

Pulmonary hemorrhage is an acute bleeding from the lung, from the upper respiratory tract and the trachea, and the pulmonary alveoli. When evident clinically, the condition is usually massive. The onset of pulmonary hemorrhage is characterized by a cough productive of blood (hemoptysis) and worsening of oxygenation leading to cyanosis. Treatment should be immediate and should include tracheal suction, oxygen, positive pressure ventilation, and correction of underlying abnormalities such as disorders of coagulation. A blood transfusion may be necessary.

<span class="mw-page-title-main">Allergic bronchopulmonary aspergillosis</span> Medical condition

Allergic bronchopulmonary aspergillosis (ABPA) is a condition characterised by an exaggerated response of the immune system to the fungus Aspergillus. It occurs most often in people with asthma or cystic fibrosis. Aspergillus spores are ubiquitous in soil and are commonly found in the sputum of healthy individuals. A. fumigatus is responsible for a spectrum of lung diseases known as aspergilloses.

<span class="mw-page-title-main">Aspergillosis</span> Medical condition

Aspergillosis is a fungal infection of usually the lungs, caused by the genus Aspergillus, a common mould that is breathed in frequently from the air, but does not usually affect most people. It generally occurs in people with lung diseases such as asthma, cystic fibrosis or tuberculosis, or those who are immunocompromised such as those who have had a stem cell or organ transplant or those who take medications such as steroids and some cancer treatments which suppress the immune system. Rarely, it can affect skin.

Rasmussen aneurysm is a distinctive variant of pseudoaneurysm of a branch of the pulmonary artery, predominantly found adjacent to or within a lung cavity, both often arising as a complication of pulmonary tuberculosis. The condition was originally described by Fritz Valdemar Rasmussen in 1868. It is a relatively uncommon complication associated with cavitary tuberculosis of the lung, with its prevalence observed in approximately 5–8% of cases based on autopsy findings.

Pathogenic fungi are fungi that cause disease in humans or other organisms. Although fungi are eukaryotic, many pathogenic fungi are microorganisms. Approximately 300 fungi are known to be pathogenic to humans; their study is called "medical mycology". Fungal infections are estimated to kill more people than either tuberculosis or malaria—about two million people per year.

<span class="mw-page-title-main">Mucormycosis</span> Fungal infection

Mucormycosis, also known as black fungus, is a severe fungal infection that comes under fulminant fungal sinusitis, usually in people who are immunocompromised. It is curable only when diagnosed early. Symptoms depend on where in the body the infection occurs. It most commonly infects the nose, sinuses, eyes and brain resulting in a runny nose, one-sided facial swelling and pain, headache, fever, blurred vision, bulging or displacement of the eye (proptosis), and tissue death. Other forms of disease may infect the lungs, stomach and intestines, and skin. The fatality rate is about 54%.

<i>Pseudallescheria boydii</i> Species of fungus

Pseudallescheria boydii is a species of fungus classified in the Ascomycota. It is associated with some forms of eumycetoma/maduromycosis and is the causative agent of pseudallescheriasis. Typically found in stagnant and polluted water, it has been implicated in the infection of immunocompromised and near-drowned pneumonia patients. Treatment of infections with P. boydii is complicated by resistance to many of the standard antifungal agents normally used to treat infections by filamentous fungi.

<span class="mw-page-title-main">Geotrichosis</span> Medical condition

Geotrichosis is a mycosis caused by Geotrichum candidum.

<span class="mw-page-title-main">Chronic pulmonary aspergillosis</span> Fungal infection

Chronic pulmonary aspergillosis is a long-term fungal infection caused by members of the genus Aspergillus—most commonly Aspergillusfumigatus. The term describes several disease presentations with considerable overlap, ranging from an aspergilloma—a clump of Aspergillus mold in the lungs—through to a subacute, invasive form known as chronic necrotizing pulmonary aspergillosis which affects people whose immune system is weakened. Many people affected by chronic pulmonary aspergillosis have an underlying lung disease, most commonly tuberculosis, allergic bronchopulmonary aspergillosis, asthma, or lung cancer.

<i>Ochroconis gallopava</i> Species of fungus

Ochroconis gallopava, also called Dactylaria gallopava or Dactylaria constricta var. gallopava, is a member of genus Dactylaria. Ochroconis gallopava is a thermotolerant, darkly pigmented fungus that causes various infections in fowls, turkeys, poults, and immunocompromised humans first reported in 1986. Since then, the fungus has been increasingly reported as an agent of human disease especially in recipients of solid organ transplants. Ochroconis gallopava infection has a long onset and can involve a variety of body sites. Treatment of infection often involves a combination of antifungal drug therapy and surgical excision.

<i>Aspergillus candidus</i> Species of fungus

Aspergillus candidus is a white-spored species of fungus in the genus Aspergillus. Despite its lack of pigmentation, it is closely related to the most darkly-pigmented aspergilli in the Aspergillus niger group. It is a common soil fungus worldwide and is known as a contaminant of a wide array of materials from the indoor environment to foods and products. It is an uncommon agent of onychomycosis and aspergillosis. The species epithet candidus (L.) refers to the white pigmentation of colonies of this fungus. It is from the Candidi section. The fungi in the Candidi section are known for their white spores. It has been isolated from wheat flour, djambee, and wheat grain.

<span class="mw-page-title-main">Fungal sinusitis</span> Inflammation of the paranasal sinuses due to fungal infection

Fungal sinusitis or fungal rhinosinusitis is the inflammation of the lining mucosa of the paranasal sinuses due to a fungal infection. It occurs in people with reduced immunity. The maxillary sinus is the most commonly involved. Fungi responsible for fungal sinusitis are Aspergillus fumigatus (90%), Aspergillus flavus, and Aspergillus niger. Fungal sinusitis occurs most commonly in middle-aged populations. Diabetes mellitus is the most common risk factor involved.

<span class="mw-page-title-main">Lung cavity</span> Medical condition

A lung cavity or pulmonary cavity is an abnormal, thick-walled, air-filled space within the lung. Cavities in the lung can be caused by infections, cancer, autoimmune conditions, trauma, congenital defects, or pulmonary embolism. The most common cause of a single lung cavity is lung cancer. Bacterial, mycobacterial, and fungal infections are common causes of lung cavities. Globally, tuberculosis is likely the most common infectious cause of lung cavities. Less commonly, parasitic infections can cause cavities. Viral infections almost never cause cavities. The terms cavity and cyst are frequently used interchangeably; however, a cavity is thick walled, while a cyst is thin walled. The distinction is important because cystic lesions are unlikely to be cancer, while cavitary lesions are often caused by cancer.

References

  1. "Aspergilloma". Medical Dictionary. TheFreeDictionary.
  2. "Life". Archived from the original on 2017-06-22. Retrieved 2014-10-21.
  3. Soubani AO, Chandrasekar PH (June 2002). "The clinical spectrum of pulmonary aspergillosis". Chest. 121 (6): 1988–9. doi:10.1378/chest.121.6.1988. PMID   12065367. Archived from the original on 2013-04-14.
  4. Capone, A.; Di Bella, S.; Chinello, P.; Chiappetta, D.; Campoli, C.; Petrosillo, N. (2013). "Multiple Bilateral Pulmonary "Fungus Balls" in an Immunocompetent Patient Unsuitable for Surgical Treatment: Efficacy of Azoles Treatment". Mycopathologia. 175 (3–4): 361–363. doi:10.1007/s11046-013-9639-y. ISSN   0301-486X.
  5. Przyjemski, CJ; Mattii, R (1980). "The Formation of Pulmonary Mycetomata". Cancer. 46 (7): 1701–1704. doi: 10.1002/1097-0142(19801001)46:7<1701::AID-CNCR2820460733>3.0.CO;2-4 . PMID   6932257.