Allergic bronchopulmonary aspergillosis
Allergic bronchopulmonary aspergillosis is a chronic disease of the bronchopulmonary system, caused by infections of the airways by aspergillus fungi and characterized by the development of an allergic inflammatory process in the bronchi. Aspergillosis usually occurs in patients with bronchial asthma, manifested by fever, cough with mucopurulent sputum, chest pain, periodic attacks of suffocation. Diagnosis is made on the basis of clinical examination, blood and sputum tests, radiological examination of the lungs, and allergy tests. Treatment is with glucocorticoids and antifungal drugs.
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Allergic bronchopulmonary aspergillosis is an infectious and allergic moldy mycosis caused by aspergillus fungi (usually Aspergillus fumigatus) and manifested by the development of airway dysbiosis, allergic inflammation of the bronchial mucosa and subsequent lung fibrosis. The disease occurs mainly in patients with atopic bronchial asthma (90% of all cases of aspergillosis), as well as in cystic fibrosis and in immunocompromised individuals.
The disease was first identified and described in Great Britain in 1952 among patients with bronchial asthma with prolonged rise in body temperature. Currently, allergic bronchopulmonary aspergillosis occurs more frequently in people between the ages of 20 and 40, and is diagnosed in 1-2% of bronchial asthma patients. Respiratory tract damage by aspergillus fungi is especially dangerous for those with congenital and acquired immunodeficiency.
The causative agent of allergic bronchopulmonary aspergillosis is the yeast-like fungi of the genus Aspergillus. About 300 representatives of these microorganisms are known, 15 of which can cause infectious and allergic inflammation if they enter the respiratory tract. In the vast majority of cases, moldy mycosis in the bronchi occurs when Aspergillus fumigatus invades.
Aspergillus fumigatus is ubiquitous, with fungal spores in the air in both summer and winter. Favorite habitats of these microorganisms are damp, swampy areas, soils rich in organic fertilizers, squares and parks with fallen leaves, residential and non-residential premises with high air humidity (bathrooms, bathrooms, basements in old houses), soil of indoor plants, bird cages, air conditioners.
The main risk factors that facilitate the development of allergic bronchopulmonary aspergillosis are hereditary predisposition (presence of bronchial asthma and other allergic diseases in relatives), long-term contact with aspergillus (work on garden plots, cattle farms, flour mills), reduced body defenses (primary and secondary immunodeficiency, chronic diseases of bronchopulmonary system, blood diseases, malignant neoplasms, etc.). ).
Allergic bronchopulmonary aspergillosis in the vast majority of cases develops in patients with atopic bronchial asthma, more often in the fall and spring period, i.e. in cold wet weather. The disease begins acutely, with chills, fever up to 38-39 degrees, chest pain, cough with mucopurulent sputum, hemoptysis. Bronchial asthma symptoms also become more pronounced (feeling of lack of air, recurrent attacks of suffocation). There are signs of intoxication: general weakness, somnolence, pale skin, lack of appetite, weight loss, prolonged maintenance of subfebrile temperature etc.
In the chronic course of allergic bronchopulmonary aspergillosis manifestations of the disease may be erased – without signs of intoxication, with periodic cough with mucous sputum, which may have brownish inclusions, shortness of breath when exercising, a feeling of lack of air. If aspergillosis occurs against a background of immunodeficiency, the clinical picture will include symptoms of the underlying disease (acute leukemia, pulmonary tuberculosis, sarcoidosis, obstructive lung disease, malignant neoplasm of specific localization).
Diagnosis of allergic bronchopulmonary aspergillosis is made by an allergologist-immunologist and pulmonologist based on the history, clinical picture of the disease, data of laboratory and instrumental studies, allergological tests:
Interview and examination. Medical history may indicate hereditary burden of allergic diseases, presence of atopic bronchial asthma in a patient, periodic or prolonged contact with aspergillus in the home or in the course of professional activity. Physical examination of about half of patients with allergic bronchopulmonary aspergillosis reveals dullness of percussion sound in the upper lungs and listening with auscultation of moist small vesicular rales, as well as signs of general condition disorders – shortness of breath, pallor, sweating, subfebrile or hyperthermia.
Laboratory Diagnostic Tests. At laboratory examination in peripheral blood eosinophilia (more than 20%) is determined, sometimes leukocytosis and increased sedimentation rate are noted. Cytological analysis of sputum reveals a predominance of eosinophils, microscopy of sputum may reveal elements of mycelium aspergillus. Bacteriological examination of sputum reveals a culture of Aspergillus fumigatus with growth of fungi on nutrient media.
Allergological examination. Skin allergy tests with Aspergillus extract are performed (a typical immediate type reaction is detected). Diagnosis of allergic bronchopulmonary aspergillosis is confirmed by determination of increased level of total immunoglobulin E and specific IgE and IgG to Aspergillus fumigatus in blood serum.
X-ray diagnosis. Bronchography and computed tomography reveal proximal bronchiectasis, “volatile” infiltrates in the lungs.
Differential diagnosis of allergic bronchopulmonary aspergillosis is made with pulmonary tuberculosis, sarcoidosis, chronic obstructive pulmonary disease, eosinophilic lung lesions of other etiology.
Treatment of bronchopulmonary aspergillosis
The main areas of treatment for aspergillosis with bronchopulmonary involvement are anti-inflammatory therapy, reducing body sensitization and reducing aspergillus activity.
In the acute period of the disease systemic glucocorticosteroid hormones are prescribed for at least six months (the drug of choice is prednisolone). Glucocorticosteroids are started in therapeutic doses and continued until complete resorption of infiltrates and normalization of antibody titers, after which maintenance treatment is started for another 4-6 months. After full arrest of inflammatory process, that is in remission stage, antifungal therapy with amphotericin B or traconazole during 4-8 weeks is started.
Prognosis and prevention
The prognosis depends on the frequency and severity of exacerbations of aspergillosis, the accompanying background. If exacerbations are frequent and there is a history of other diseases, the quality of life suffers significantly. The primary infestation can be prevented by following the rules of caution when carrying out agricultural work. First of all, it concerns people with bronchial asthma and immune deficiencies. To prevent relapses of allergic bronchopulmonary aspergillosis, maximum reduction of contact with aspergillus and, if possible, relocation to a mountainous area with a dry climate, should be ensured.
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