View
229
Download
4
Category
Tags:
Preview:
Citation preview
PATHOGEN FUNGIFacultative pathogens
Saprophyte Aspergillus fumigatus
Aspergillus flavus
Cryptococcus neoformans
Mucoraceae
Parasite Candida albicans
Candida tropicalis
Obligate pathogens Histoplasma capsulatum
Coccidioides immitis
Blastomyces dermatitidis
Sporothrix shenckii
RISK FACTORS
Immuncompromised state, treatment
Cytostatic treatment
Antibiotic and steroid treatment
Leukemy
Neutropenic patients
Malignancies
Diabetes mellitus
AIDS
After intensive therapy
After transplantation
PATHOLOGICAL FINDINGS
Epitheloid hyperplasia
Histocyte granulomas
Thrombotic arteriitis
Caseation granuloma
Fibrosis
Calcification
DIAGNOSTIC METHODSMicroscopic examination
native smeardifferent stainings
CultureSpecial culture media
Histology+ culture
Skin testSerology
Differential diagnosistumortuberculosischr pneumonia
THERAPYMedical treatment
Polyens Amphotericin B (Fungisone)
Nystatin
Pimafucin
5 fluorocytosin Ancotil
Azoles Ketoconazole (Nizoral)
Clotrimazole (Canesten)
Caspofungin (cancidas)
Fluconazole (Diflucan)
Itraconazole (Orungal)
Voriconazole (Vfend) (2. gen.)
Surgery
CLINICAL MANIFESTATION OF ASPERGILLOSIS
Allergic aspergillosisExtrinsic allergic alveolitis
hypersensitivity pneumonitisAllergic bronchopulmonary aspergillosis
AspergillomasInvasive aspergillosisRare manifestations
Aspergillus endocarditisAspergillus pneumoniaEndophthalmitis
ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS
Type I immediate hypersensitivity reactionType III antigen, antibody, immune komplex reactionDiagnosis
Bronchial obstructionFeverEosinophyliaSkin testIgG se precipitating antibody Total, specific IgE
X-ray Small, fleeting inflitratesHilar, paratracheal adenopathy
Chronic consolidationAlveolitis – fibrosisBronchiectasis
TherapyChromoglycateCorticosteroid
ASPERGILLOMA
Saprophytic colonisation of fungi in pulmonary cavities
Manifestation No symptoms Haemoptysis Fever Cachexia
Chraracteristic x-ray picture!Therapy: surgery
INVASIVE ASPERGILLOSIS
Immuncompromised host!Necrotising pneumoniaEmpyemaPulm., extrapulm. Dissemination
Symptoms: fever, pleural pain, haemotysisTherapy: Amphotericin B
or voriconazole
itraconazole, caspofungin
CANDIDIASISNormal inhabitants of mucocutaneous body surfaces.
80% of all systemic fungal infection
Manifestation
Disease of skin and mucosa
Gynecological disease
Oesophagitis
In the lung: Bronchitis
Pneumonia
Pleurisy
Therapy: Amphotericin B, caspofungin, fluconazole, itraconazole, voriconazole
CRYPTOCOCCOSISIt is the 4. Most common cause of opportunistic infections in AIDS patients in the US.
Manifestations:
asymptomatic colonisation
ext. All. Alveolitis
primary complex
toruloma
Diagnosis: Masson-Fontana staining
Complication: meningoencephalitis
Therapy: spontaneous healing, amphotericin B, fluconazole, flucytosine
HISTOPLASMOSISIt is the most common systemic mycosis in the USA.
Manifestation
Subclinical
Acute form: Influenzalike disease
X-ray: small scattered, patchy infiltrates
calcification
Progressive, disseminated form
Rare (AIDS)
Chr. pulmonary form
(COPD)
Segmental, interstitial pneumonitis
Chr cavitary disease
Diagnosis: Wright’s or Giemsa staining
Prognosis: good
Therapy: itraconazole, amphotericin B
COCCIDIOIDOMYCOSISAcute, benign disease
Primary infection: infuenzalike symptoms
Radiological findings:
Segmental pneumonia
Minimal infiltrates
Adenopathy, pleural effusion
Nodular lesions, cavities
Prognosis is good without any therapy.
Diagnosis: eosinophilia, IgGProgressive, extrapum. manifestation
COCCIDIOIDOMYCOSIS• Risk factors for dissemination of Coccidioides Immitis infection
• Older age• Males• Non-caucasians, Filipinos• Immunsuppression• Gravidity
• Therapy• Azoles• Fluconazole > Itraconazole• Ketoconazole: less effective
20
Occupational lung diseases
Pneumoconiosis
Hypersensitivity pneumonitis
Obstructive airway diseases
Toxic damages
Malignant lung diseases
Pleural diseases
21
Common causes of occupational asthmaAgents
Isocyanates
Flour
Epoxy resins
Animals (rats, mice)
Wood dusts
Azodicarbonamide
Persulphate salts
Latex
Drugs
Grain dust
Occupational exposure
Spray paints, varnishes,adhesives, polyurethanefoam manufacture
Bakers
Hardening agents,adhesives
Laboratory workers
Sawmill workers, joiners
Polyvinyl plasticsmanufacture
Hairdressers
Healthcare workers
Pharmaceutical industry
Farmers, millers, bakers
Occupational asthma• Diagnosis:
– Asthma diagnosis– Causative connection between asthma and working place
• Clinical manifestations– Immediate asthmatic response– Delayed asthmatic response– Combined response
• Therapy:– Avoidance of exposition– Protective devices– Asthma treatment
23
24
PNEUMOCONIOSIS
Etiologic agents: inhalation of inorganic dusts
metal dusts
free silica
coal dusts
25
SILICOSIS
The base of disease is the progressive concentric fibrosis with hyalinisation in the centre.
Free silica: mining
stone cutting
road and building construction
blasting
26
DETERMINING FACTORS IN DEVELOPMENT OF SILICOSIS
Silicic acid content
Content of dusts in the place of work
(200 000/m3)
Size of dust (<2 micron)
Time of exposure
Individual inclination (smoking)
27
SILICOSISSymptoms: no symptoms
dyspnoehypoxaemia, hypercapnia=>ventilatory failure=>cor pulmonale
X-ray: nodular disseminationsilicomas (=>emphysematic bullae)hilar adenopathycalcification, egg shell pattern
Complications: chr. bronchitisemphysemaptx
Tb is more frequentCaplan’s syndromaTherapy: symptomaticProphylaxis!
33
ASBESTOSIS
• Hydrosilicate – fibre, thread
• Pulmonal clearence depends on the ratio of length and diameter of fibers
• 50-100 asbest particula/cm3 → mesothelioma
• Basal and subpleural fibrosis
35
HYPERSENSITIVE PNEUMONITIS(Extrinic allergic alveolitis)It is an immunologically induced inflammation of lung
parenchyma involving alveolar walls and terminal airways secondary to repeated inhalation of a variety of organic dusts and other agents by susceptible host.
Manifestations:Farmer’s lung (1932) – thermophylic actinomycetesBird fancier’s breeder’s or handler’s lung
Miller’s lungBagassosisByssinosis
Air conditioner’s lungCoffee worker’s lung
36
HYPERSENSITIVE PNEUMONITIS
Clinical forms:
Acute: (type III. reaction) cough, fever, chills, malaise, dyspnoe may occur 6-8 hours after exposure and usually clear within few days
Subacute: (type IV reaction) symptoms appear over a period of week( cough, dyspnoe, cyanosis). Symptoms disappear within weeks, or months, if causative agent is no longer inhaled.
Chronic: (type IV reaction) gradually progressive intersistial disease associated with cough, exertional dyspnoe without a prior history of acute or subacute disease.
39
HYPERSENSITIVE PNEUMONITISDiagnosis:
anamnesisx-ray: normal
poorly defined patchy or diffuse infiltrates reticulonodular lesions
lung function tests:impaired diffusing capacity, decreased comliance exercise induced hypoxaemia
Se precipitins against suspected antigensBAL: acute : neutrophyls, monocytes(5%)
chr: lymphocytes(60-70%)Lung biopsy: intersitial alveolar infiltrates
bronchiolitisTherapy:
avoidance of antigenscorticosteroids
Recommended