Ubiquitous WorldwideTYPES:A fumigatusA flavusA nigerA terreusA lentulus

Rapid growth Basic morphology: Aerial hyphae with conidia; long

conidiophores with terminal vesicles on which phialides produce biseptal chain of conidia

Species variate in these

Fungal conidia formed in abundance Aerosolized Reach lungs Macrophages can engulf & destroy conidiaIMMUNOCOMPROMISED:Leukaemia, stem cell transplant,

corticosteroidsMacrophages cannot contain inoculum;Conidia swell, germinate to hyphae in

cavities, BV

ALLERGIC FORMS:1.IgE AB formed to As conidial Ag Second exposure: immediate asthama2. Allergic Bronchopulmonary

Aspergillosis Conidia germinate,hyphae colonize

bronchial tree; parenchyma spared;

Inhaled enter an existing cavity, germinate to abundant hyphae in

abnormal space as in TB, sarcoidosis, emphysema

Asymptomatic Cough, dysponea, hemoptysis, fatigue,

weight loss Invade nasal sinuses, cornea, nail, ear

canal

Asthama Recurrent chest infilterates Eosinophilia Both type 1 & 3 hypersensitivity

reaction Permenant lung scarring3.Extrinsic Allergic Alveolitis: Normal individuals with massive conidial

exposure

Inhalation; germination Acute pneumonic process: mild necrosis to Dissemination +/-RISK: Immuno-compromised: AIDS; CD4 count< 50cells/mm Stem cell allogenic hemopoietic transplant Leukaemia/lymphoma Corticosteroid therapy

Specimen: Sputum Lung biopsy Resp tract specimenMicroscopy: KOH mount calcofluor stain histology Hyphae: 4um wide, septate,hyaline,

branch dichotomously

Fever, cough, dysponea, hemoptysis Hyphae invade BV; lumen & wall to

cause thrombosis, infarction & necrosisDissemination to organs GIT& Liver Kidney BrainFATE: grave without T/M

ID test positive AB: no help Cell wall galactomannan may helpT/M: Itraconazole; posaconazole Amp R in leukamia centres Amphotericin B Cytokine immuotherapy: interferon/gran-mac colony

Stimu Allergic: steroids, disodium chromoglychatePrevention Avoid exposure to conidia in allergic & IC uhospital units