Edit Csada, MD18.11.2015.

Facultative pathogens Moulds

Aspergilli Mucoraceae

Yeasts Candida Cryptococcus

Obligate pathogenes Histoplasma capsulatum Coccidioides immitis Blastomyces dermatitidis Sporothrix shenckii

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Immuncompromised state, treatmentCytostatic treatmentAntibiotic and steroid treatmentLeukemyNeutropenic patientsMalignanciesDiabetes mellitusAIDSAfter intensive therapyAfter transplantation

Epitheloid hyperplasia

Histocyte granulomasThrombotic arteriitisCaseation granulomaFibrosisCalcification

Microscopic examinationnative smeardifferent stainings

CultureSpecial culture media

Histology+ culture

Skin testSerology

Differential diagnosistumortuberculosischr pneumonia

Medical treatmentPolyens Amphotericin B (Fungisone)

Nystatin Pimafucin

5 fluorocytosin AncotilAzoles Ketoconazole (Nizoral)

Clotrimazole (Canesten) Caspofungin (cancidas) Fluconazole (Diflucan)

Itraconazole (Orungal) Voriconazole (Vfend) (2. gen.)

Surgery

Allergic aspergillosisExtrinsic allergic alveolitis

hypersensitivity pneumonitisAllergic bronchopulmonary

aspergillosis

AspergillomasInvasive aspergillosisRare manifestations

Aspergillus endocarditisAspergillus pneumoniaEndophthalmitis

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

Saprophytic colonisation of fungi in pulmonary cavities

Manifestation No symptoms Haemoptysis Fever Cachexia

Chraracteristic x-ray picture!Therapy: surgery

„Halo sign”

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Immuncompromised host!Necrotising pneumoniaEmpyemaPulm., extrapulm.

DisseminationSymptoms: fever, pleural pain, haemotysisTherapy: Amphotericin B

or voriconazoleitraconazole, caspofungin

Normal inhabitants of mucocutaneous body surfaces.80% of all systemic fungal infectionManifestation

Disease of skin and mucosaGynecological diseaseOesophagitisIn the lung: Bronchitis

Pneumonia Pleurisy

Therapy: Amphotericin B, caspofungin, fluconazole, itraconazole, voriconazole

It is the 4. Most common cause of opportunistic infections in AIDS patients in the US.Manifestations:

asymptomatic colonisationext. All. Alveolitisprimary complextoruloma

Diagnosis: Masson-Fontana stainingComplication: meningoencephalitisTherapy: spontaneous healing, amphotericin B, fluconazole, flucytosine

It is the most common systemic mycosis in the USA.Manifestation Subclinical Acute form: Influenzalike disease X-ray: small scattered, patchy infiltrates

calcificationProgressive, disseminated form

Rare (AIDS)Chr. pulmonary form

(COPD)Segmental, interstitial pneumonitisChr cavitary disease

Diagnosis: Wright’s or Giemsa stainingPrognosis: goodTherapy: itraconazole, amphotericin B

Acute, benign diseasePrimary infection: infuenzalike symptoms Radiological findings:

Segmental pneumoniaMinimal infiltratesAdenopathy, pleural effusionNodular 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

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PneumoconiosisHypersensitivity pneumonitisObstructive airway diseasesToxic damagesMalignant lung diseasesPleural diseases

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Agents

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

Diagnosis: Asthma diagnosis Causative connection between

asthma and working place Clinical manifestations

Early asthmatic response Late asthmatic response Combined response

Therapy: Avoidance of exposition Protective devices Asthma treatment

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Etiologic agents: inhalation of inorganic dusts

metal dusts free silica coal dusts

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The base of disease is the progressive concentric fibrosis with hyalinisation in the centre.

Free silica: miningstone cuttingroad and building

constructionblasting

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Silicic acid contentContent of dusts in the place of work

(200 000/m3)Size of dust (<2 micron)Time of exposureIndividual inclination (smoking)

Symptoms: no symptomsdyspnoehypoxaemia, 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!

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Silicosis

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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

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(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

Clinical forms:Acute: (type III. reaction) cough, fever, chills, malaise, dyspnoe may occur 6-8 hours after exposure and usually clear within few daysSubacute: (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.

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Diagnosis:anamnesisx-ray: normal

poorly defined patchy or diffuse infiltrates

reticulonodular lesionslung 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

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41Thank you for your attention!