Pulmonary aspergillosis
Introduction
Introduction to pulmonary aspergillosis The pathogens of pulmonary aspergillosis are mainly Aspergillus fumigatus, and a few are aflatox, earthworm, black bacillus, bacillus sphaeroides, kohlrabi, and koji. In China, there were more than 300 cases of respiratory tract infections reported from 1949 to the end of 1988, but only 47 cases before 1972. The majority of pulmonary aspergillosis is secondary infection, and the primary is extremely rare. The disease is generally divided into aspergillosis, allergic bronchopulmonary aspergillosis (ABPA) and invasive pulmonary aspergillosis ( IPA) and other three types. basic knowledge The proportion of illness: 0.024% Susceptible people: no special people Mode of infection: respiratory transmission Complications: Asthma Allergic rhinitis
Cause
Causes of pulmonary aspergillosis
Aspergillus fumigatus (30%):
Pulmonary aspergillosis is mainly caused by Aspergillus fumigatus. The bacteria are parasitic in the upper respiratory tract and can only cause disease when the body's immunity is reduced in patients with chronic diseases.
Inhaled Aspergillus spores (20%):
There are Aspergillus spores everywhere in the air. In the autumn and winter and the rainy season, when the stored grain grass is hot and mild, it is more. Inhalation of Aspergillus spores does not necessarily cause disease, and a large amount of inhalation can cause acute tracheal-bronchitis or pneumonia. The disease is often secondary to existing diseases in the lungs, such as bronchial cysts, bronchiectasis, pneumonia, lung abscesses and so on. The endotoxin of Aspergillus causes tissue necrosis, and the lesion is invasive, consolidation, peribronchial inflammation or miliary chronic lesions.
Prevention
Pulmonary aspergillosis prevention
When working in an environment suspected of being infected with Aspergillus, protective work should be done, such as wearing a protective mask to avoid inhaling a large number of germs. When operating in fungal laboratories, such as Aspergillus, A. acumin, and Aspergillus, it is necessary to operate Take care to prevent these bacteria from being inhaled into the lungs.
Complication
Pulmonary aspergillosis complications Complications asthma allergic rhinitis
Can be complicated by asthma, allergic rhinitis and so on.
Symptom
Symptoms of pulmonary aspergillosis Common symptoms Cough out brown sputum suppository eosinophilia chest pain
There are four types of clinical.
First, bronchial-pneumonia
The mycelium grows on the bronchial mucosa but does not invade the wall. Mucosal inflammation is mild, coughing, coughing ( can be brownish yellow), low fever, etc. Such as erosion of lung tissue, it can cause localized granulomatosis or pneumonia, lung abscess.
Second, allergic aspergillosis
After inhalation of a large number of spores to those who are allergic to Aspergillus, the small bronchi is blocked, causing transient atelectasis, which may also cause repeated migratory infiltration in the distal lung. The patient was chills, fever, fatigue, irritating cough, coughing brownish purpura, sometimes with blood. There are a large number of eosinophils and mycelium in the sputum. The culture of Aspergillus fumigatus was positive. The patient had significant asthma and increased blood eosinophilia around the patient.
Third, the koji ball
Aspergillus parasitic in the cavity associated with chronic lung disease (such as pulmonary cyst, bronchiectasis, tuberculosis cavity) reproduction, accumulation, and fibrin and mucosal cells agglomerate to form a koji ball, visible under the X-ray There is a ball shadow in the chronic cavity that moves within the cavity as the body position changes. The koji ball does not invade the tissue, does not cause systemic symptoms of the patient, only irritating cough, and sometimes repeated hemoptysis. Because the koji ball is not connected to the bronchus, there are not many cockroaches.
Fourth, secondary pulmonary aspergillosis
The terminal stage of seriously ill patients (such as leukemia, lymphoma), and the use of broad-spectrum antibiotics, immunosuppressive drugs or various causes of low immunity, the pulmonary infection with the disease is a localized granulomatosis or extensive purulent Pneumonia, with abscess formation. The lesions are acute coagulative necrosis, with necrotizing vasculitis, thrombosis and thrombosis, and even sowing organs such as the pleura, meninges, liver, spleen, etc., the prognosis is very poor.
Examine
Examination of pulmonary aspergillosis
1, chest X-ray examination: allergic type shows increased lung texture or transient lung infiltration; invasive type of bronchial pneumonia changes; Aspergillus ball is mostly located in the cavity, resulting in a hollow half-moon shape, the ball like a pendulum can follow the body position Change and move.
2, inspection: 1 smear microscopy can be seen hyphae and spores; 2 repeated sputum culture positive for diagnosis; 3 allergic sputum can find a large number of eosinophils, increased blood total IgE; 4 Aspergillus antigen skin Test, serum precipitation test can help diagnose.
Diagnosis
Diagnosis and identification of pulmonary aspergillosis
diagnosis
The secretions are aspirated from the deep part of the bronchus, and the hyphae are found by smear. The culture is positive for many times, which is helpful for diagnosis. The typical X-ray characteristics of the koji bacteria have diagnostic significance. The intradermal test and the serum sedimentation test of the Aspergillus antigen have diagnostic value. Paroxysmal bronchial asthma, peripheral blood eosinophilia, elevated serum IgE, X-ray showed lung infiltration, smears of mycorrhizal smears by fiberoptic bronchoscopy, or cultured with Aspergillus growth, can be diagnosed For allergic bronchopulmonary aspergillosis, fluoroscopy under the fluoroscopy for lung biopsy has a diagnostic value for aspergilloma and invasive pulmonary aspergillosis.
Differential diagnosis
It should be differentiated from pulmonary candidiasis, lung cancer, tuberculosis, and allergic pneumonia.
