Allergic bronchopulmonary aspergillomycosis
Allergic bronchopulmonary aspergillomycosis is the chronic disease of bronchopulmonary system caused by damage of airways mushrooms of an aspergillama and which is characterized by development in bronchial tubes of allergic inflammatory process. Aspergillomycosis, as a rule, arises at patients with bronchial asthma, is shown by fever, cough with a mucopurulent phlegm, thorax pains, periodic attacks of suffocation. The diagnosis is established taking into account the given clinical examination, blood tests and a phlegm, a radiological research of easy, allergologichesky tests. Treatment is carried out with use of glucocorticoids and antifungal medicines.
Allergic bronchopulmonary aspergillomycosis
Allergic bronchopulmonary aspergillomycosis is the infectious and allergic mold mycosis caused by aspergillama fungi (as a rule, it is Aspergillus fumigatus) and shown development of dysbacteriosis of airways, an allergic inflammation of a mucous membrane of bronchial tubes and the subsequent fibrosis of lungs. The disease arises mainly at patients with atopic bronchial asthma (90% of all cases of aspergillomycosis), and also at a mukovistsidoza and at persons with the weakened immunity.
For the first time the disease was revealed and described in Great Britain in 1952 among patients with bronchial asthma at whom long temperature increase of a body was noted. Now allergic bronchopulmonary aspergillomycosis meets more often at aged people from 20 to 40 years and is diagnosed for 1-2% of patients with bronchial asthma. Damage of airways mushrooms of an aspergillama constitutes special danger to persons with the congenital and acquired immunodeficiency.
The causative agent of allergic bronchopulmonary aspergillomycosis – drozhzhepodobny mushrooms from a sort . In total about 300 representatives of these microorganisms are known, 15 of which can cause development of an infectious and allergic inflammation at hit in airways. In most cases mold mycosis in bronchial tubes arises at Aspergillus fumigatus penetration.
Aspergilla everywhere are widespread, disputes of mushrooms are airborne both in the summer, and in the winter. Favourite habitats of these microorganisms – the damp, boggy area, soils with the rich content of organic fertilizers, squares and parks with fallen leaves, inhabited and non-residential premises with the increased humidity of air (bathrooms, bathrooms, cellars in old houses), the earth of houseplants, cages of birds, conditioners.
The major factors of risk facilitating development of allergic bronchopulmonary aspergillomycosis are hereditary predisposition (presence of bronchial asthma and other allergic diseases at relatives), long contact with aspergilla (work on a personal plot, livestock farms, the flour-grinding enterprises), decrease in protective forces of an organism (primary and secondary immunodeficiency, chronic diseases of bronchopulmonary system, a blood disease, malignant new growths, etc.).
Disputes of mushrooms of Aspergillus during a breath get into airways, settle on a mucous membrane of bronchial tubes, sprout and begin the activity. At the same time there is an emission of the proteolytic enzymes damaging cages of an epithelium of bronchial tubes. Reaction of immune system to anti-genes causes formation of mediators of an allergy, synthesis of E, A and G immunoglobulins, development of inflammatory process of the allergic nature in bronchial tubes.
Allergic bronchopulmonary aspergillomycosis in most cases develops at patients with atopic bronchial asthma, is more often during the autumn and spring period, that is during cold wet weather. The disease begins sharply, with a fever, temperature increase to 38-39 degrees, emergence of pains in a thorax, cough with a mucopurulent phlegm, a blood spitting. At the same time there are more expressed also symptoms of bronchial asthma (feeling of shortage of air, the repeating suffocation attacks). Symptoms of intoxication of an organism are noted: general weakness, drowsiness, pallor of integuments, lack of appetite, decrease in body weight, long preservation of subfebrilny temperature etc.
At the chronic course of allergic bronchopulmonary aspergillomycosis of display of a disease can be erased – without symptoms of intoxication, with periodic cough with a mucous phlegm in which there can be brownish inclusions, small short wind at physical activities, feeling of shortage of air. If aspergillomycosis proceeds against the background of an immunodeficiency, at a clinical picture there will be symptoms of the main disease (a sharp leukosis, tuberculosis of lungs, a sarkoidoz, an obstructive pulmonary disease, a malignant new growth of concrete localization).
The diagnosis of allergic bronchopulmonary aspergillomycosis is established by the allergist-immunologist and the pulmonologist on the basis of studying of the anamnesis, a clinical picture of a disease, these laboratory and tool researches, allergologichesky tests.
The anamnesis of a disease can indicate a hereditary otyagoshchennost on allergic diseases, presence of atopic bronchial asthma at the patient, periodic or long contact with aspergilla in life or in the course of professional activity. At fizikalny inspection approximately at a half of patients with allergic bronchopulmonary aspergillomycosis obtusion of a perkutorny sound in the top departments of lungs and listening is defined at an auskultation of damp melkopuzyrchaty rattles, and also signs of violation of the general state – short wind, pallor of integuments, perspiration, subfebrilitt or a hyperthermia.
At a laboratory research in peripheral blood the eozinofiliya (more than 20%) is defined, also increase in SOE is sometimes noted . In the cytologic analysis of a phlegm prevalence of eosinophils comes to light, at microscopy of a phlegm mycelium elements can be defined. The bacteriological research of a phlegm allows to reveal culture of Aspergillus fumigatus with a growth of mushrooms on nutrient mediums.
Skin allergologichesky tests with extract from are carried out (typical reaction of immediate type comes to light). The diagnosis of allergic bronchopulmonary aspergillomycosis is confirmed when determining of the increased level of the general immunoglobulin E and specific IgE and IgG to Aspergillus fumigatus in blood serum. When carrying out a bronchography and computer tomography proximal bronkhoektaza, "flying" infiltrates in lungs come to light.
Differential diagnosis of allergic bronchopulmonary aspergillomycosis is carried out with tuberculosis of lungs, sarkoidozy, a chronic obstructive pulmonary disease, eozinofilny pulmonary defeats of other etiology.
Treatment of allergic bronchopulmonary aspergillomycosis
The main directions of treatment of aspergillomycosis with defeat of bronchopulmonary system – anti-inflammatory therapy, reduction of a sensitization of an organism and decrease of the activity .
During the sharp period of a disease system glyukokortikosteroidny hormones for not less than six months are appointed (choice medicine – Prednisolonum). Application of glucocorticosteroids is begun in medical dosages and continued to a full rassasyvaniye of infiltrates and normalization of credits of antibodies then pass to the supporting reception on an extent of 4-6 months. After full knocking over of inflammatory process, that is in a remission stage, begin to carry out antifungal therapy amfoteritsiny B or trakonazoly within 4-8 weeks.
Forecast and prevention
The forecast depends on frequency and weight of exacerbations of aspergillomycosis, the accompanying background. At frequent aggravations and existence of other diseases in the anamnesis quality of life significantly suffers. Observance of rules of precaution when carrying out agricultural works allows to warn primary invasion. First of all it touches faces with bronchial asthma and immudefitsita. For prevention of a recurrence of allergic bronchopulmonary aspergillomycosis it is necessary to provide the maximum decrease in contact with aspergilla, and in the presence of such opportunity – moving to the mountain area with an arid climate.