Aspergillomycosis – the mycosis caused by different types of mold fungi of the sort Aspergillus and proceeding with chronic toksiko-allergic manifestations. At aspergillomycosis the bronchopulmonary system and additional bosoms mainly is surprised; more rare - skin, visual system, TsNS, etc. At patients with low immune responsiveness disseminirovanny aspergillomycosis can develop. The leading role in diagnosis of aspergillomycosis is played by laboratory methods: microscopy, , serological reactions, PTsR. Statement of inhalation and skin and allergic tests is possible. Treatment of aspergillomycosis is carried out by antifungalny medicines.
Aspergillomycosis – a fungal disease as which causative agent mold mushrooms of an aspergilla act. Aspergilla can cause various superficial and deep mycoses of internals, skin and mucous membranes therefore aspergillomycosis is studied within a number of clinical disciplines: mycology, pulmonology, otolaryngology, dermatology, ophthalmology, etc. For the last two decades the frequency of infection with aspergillomycosis in population grew by 20% that is connected with increase in number of patients with the congenital and acquired immunodeficiency, spread of drug addiction and HIV infection, irrational use of antibiotics, use of immunosupressivny medicines in oncology and transplantology. All this once again confirms the growing relevance of aspergillomycosis.
As causative agents of aspergillomycosis at the person the following types of mold fungi of the sort Aspergillus can act: A. flavus, A. Niger, A. Fumigatus, A. nidulans. A. terreus, A. clavatus. Aspergilla are aerobes and geterotrofa; are capable to grow at a temperature up to 50 °C, it is long to remain when drying and freezing. In the environment of an aspergilla are widespread everywhere – in the soil, air, water. Favorable conditions for growth and reproduction are available in ventilating and shower systems, conditioners and humidifiers, old things and books, crude walls and ceilings, is long the stored foodstuff, agricultural and houseplants, etc.
Infection with aspergillomycosis most often occurs in the inhalation way at inhalation of the particles of dust containing a mycelium. Agricultural workers, employees of the bumagopryadilny and weaver's enterprises, millers, and also breeders of pigeons as pigeons, are more often than other birds are subject to the greatest risk of developing of a disease, have aspergillomycosis. Developing of a fungal infection is promoted by infection when holding invasive procedures: bronkhoskopiya, punctures of okolonosovy bosoms, endoscopic biopsy, etc. The contact way of transfer of aspergillomycosis through the damaged integuments and mucous membranes is not excluded. Also perhaps alimentary infection at the use of kontaminirovanny food of an aspergillama (for example, chicken meat).
Except exogenous infection of an aspergillama, autozarazheniye cases (are known at activation of the fungi living on skin, mucous a pharynx and airways) and transplacentary infection. Immunodeficiencies of any genesis, chronic diseases of respiratory system (HOBL, tuberculosis, a bronkhoektatichesky disease, bronchial asthma, etc.), diabetes, dysbacteriosis, burn injuries belong to risk factors of incidence of aspergillomycosis; reception of antibiotics, corticosteroids and tsitostatik, performing radiation therapy. Cases of development of the mycoses of the mixed etiology caused by different types of fungi – aspergillam, Candida, actinomycetes are frequent.
Classification of aspergillomycosis
Thus, depending on ways of spread of a fungal infection distinguish endogenous (autoinfektion), exogenous (with an airborne and alimentary way of transfer) and transplacentary aspergillomycosis (with a vertical way of infection).
On localization of pathological process allocate the following forms of aspergillomycosis: bronchopulmonary (including aspergillomycosis of lungs), ENT organs, skin, eye, bone, septic (generalized) and so forth. About 90% of all cases of aspergillomycosis are the share of primary defeat of a respiratory path and lungs; additional bosoms of a nose – 5%. Involvement of other bodies are diagnosed less than for 5% of patients; the dissemination of aspergillomycosis develops approximately in 30% of cases, mainly, at the weakened faces with the burdened premorbidny background.
The form of pathology which is the most studied today is aspergillomycosis of lungs. Initial stages of bronchopulmonary aspergillomycosis mask under clinic of a trakheobronkhit or bronchitis. Patients are disturbed by cough with a phlegm of grayish color, a blood spitting, the general weakness, weight loss. At distribution of process on lungs the pulmonary form of mycosis - aspergillezny pneumonia develops. In a sharp phase fever of the wrong type, oznoba, cough with a plentiful mucopurulent phlegm, short wind, thorax pains is noted. At breath from a mouth the mold smell can be felt. By means of a microscopic research of a phlegm colonies of a mycelium and disputes are found.
At patients with associated diseases of respiratory system (pulmonary fibrosis, emphysema, cysts, lung abscess, sarkoidozy, tuberculosis, a hypoplasia, histoplasmosis) quite often forms an aspergilloma of lungs – the encapsulated center containing mushroom hyphas, fibrin, slime and cellular elements. Death of patients from aspergillomy can be caused by pulmonary bleeding or asphyxia.
Aspergillomycosis of ENT organs can proceed in the form of external or average otitis, rhinitis, sinusitis, tonsillitis, pharyngitis. At aspergillezny otitis there is hyperaemia, a peeling and an itch of skin of external acoustical pass in the beginning. Eventually acoustical pass is filled with the friable grayish weight containing threads and disputes of a mushroom. The spread of aspergillomycosis on an eardrum which is followed by the sharp pricking ear pains is possible. Damages of maxillary and wedge-shaped bosoms, a trellised bone, transition of a fungal invasion to orbits are described. Eye aspergillomycosis can take the form of conjunctivitis, an ulcer blefarit, a nodular keratit, a dakriotsistit, a blefaromeybomit, a panoftalmit. Complications in the form of deep ulcers of a cornea, uveit, glaucoma, sight loss are frequent.
Aspergillomycosis of skin is characterized by emergence of an eritema, infiltration, brownish scales, a moderate itch. In case of development of an onikhomikoz there is a deformation of nail plates, change of color on dark yellow or brownish-greenish, dyeing of nails. Aspergillomycosis of a GIT proceeds under the guise of erosive gastritis or an enterokolit: nausea, vomiting, diarrhea are typical for it a mold smell from a mouth.
The generalized form of aspergillomycosis develops at a hematogenic dissemination from primary center in various bodies and fabrics. At this form of a disease there are an aspergillezny endocarditis, meningitis, encephalitis; abscesses of a brain, kidneys, liver, myocardium; damage of bones, GIT, ENT organs; aspergillezny sepsis. The lethality from a septic form of aspergillomycosis is very high.
Diagnosis of aspergillomycosis
Depending on a mycosis form patients go for consultation to the expert of the corresponding profile: to the pulmonologist, otolaryngologist, ophthalmologist, mycologist. In the course of diagnosis of aspergillomycosis much attention is paid to the anamnesis, including professional, to existence of chronic pulmonary pathology and an immunodeficiency. At suspicion on a bronchopulmonary form of aspergillomycosis the X-ray analysis and KT of lungs, a bronkhoskopiya with a phlegm fence, a bronkhoalveolyarny unleavened wheat cake is carried out.
Basis of diagnosis of aspergillomycosis the complex of laboratory researches for as which material can serve a phlegm, washing waters makes scrapes of bronchial tubes, from smooth skin and nails, separated from bosoms of a nose and external acoustical pass, prints from a surface of a cornea, kcal and so forth Aspergilla can be found by means of microscopy, a cultural research, PTsR, serological reactions (IFA, RSK, RIA). Conducting skin and allergic tests with anti-genes is possible.
Differential diagnosis of aspergillomycosis of lungs is carried out with inflammatory diseases of a respiratory path of a virus or bacterial etiology, sarkoidozy, candidiasis, tuberculosis of lungs, mukovistsidozy, tumors of lungs, etc. Aspergillomycosis of skin and nails has similarity to an epidermofitiya, rubromikozy, syphilis, tuberculosis, actinomycosis.
Treatment of aspergillomycosis
Depending on weight of a condition of the patient and a form of aspergillomycosis treatment can be performed in out-patient conditions or in a hospital of the corresponding profile. Antifungalny therapy is carried out by medicines: In, , , , . Antifungal medicines can be appointed inside, intravenously, in the form of inhalations. At aspergillomycosis of skin, nails and mucous membranes local processing of the centers is carried out by antifungal means, antiseptics, enzymes. Antifungal therapy continues from 4 to 8 weeks, sometimes - up to 3 months and longer.
At an aspergilloma of lungs surgical tactics – an economical resection of a lung or lobectomy is shown. In the course of treatment of any form of aspergillomycosis performing the stimulating and immunocorrective therapy is necessary.
Forecast and prevention of aspergillomycosis
The optimum current is noted at aspergillomycosis of skin and mucous membranes. The lethality from pulmonary forms of mycosis makes 20-35%, and at persons with an immunodeficiency – to 50%. The septic form of aspergillomycosis has the adverse forecast. To measures, infection with the aspergillomycosis allowing to warn, actions for improvement of sanitary and hygienic conditions belong: fight against dust on production, carrying by workers mills, granaries, vegetable storehouses, the weaver's enterprises of individual means of protection (respirators), improvement of ventilation of shops and warehouses, regular mycologic inspection of persons from risk groups.