ASPERGILLOMA SYNDROME

 

ABOUT AUTHOR:
Akshay Rajgaria, Prajna Tripathy
Kanak Manjari Institute of pharmaceutical Sciences.
Rourkela, Orissa
akshaykrish2007@gmail.com

ABSTRACT:
An aspergilloma, also known as a mycetoma or fungus ball, is a clump of fungus which exists in a body cavity such as the lung. It is associated with the Aspergillus species, but Zygomycota and Fusarium may also form similar structures

REFERENCE ID: PHARMATUTOR-ART-2141

INTRODUCTION:
Aspergillosis is a group of illnesses caused by a certain type of mold. These illnesses usually affect the respiratory system. The mold that triggers the illnesses, aspergillus, occurs widely indoors and outdoors. Most strains of this mold are harmless. But a few can cause serious illnesses when their spores are inhaled by people with a weakened immune system, underlying lung disease or asthma. In some people, the spores trigger an allergic reaction. Other people develop mild to serious lung infections. The most serious form of aspergillosis — invasive aspergillosis — occurs when the infection spreads to blood vessels and beyond. Depending on the type of aspergillosis, treatment may involve observation, antifungal medications or, in rare cases, surgery

CAUSES:
Aspergillomas are formed when the fungus aspergillus grows in a clump in a lung cavity, or invades previously healthy tissue, causing an abscess. Aspergillus is a common fungus. It grows on dead leaves, stored grain, bird droppings, compost piles, and other decaying vegetation. Cavities in the lung may have been caused by:

  • Coccidioidomycosis
  • Cystic fibrosis
  • Histoplasmosis
  • Lung abscess
  • Lung cancer
  • Sarcoidosis
  • Tuberculosis

SIGN AND SYMPTOM:
The signs and symptoms of aspergillosis vary with the type of illness you develop:

Allergic reaction:
Some people with asthma or cystic fibrosis have an allergic reaction to aspergillus mold. Signs and symptoms of this condition, known as allergic broncho pulmonary aspergillosis, include:

  • Fever.
  • A cough that may bring up blood or plugs of mucus.
  • Worsening asthma.

Fungal mass:
A growth of tangled fungus fibers (fungus ball) may develop if there are air spaces (cavities) in the lungs. This type of aspergillosis is called aspergilloma. Lung cavities may develop in people with pre-existing lung conditions, such as emphysema, tuberculosis or advanced sarcoidosis. Aspergilloma is a benign condition that may not initially produce symptoms, but over time it can cause:

  • A cough that often brings up blood (hemoptysis), sometimes large amounts
  • Wheezing
  • Shortness of breath
  • Unintentional weight loss
  • Fatigue

Infection:
The most severe form of aspergillosis, invasive pulmonary aspergillosis, occurs when the infection spreads rapidly from the lungs through your bloodstream to your brain, heart, kidneys or skin. This occurs only in people whose immune system is weakened, commonly from chemotherapy. Signs and symptoms depend on which organs are affected, but in general, invasive aspergillosis can cause:

  • Fever and chills
  • Cough that brings up blood-streaked sputum (hemoptysis)
  • Severe bleeding from your lungs
  • Shortness of breath
  • Chest or joint pain
  • Nosebleed
  • Facial swelling on one side
  • Skin lesions

TREATMENT:
Aspergillosis treatments vary with the type of disease. Possible treatments include:

Observation. Aspergillomas often don't need treatment, and medications aren't usually effective in treating these fungal masses. Instead, aspergillomas that don't cause symptoms may simply be closely monitored by chest X-ray.

Oral corticosteroids. The goal in treating allergic bronchopulmonary aspergillosis is to prevent existing asthma or cystic fibrosis from becoming worse. The best way to do this is with oral corticosteroids. Antifungal medications by themselves aren't helpful for allergic bronchopulmonary aspergillosis, but they may be used in combination with corticosteroids to reduce the dose of steroids and improve lung function.

Antifungal medications. These drugs are the standard treatment for invasive pulmonary aspergillosis. Historically, the drug of choice has been amphotericin B, but the newer medication voriconazole (Vfend) is now preferred because it appears more effective and may have fewer side effects. All antifungals can cause serious problems, however, including kidney and liver damage, and they frequently interact with other medications given to people who have weakened immune systems.

Surgery. Because antifungal medications don't penetrate aspergillomas very well, surgery to remove the fungal mass is the first-choice treatment when bleeding from the mass in the lungs occurs. But the surgery is risky, and your doctor may instead suggest embolization. In this procedure, your doctor, usually a radiologist, threads a small catheter into the artery that supplies blood to the cavity containing the fungus ball, and injects a special material that clogs the artery. Though this procedure can stop massive bleeding, it doesn't prevent it from recurring, so it's generally considered a temporary treatment.

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