DefinitionThis section has been translated automatically.
Mould infection mostly caused by Aspergillus spp.
PathogenThis section has been translated automatically.
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Occurrence/EpidemiologyThis section has been translated automatically.
The main reservoir of Aspergillus spp. is long-term stored plant material (hay, compost, potting soil). Aspergillus is found ubiquitously. Frequently occurring as lung and CNS complications in immunocompromised patients.
EtiopathogenesisThis section has been translated automatically.
Weakness of the immune system, malignant tumours, 15% in patients with cystic fibrosis (E84.8), long-term therapy with glucocorticoids, cytostatics, after X-ray radiation; in patients with stem cell transplantation.
Clinical featuresThis section has been translated automatically.
- Infestation of skin, mucous membranes and nails see below Onychomycosis (primary cutaneous or mucosal aspergillosis).
- Further local infestation of the auditory canal, ear and sinuses possible.
- In case of systemic infestation, infection occurs by inhalation of the spores. The lungs are primarily affected:
- Aspergilloma that spreads in a cavity of the lung.
- Allergic bronchopulmonary aspergillosis (ABPA) with bronchial asthma (IgE-mediated allergic bronchial asthma can also occur independently of ABPA).
- Invasive Pulmonary Aspergillosis and Aspergillus Pneumonia
- In cases of pronounced polyätiological immunodeficiency (e.g. AIDS, organ transplantation), haematogenic spreading with infestation of several internal organs, pyemic-septic course with metastasis mainly in the heart muscle, endocardium, central nervous system and kidneys may occur.
- Primary cutaneous neonatal aspergillosis in premature infants: rare but increasing disease which is mainly observed in immature infants. It is caused by small local injuries and insufficient keratinization of the immature organism. Clinically there are 1 or more grossly consistent, surface smooth, reddish papules.
Exogenous-allergic alveolitis: Aspergillus species can (rather rarely) have a triggering effect here.
DiagnosisThis section has been translated automatically.
- Pathogen detection microscopically and culturally in tissue samples.
- Detection of Aspergillus antibodies in the Aspergillus/Galactomann antigen test from serum, bronchial secretion or cerebrospinal fluid.
- In case of organ infestation: X-ray, spiral CT, Ak detection, brocnhoscopy with detection of aspergillus in bronchial secretion.
- Histological detection in biopsies.
General therapyThis section has been translated automatically.
For these balls of fungus spreading in lung caverns, purely drug-based therapy is ineffective. Surgical removal of aspergillomas if present.
External therapyThis section has been translated automatically.
Internal therapyThis section has been translated automatically.
For systemic invasive aspergillosis:
- Therapy of the 1st choice is voriconazole (adults and children > 12 years). 2 times/day (every 12 hours) 6 mg/kg bw. Maintenance dose from day 2: 2 times/day 4 mg/kg bw i.v. ).
- Alternatively: Amphotericin B (e.g. Ampho-Moronal 100 mg) 4 times/day 1 tbl. for 2-4 weeks or liposomal amphotericin B (e.g. AmBisome®) initial 1 mg/kg bw i.v., if necessary gradually increasing to 3 mg/kg bw i.v.). Possibly combination with flucytosine (e.g. Ancotil®: 150-200 mg/kg bw/day i.v. for 3-4 weeks in 4 single doses over 20-40 minutes each).
- Alternatively: Itraconazole (e.g. Sempera) 2 times/day 2 Kps. p.o. for 2-5 months.
- Alternative: In case of failure of all above mentioned therapies, try caspofungin (e.g. Cancidas®: initial 70 mg/day i.v. up to 7 days after the symptoms have subsided).
ProphylaxisThis section has been translated automatically.
Posaconazole is used prophylactically in severely immunocompromised patients.
Note(s)This section has been translated automatically.
There is increasing evidence of azole resistance in Aspergillus species (Dabas Y et al. 2018).
LiteratureThis section has been translated automatically.
- Dabas Y et al (2018) "Emergence of azole resistant Aspergillus fumigatus from immunocompromised hostsin
India". Antimicrobial agents Chemother pii: AAC.02264-17.
- Helmi M (2003) Aspergillus infection in lung transplant recipients with cystic fibrosis: risk factors and outcomes comparison to other types of transplant recipients. Chest 123: 800-808
- Klotz D et al (2013) Primary kuntane aspergillosis in an extremely immature premature baby. Dermatologist 64: 664-665
- Tarrand JJ et al (2003) Diagnosis of invasive septate mold infections. A correlation of microbiological culture and histologic or cytologic examination. At J Clin Pathol 119: 854-858
Incoming links (20)Amphotericin b, liposomal; Aspergillosis disseminated; Aspergillus flavus; Aspergillus fumigatus; Clotrimazole ointment hydrophilic 2% (nrf 11.50.); Dermatomycoses; Eosinophilia skin changes; Galactomannan; Galactomannan antigen test; Isavuconazole; ... Show all
Outgoing links (12)Allergic bronchopulmonary aspergillosis; Antimycotics; Aspergillus flavus; Aspergillus fumigatus; Caspofungin; Clotrimazole tincture 2%; Galactomannan antigen test; Glucocorticosteroids; Moulds; Onychomycosis (overview); ... Show all
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