Ms. Li, 35, was recently distressed, coughing and gasping repeatedly for a month, taking a lot of medicines that didn't work. Reluctantly, she went to the hospital for a chest CT, and the doctor found that her lungs were full of large and small nodules, the largest of which was about 2 cm. Is it a malignancy? Or is it some kind of infection? The doctor asked about the medical history, Ms. Li said that she returned to her hometown more than a month ago, helped her parents collect corn for several days, and began to cough two or three days after returning, and always thought that she was cold from work. Doctors are associated with this pathogenesis and are highly suspected of being infected by some pathogen. So I did a tracheoscopy, biopsy pathology to find Aspergillus, so far, Ms. Li was finally diagnosed with aspergillus lung infection.
"Small balls" grow in the lungs, not swallowed, but parasitically formed by fungi in them. How do fungi get into the lungs?
Aspergillus bacteria account for about 12% of the fungi in the air, and if there are Aspergillus floating in the air in the environment, it is possible to be inhaled into the body. Aspergillus fungus, after entering the human body, can colonize the trachea and bronchial tubes, and stimulate the bronchi to secrete viscous fluid, blocking the trachea, causing cough and asthma, while Aspergillus will continue to multiply to form aspergilloma.
The incidence of fungal infections in the lungs is getting higher and higher, and Aspergillus is a conditional pathogenic bacteria, which used to occur in people with low immunity, but now there is a tendency to spread to people with normal immunity. Aspergillus is an important pathogenic bacterium in pathogenic fungi, according to the patient's immunity status and the number of inhaled aspergillus, the invasion of human lungs mainly causes three diseases, including aspergilloccus, invasive pulmonary aspergillosis and allergic bronchopulmonary aspergillosis. Invasive pulmonary aspergillosis is the most severe of these types.
Invasive pulmonary aspergillosis
This is a respiratory term only released in 2018, Aspergillus infects the lungs and directly forms lesions in the lungs. Usually occurs in immunocompromised people, including patients after chemotherapy for malignancies, patients who have been taking glucocorticoids and immunosuppressive drugs for a long time, diabetic patients, etc., can form clump shadows and flaky shadows in the lungs, and nodules are the most common CT manifestations of invasive pulmonary aspergillosis, and some can also form cavities, and circular "halo signs" will be formed around the lesion. Clinical manifestations are persistent fever, cough, chest pain, and dyspnea in severe cases. Fever is common and often occurs in parallel with broad-spectrum antibiotic therapy, and fever is often masked by the use of hormones. Aspergillocete hyphae are prone to invade blood vessels, forming local embolism and bleeding, causing hemoptysis.
Allergic bronchopulmonary aspergillosis
Allergic bronchopulmonary aspergillosis is mainly manifested as wheezing, which is actually a hypersensitivity reaction of the body to aspergillus antigens. Severe allergic reactions can form a large amount of viscous mucus embolism in the trachea, it is easy to form a central bronchiectasis, patients with simultaneous asthma-like attacks, easy to confuse with asthma, but the use of anti-asthma drugs is ineffective.
Diagnosis of allergic bronchopulmonary aspergillosis must detect allergic antibody IgE in the blood, which is more than 1000, and can be diagnosed if the disease is positive for aspergillosis antigenic tests. Ct images of the chest showing bronchiectasis with mucus thrombosis are more indicative of the disease.
How to treat invasive pulmonary aspergillosis and allergic bronchopulmonary aspergillosis
Empiric antifungal therapy should be initiated in a timely manner when invasive Aspergillus pneumoconiosis is clinically suspected, and the effectiveness of treatment depends on early diagnosis, degree of dissemination, strength of antifungal therapy, and host immune status. Itraconazole is usually used, but for critically ill patients, voriconazole and caspofenin can also be used, combined with 2 antifungal drugs if necessary, plus nutritional support and immunomodulatory therapy. Antifungal therapy is longer, 3-6 months, or even longer, until the clinical and radiographic changes disappear and the culture turns negative.
Allergic bronchopulmonary aspergillosis is a disease that must be considered when asthma treatment is not very effective. Treatment is mainly oral itraconazole or voriconazole, which takes 4-6 months or even longer, while oral glucocorticoids can quickly alleviate the patient's asthma symptoms, alleviate allergic reactions, and add sputum drugs to reduce sputum embolization, which can alleviate airway obstruction.