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Aspergillosis is a condition caused by fungi of the genus Aspergillus, which causes all kinds of allergic reactions, open lung infections or superficial skin infections. The greatest amount of fungi is found in the soil and their spores are carried in the air. In addition, they are found on healthy human skin – especially on the hairy head and in the spaces between the fingers.
What is Aspergillosis?
Apergillosis is a disease caused by mold fungi of the genus Aspergillus. They are characterized by widespread occurrence both in nature and the human environment. The greatest amount of them is found in soil and decaying organic matter. Mold spores are dispersed in the air (isolated from dust). They are also present on healthy human skin, especially on the hairy head and the interdigital spaces of the feet. They are the cause of opportunistic infections in immunocompromised risk groups. Mold fungi can be the etiological factor of both superficial fungal infections of the skin and its appendages, and organ mycoses.
Mushrooms that cause aspergillosis
1. Mold species of the genus Aspergillus most often isolated from lesions: Aspergillus fumigatus plays a key role in pathology, other pathogenic species are: A. flavus, A. niger, A. nidulans, A. versicolor.
2. Aspergillus is a common pathogen of opportunistic fungal infections in immunocompromised patients, causing organ infections such as lung, bone, CNS and systemic aspergillosis. There have also been reports of superficial skin and nail infections.
These microorganisms are ubiquitous in nature, they live on leaves, decaying plants, in the air of hospitals. They are often detected in asymptomatic patients.
Types of aspergillosis
The human body is attacked by various types of aspergillosis. Taking certain medications and the accompanying ailments increase the risk of developing certain types.
1. Invasive aspergillosis People with a weakened immune system, receiving chemotherapy, cancer or AIDS are at risk of this type of disease (these diseases make it difficult to fight infection). The invasive form of the disease usually affects the lung tissue and can travel to the kidneys and the brain. Ignoring the disease and not implementing treatment can lead to infectious pneumonia, which ultimately puts the life of patients with a lowered immune system at risk.
2. Allergic bronchopulmonary aspergillosis – this type of disease usually affects people with lung problems (e.g. asthma or cystic fibrosis). It manifests itself by coughing and wheezing.
3. Aspergiloma – arises as a result of contact with the fungus during tuberculosis or other ailments that may lead to the growth of the fungus. It is manifested by growths, a ball fungus, which consists of white blood cells and clots. This lesion usually does not spread to the rest of the body, but it can enlarge and thus damage lung tissue.
Symptoms of aspergillosis
1. Onychomycosis – caused by fungi of the genus Aspergillus? (-> onychomycosis, -> nail aspergillosis).
2. Mycosis of the skin caused by fungi of the genus Aspergillus. Primary cutaneous aspergillosis is described sporadically, most often as a result of burn wounds or other damage to the epidermis: the lesions are usually single and superficial, dandruff in nature, less often in the form of necrotic ulcers. Primary cutaneous aspergillosis (local mold inoculation in a weakened host) is most commonly caused by Aspergillus flavus. The gateways of infection are places after intravenous punctures, places under dressings, burns (secondary superinfection) and pyoderma gangrenosum foci.
3. Systemic Aspergillosis – about 5% of secondary skin lesions occur, most often in the form of single foci of inflammation with a tendency to develop necrotic ulcersseeding is sometimes observed papular changes with a tendency to suppuration. Aspergillus sp. Is isolated as a saprophyte from dandruff lesions of the scalp or from exfoliated erythematous foci in the seborrheic areas.
4. Skin infections of the outer ear. Mushrooms of the genus Aspergillus are quite often isolated from lesions within the outer ear – aspergillosis of the outer ear occurs in the form of erythematous-exfoliative inflammatory changes resembling eczema or seborrheic lesionsoften accompanied by leakage from the ear. Sometimes there are small ulcerations covered with scab, on the surface of inflamed skin greenish or dark raids depending on the species of aspergilloma. Symptoms include:
- pain,
- severe itching
- feeling of pressure in the outer ear,
- sometimes severely impaired hearing.
Skin infections of the outer ear can be accompanied by symptoms of perchondritis.
5. Lung infections. Aspergillus fumigatus causes pulmonary diseases, e.g. in the tuberculous cavity it can arise aspergilloma (aspergilloma). In some patients, this microorganism can cause asthma by producing an allergic reaction with inflammation and swelling of the proximal bronchi. Immunosuppressed patients may also develop invasive lung disease with formation of blockages in the skin (fungal seeding).
6. Aspergillus can also cause invasive sinusitis.
7. Nail aspergillosis is onychomycosis caused by fungi of the genus Aspergillus. Is characterised by yellow, gray or dark green discoloration of the nail plates (image of dirty nails). Clinically, nail aspergillosis occurs in the form of distal and lateral subungual onychomycosis or superficial white onychomycosis (-> Onychomycosis).
Diagnosis of aspergillosis
The diagnosis of aspergillosis is based on microscopic and culture methods aimed at revealing the presence of specific embryos. In addition, in the diagnosis of invasive disease, immunological tests are used to detect anti-Aspergillus antibodies and Aspergillus galactomann antigen in blood serum. The doctor may also insert a diagnostic instrument through the patient’s mouth or nose, which extends into the lungs and draws a small amount of fluid for examination for ringworm.
Research may also include:
- computed tomography (to obtain a better picture of the lungs),
- Chest x-ray,
- sputum culture analysis and sputum stain testing.
In addition, the physician should talk to the patient about their symptoms and review their medical history for conditions that make them more susceptible to aspergillosis.
Aspergillosis – treatment
Pharmacological treatment of aspergillosis is based on the use of amphotericin B and voriconazole. In addition, surgical removal of the affected areas is suggested. A particular indication for the procedure is infection of the heart valve (after the procedure, broad antifungal treatment is usually implemented).
Can aspergillosis be completely cured?
Allergic aspergillosis usually resolves with treatment, but may be relapsed through contact with the fungus. On the other hand, recovery from invasive aspergillosis depends on the patient’s state of health and the efficiency of his immune system. Very often, aspergillosis does not require any treatment.
IMPORTANT: Regardless of the type of disease, failure to respond to treatment can even lead to death. The developing complications may include respiratory failure, bleeding in the lungs, biliary obstruction and kidney damage.
Lit .: [1] Ajith C., Dogra S., Radotra B.D. i wsp.: Primary cutaneous aspergillosis in an immunocompetent individual. J Eur Acad Dermatol Venereol 2006, 20(6); 738-9. [2] Klein K.C., Blackwood R.A.: Topical voriconazole solution for cutaneous aspergillosis in a pediatric patient after bone marrow transplant. Pediatrics 2006, 118(2); 506-8. [3] Andresen J., Nygaard E.A., Stordal K.: Primary cutaneous aspergillosis (PCA) a case report. Acta Paediatr 2005, 94(6); 761-2.
Source: A. Kaszuba, Z. Adamski: “Lexicon of dermatology”; XNUMXst edition, Czelej Publishing House