edit csada, md 18.11.2015.. facultative pathogens moulds aspergilli mucoraceae yeasts candida ...
TRANSCRIPT
Edit Csada, MD18.11.2015.
Facultative pathogens Moulds
Aspergilli Mucoraceae
Yeasts Candida Cryptococcus
Obligate pathogenes Histoplasma capsulatum Coccidioides immitis Blastomyces dermatitidis Sporothrix shenckii
2
Immuncompromised state, treatmentCytostatic treatmentAntibiotic and steroid treatmentLeukemyNeutropenic patientsMalignanciesDiabetes mellitusAIDSAfter intensive therapyAfter transplantation
Epitheloid hyperplasia
Histocyte granulomasThrombotic arteriitisCaseation granulomaFibrosisCalcification
Microscopic examinationnative smeardifferent stainings
CultureSpecial culture media
Histology+ culture
Skin testSerology
Differential diagnosistumortuberculosischr pneumonia
Medical treatmentPolyens Amphotericin B (Fungisone)
Nystatin Pimafucin
5 fluorocytosin AncotilAzoles Ketoconazole (Nizoral)
Clotrimazole (Canesten) Caspofungin (cancidas) Fluconazole (Diflucan)
Itraconazole (Orungal) Voriconazole (Vfend) (2. gen.)
Surgery
Allergic aspergillosisExtrinsic allergic alveolitis
hypersensitivity pneumonitisAllergic bronchopulmonary
aspergillosis
AspergillomasInvasive aspergillosisRare manifestations
Aspergillus endocarditisAspergillus pneumoniaEndophthalmitis
Type I immediate hypersensitivity reactionType III antigen, antibody, immune komplex
reactionDiagnosis
Bronchial obstructionFeverEosinophyliaSkin testIgG se precipitating antibody Total, specific IgE
X-ray Small, fleeting inflitratesHilar, paratracheal adenopathy
Chronic consolidationAlveolitis – fibrosisBronchiectasis
TherapyChromoglycateCorticosteroid
Saprophytic colonisation of fungi in pulmonary cavities
Manifestation No symptoms Haemoptysis Fever Cachexia
Chraracteristic x-ray picture!Therapy: surgery
„Halo sign”
14
Immuncompromised host!Necrotising pneumoniaEmpyemaPulm., extrapulm.
DisseminationSymptoms: fever, pleural pain, haemotysisTherapy: Amphotericin B
or voriconazoleitraconazole, caspofungin
Normal inhabitants of mucocutaneous body surfaces.80% of all systemic fungal infectionManifestation
Disease of skin and mucosaGynecological diseaseOesophagitisIn the lung: Bronchitis
Pneumonia Pleurisy
Therapy: Amphotericin B, caspofungin, fluconazole, itraconazole, voriconazole
It is the 4. Most common cause of opportunistic infections in AIDS patients in the US.Manifestations:
asymptomatic colonisationext. All. Alveolitisprimary complextoruloma
Diagnosis: Masson-Fontana stainingComplication: meningoencephalitisTherapy: spontaneous healing, amphotericin B, fluconazole, flucytosine
It is the most common systemic mycosis in the USA.Manifestation Subclinical Acute form: Influenzalike disease X-ray: small scattered, patchy infiltrates
calcificationProgressive, disseminated form
Rare (AIDS)Chr. pulmonary form
(COPD)Segmental, interstitial pneumonitisChr cavitary disease
Diagnosis: Wright’s or Giemsa stainingPrognosis: goodTherapy: itraconazole, amphotericin B
Acute, benign diseasePrimary infection: infuenzalike symptoms Radiological findings:
Segmental pneumoniaMinimal infiltratesAdenopathy, pleural effusionNodular lesions, cavities
Prognosis is good without any therapy.Diagnosis: eosinophilia, IgGProgressive, extrapum. manifestation
COCCIDIOIDOMYCOSIS
• Risk factors for dissemination of Coccidioides Immitis infection• Older age• Males• Non-caucasians, Filipinos• Immunsuppression• Gravidity
• Therapy• Azoles• Fluconazole > Itraconazole• Ketoconazole: less effective
21
PneumoconiosisHypersensitivity pneumonitisObstructive airway diseasesToxic damagesMalignant lung diseasesPleural diseases
22
Agents
Isocyanates
Flour
Epoxy resins
Animals (rats, mice)
Wood dusts
Azodicarbonamide
Persulphate salts
Latex
Drugs
Grain dust
Occupational exposure
Spray paints, varnishes,adhesives, polyurethanefoam manufacture
Bakers
Hardening agents,adhesives
Laboratory workers
Sawmill workers, joiners
Polyvinyl plasticsmanufacture
Hairdressers
Healthcare workers
Pharmaceutical industry
Farmers, millers, bakers
Diagnosis: Asthma diagnosis Causative connection between
asthma and working place Clinical manifestations
Early asthmatic response Late asthmatic response Combined response
Therapy: Avoidance of exposition Protective devices Asthma treatment
24
Etiologic agents: inhalation of inorganic dusts
metal dusts free silica coal dusts
25
The base of disease is the progressive concentric fibrosis with hyalinisation in the centre.
Free silica: miningstone cuttingroad and building
constructionblasting
26
27
Silicic acid contentContent of dusts in the place of work
(200 000/m3)Size of dust (<2 micron)Time of exposureIndividual inclination (smoking)
Symptoms: no symptomsdyspnoehypoxaemia, hypercapnia=>ventilatory failure=>cor pulmonale
X-ray: nodular disseminationsilicomas (=>emphysematic bullae)hilar adenopathycalcification, egg shell pattern
Complications: chr. bronchitisemphysemaptx
Tb is more frequentCaplan’s syndromaTherapy: symptomaticProphylaxis!
28
29
30
31
32
Silicosis
33
Hydrosilicate – fibre, thread Pulmonal clearence depends on the ratio
of length and diameter of fibers 50-100 asbest particula/cm3 →
mesothelioma Basal and subpleural fibrosis
34
35
(Extrinic allergic alveolitis)It is an immunologically induced inflammation
of lung parenchyma involving alveolar walls and terminal airways secondary to repeated inhalation of a variety of organic dusts and other agents by susceptible host.
Manifestations:Farmer’s lung (1932) – thermophylic actinomycetesBird fancier’s breeder’s or handler’s lung
Miller’s lungBagassosisByssinosis
Air conditioner’s lungCoffee worker’s lung 36
Clinical forms:Acute: (type III. reaction) cough, fever, chills, malaise, dyspnoe may occur 6-8 hours after exposure and usually clear within few daysSubacute: (type IV reaction) symptoms appear over a period of week( cough, dyspnoe, cyanosis). Symptoms disappear within weeks, or months, if causative agent is no longer inhaled.Chronic: (type IV reaction) gradually progressive intersistial disease associated with cough, exertional dyspnoe without a prior history of acute or subacute disease.
37
38
39
Diagnosis:anamnesisx-ray: normal
poorly defined patchy or diffuse infiltrates
reticulonodular lesionslung function tests:impaired diffusing capacity,
decreased comliance exercise induced hypoxaemia
Se precipitins against suspected antigensBAL: acute : neutrophyls, monocytes(5%)
chr: lymphocytes(60-70%)Lung biopsy: intersitial alveolar infiltrates
bronchiolitisTherapy:
avoidance of antigenscorticosteroids
40
41Thank you for your attention!