acute invasive pulmonary aspergillosis
Introduction
Brief introduction of acute invasive pulmonary aspergillosis Acute invasive pulmonary aspergillosis (acuteinvasive pulmonary aspergillosis) is the most common and severe form of invasive pulmonary aspergillosis. Aspergillus bronchopneumonia and disseminated pulmonary aspergillosis can generally fall into this category. basic knowledge The proportion of patients: 0.012% - 0.035% (the incidence of HIV-infected patients and low-grade patients is about 0.012% - 0.035%) Susceptible people: no special people Mode of infection: non-infectious Complications: respiratory failure
Cause
Acute invasive pulmonary aspergillosis
(1) Causes of the disease
Invasive aspergillosis is caused by the invasion of Aspergillus oryzae (mainly Aspergillus fumigatus).
(two) pathogenesis
Phagocytic cells as one of the host's defense mechanisms, its quantity and function are important in the pathogenesis of acute invasive pulmonary aspergillosis, lymphocyte-mediated cellular immunity is also important, experimental studies have shown that neutrophils can prevent Aspergillus The formation of hyphae, while monocytes mainly affect conidia, which is consistent with the clinical situation of patients with neutropenia and cellular immune damage, the role of humoral immunity in the pathogenesis of this disease is not clear, In patients with gamma globulin deficiency or dysfunction, the incidence of this disease did not increase, suggesting that humoral immunity does not play a major role, the pathological manifestations are mainly acute necrotizing hemorrhagic pneumonia, inflammatory infiltration, suppuration, and then the formation of granuloma, hyphae in Proliferation and invasion of blood vessels in the lungs, leading to necrotizing vasculitis, causing thrombosis or thrombosis, causing hemoptysis and bloodstream dissemination, producing Aspergillus infection in the brain, liver, kidney, heart and other organs, extrapulmonary abscess, abscess Spreading can sometimes cause infections in the lungs.
Prevention
Acute invasive pulmonary aspergillosis prevention
Main measures:
1. Treatment of the primary disease to eliminate or shorten the patient's high-risk period.
2. Prevent or reduce the contact of susceptible patients with Aspergillus spores.
3. Prophylactic use of amphotericin B intravenous drug is more toxic, not suitable for prophylactic treatment, a nasal spray containing amphotericin B has a certain preventive effect, other antifungal drugs have no obvious preventive effect, High-risk patients with fever and antibiotic treatment can be used early in the treatment of amphotericin B, usually starting from 7 days of fever.
Complication
Acute invasive pulmonary aspergillosis complications Complications, respiratory failure
Concurrent respiratory failure.
Symptom
Symptoms of acute invasive pulmonary aspergillosis Common symptoms Fever with cough, slightly... Breathing difficulty chest pain hemoptysis
Typical cases are granulocytosis or receiving broad-spectrum antibiotics. Unexplained fever occurs in immunosuppressive agents and glucocorticoids. Chest symptoms are dry cough and chest pain is the most common. Although hemoptysis is not as common as the first two symptoms, it is very important. The value of suggestive diagnosis, when the lung lesions are extensive, there is an air rush, or even respiratory failure. In addition, gastrointestinal bleeding and various central nervous system symptoms can occur. The lung signs depend on the nature and extent of the lesion, when the pleura is involved. A pleural friction or rubbing sound may occur.
As mentioned above, in high-risk patients with unexplained fever, hemoptysis and pulmonary infiltration should fully consider the possibility of this disease, the diagnosis of acute invasive pulmonary aspergillosis is difficult, the positive rate of sputum specimen Aspergillus culture is very low (8% ~34%), and the positive result can be derived from the colonization of the bacteria in the upper respiratory tract. It should be combined with clinical considerations. If the patient has the corresponding underlying disease or high risk factors, it has important reference value.
Examine
Acute invasive pulmonary aspergillosis
Blood routine: Eosinophils increased, IgG precipitin was more than 90% positive, and serum total IgE was significantly increased.
Chest X-ray showed different forms of pulmonary infiltration, with bronchial pneumonia being the most common, multiple focal infiltration often distributed in the surrounding lung field, some cases similar to pulmonary embolism or infarction, large lobe lung consolidation and miliary lesions also It can be seen that as the lesion progresses, lung cavities often occur, and acute Aspergillus balls can also be formed, and the corresponding X-ray signs are seen when pleural effusion occurs.
Diagnosis
Diagnosis and differentiation of acute invasive pulmonary aspergillosis
The diagnosis depends on the application of anti-pollution technology to collect secretion culture from the lower respiratory tract or pathological examination of lung biopsy. However, the application of this traumatic diagnosis technique is often limited by the serious clinical condition of the patient, and the positive rate is also subject to the skill level of the operator. In any case, the prognosis of this disease depends to a large extent on early diagnosis and early treatment. Therefore, positive attitude should be taken for traumatic diagnostic techniques. The sensitivity of serum immunoassay for detection of antibodies is very low, and it has little application value. It is being studied to detect Aspergillus antigen to diagnose this disease. It is reported that the sensitivity and specificity of serum Aspergillus antigen detection by radioimmunoassay are 74% and 90%, respectively, which is worthy of in-depth research and accumulated experience.
