Aspergillus balls
Introduction
Introduction to Aspergillus Aspergillus is an easily identifiable and most common non-invasive fungal ball. Other fungi, especially Mucor, can occasionally produce pulmonary fungal balls, but it is best for Aspergillus. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: pleurisy
Cause
Aspergillosis
Infection (35%):
Aspergillus is an Aspergillus parasitic in the cavity of the lungs. Hyphae and cell debris form a sphere in the cavity. In addition to Aspergillus, Mucor, Peyd-like fungi and Candida can occasionally cause similar lesions. However, Aspergillus is the most common. Aspergillus grows only in the form of hyphae. The colonies are various in color and are velvety or flocculent, which is relatively stable.
Lung cavity (25%):
Aspergillus balls most commonly occur in existing lung cavities, including tuberculosis, bronchiectasis, pulmonary cysts, sarcoidosis, histiocytosis, ankylosing spondylitis, malignant tumors and other diseases, which are occasionally seen in the pleural cavity. Special surgical scar or pleural adhesion formed in the cavity, Aspergillus invasion and implantation of the cavity, belonging to septic parasitis, only with slight tissue invasion, Aspergillus ball growing in the cavity, its drainage and blood supply is poor, Aspergillus ball itself Aspergillus is wrapped around the wall. Aspergillus grows on the wall of the cave, which invades the local structure, especially the blood vessels, but rarely invades the lung parenchyma or spreads through the blood vessels. In a few cases, the Aspergillus bulb can change its benign chronic process and become invasive. It can even be fatal. Regarding the life cycle of Aspergillus, studies have shown that it grows into the cavity at an early stage, and eventually there is a spherical shadow on the X-ray. Among them, Aspergillus or live bacteria can also have dead bacteria. The outcome depends on the live bacteria and Which of the dead bacteria predominates, if the local environment is not conducive to the growth of Aspergillus, Aspergillus eventually liquefaction and cough, the residual spherical lesions of Aspergillus oryzae occasionally calcified.
There is no cavity in the lungs (25%):
Another type of patient has no cavity in the lungs. It is only an irregular infiltration of local lung tissue at the beginning, and the edge is blurred. However, as the disease develops, the irregular infiltration gradually becomes round, the edges become clear and voids are formed, and an Aspergillus ball is produced. Types are rare and there are currently few studies.
Prevention
Aspergillus ball prevention
The disease belongs to fungal infection. For patients who have already contracted this disease, masks should be worn to reduce the release of pathogens. For people living in the epidemic area, masks should also be worn to avoid the inhalation of fungal spores and hyphae. At the same time actively treat infected patients to cut off the source of transmission.
Complication
Aspergillus complication Complications pleurisy
Often complicated by bacterial infection, combined with pleural lesions.
Symptom
Aspergillosis symptoms common symptoms abscess hemoptysis weight loss cyst
The most common symptom of Aspergillus pneumoniae is hemoptysis, the incidence rate is 50% to 90%, and the amount of hemoptysis varies from very small to large amount of lethal hemoptysis. There are several hypotheses for hemoptysis, such as the movement of Aspergillus Mechanical friction and damage of blood vessels, hemolysis and anticoagulant effects by Aspergillus endotoxin, local erosion of vascular wall vessels may also be a participatory factor, other common symptoms are chronic cough, occasionally weight loss, unless combined with bacterial Infection, patients generally have no fever, aspergillus ball adjacent to the pleura can cause pleural infection, individual cases can lead to bronchopleural palsy, some patients present an occult process, lasting for many years asymptomatic, but most of the end symptoms, the aspergillus ball itself is very There are few signs, depending on the scope, nature and location of the underlying disease, the corresponding signs can be found.
Examine
Aspergillus ball inspection
1, sputum culture can confirm the presence of Aspergillus, but the positive rate is not high, fiber bronchoscopy includes anti-pollution technology to collect lower respiratory tract specimens.
2, bronchoalveolar lavage and transbronchial lung biopsy (lesion) can improve the sensitivity and specificity of the diagnosis of Aspergillus, and help to distinguish from other fungal or lung spherical lesions, biopsy should be aligned under imaging surveillance Aspergillus ball, do not damage the wall to prevent bleeding, pleural biopsy can also be used in patients with pleural lesions.
3, serum immunological examination is helpful for diagnosis, the positive rate of antibody in serum precipitant is nearly 100%, and it has high sensitivity and specificity for the differential diagnosis of patients with X-ray suspected Aspergillus ball. The positive rate of skin test in Aspergillus ball is only 22%, significantly lower than ABPA (positive rate 99%).
4. The Aspergillus ball on the X-ray shows a round dense shadow in the lung cavity or pleural cavity, and the edge has a light-transparent vignette. If the cavity is large, the spherical shadow has a pedicle connected to the wall of the hole, shaped like a pendulum, spherical. The shadow can change shape with the change of body position. If the cavity is small, the spherical lesion fills most of the cavity, and the vignette is very small, only a long and narrow half-moon translucent band. Some scholars have been in 2 cases of X-ray film. Patients with cryptogenic hemoptysis who had no positive findings in both body slices and bronchial angiograms were treated with bronchial angiography. Pathological findings showed that small bronchogenic cysts of 1 cm or so were followed by Aspergillus balls, and chest CT examinations, especially high-resolution CT. The application provides a useful technique for the discovery of Aspergillus oryzae and differential diagnosis.
Diagnosis
Aspergillus ball diagnosis
diagnosis
1. Typical X-ray signs have high diagnostic value for Pulmonary Aspergillosis. On the other hand, those with cryptogenic hemoptysis and X-ray undetermined lesions should also consider the possibility of this disease. Imaging lesions of Aspergillus have characteristic signs. However, it needs to be differentiated from other fungal balls, cavitalized hamartoma, lung cancer, lung abscess and hydatid cyst.
2, sputum culture can confirm the presence of Aspergillus, but the positive rate is not high, fiberoptic bronchoscopy including anti-pollution technology to collect lower respiratory tract specimens, bronchoalveolar lavage and transbronchial lung biopsy (lesion) can improve the sensitivity of Aspergillus ball diagnosis and Specificity, it is helpful to distinguish from other fungal bulbs or lung spherical lesions. Under biopsy, the Aspergillus bulb should be aligned under imaging surveillance. Do not damage the wall to prevent bleeding. Patients with pleural lesions may also have pleural biopsy.
3, serum immunological examination is helpful for diagnosis, the positive rate of antibody in serum precipitant is nearly 100%, and it has high sensitivity and specificity for the differential diagnosis of patients with X-ray suspected Aspergillus ball. The positive rate of skin test in Aspergillus ball is only 22%, significantly lower than ABPA (positive rate 99%).
Differential diagnosis
Imaging studies have characteristic signs of Aspergillus, but need to be differentiated from other fungal spheres, cavity-derived hamartoma, lung cancer, lung abscess and hydatid cyst.
