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Fungal lung diseases Occupational lung diseases

Fungal lung diseases Occupational lung diseases. Edit Csada, MD 07.10.2015. PATHOGEN FUNGI. Facultative pathogens Moulds Aspergilli Mucoraceae Yeasts Candida Cryptococcus Obligate pathogenes Histoplasma capsulatum Coccidioides immitis Blastomyces dermatitidis S porothrix shenckii.

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Fungal lung diseases Occupational lung diseases

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  1. Fungal lung diseasesOccupational lung diseases Edit Csada, MD 07.10.2015.

  2. PATHOGEN FUNGI • Facultative pathogens • Moulds • Aspergilli • Mucoraceae • Yeasts • Candida • Cryptococcus • Obligate pathogenes • Histoplasma capsulatum • Coccidioides immitis • Blastomyces dermatitidis • Sporothrix shenckii

  3. RISK FACTORS Immuncompromised state, treatment Cytostatic treatment Antibiotic and steroid treatment Leukemy Neutropenic patients Malignancies Diabetes mellitus AIDS After intensive therapy After transplantation

  4. PATHOLOGICAL FINDINGS Epitheloid hyperplasia Histocyte granulomas Thrombotic arteriitis Caseation granuloma Fibrosis Calcification

  5. DIAGNOSTIC METHODS Microscopic examination native smear different stainings Culture Special culture media Histology + culture Skin test Serology Differential diagnosis tumor tuberculosis chr pneumonia

  6. THERAPY Medical treatment Polyens Amphotericin B (Fungisone) Nystatin Pimafucin 5 fluorocytosin Ancotil Azoles Ketoconazole (Nizoral) Clotrimazole (Canesten) Caspofungin (cancidas) Fluconazole (Diflucan) Itraconazole (Orungal) Voriconazole (Vfend) (2. gen.) Surgery

  7. CLINICAL MANIFESTATION OF ASPERGILLOSIS Allergic aspergillosis Extrinsic allergic alveolitis hypersensitivity pneumonitis Allergic bronchopulmonary aspergillosis Aspergillomas Invasive aspergillosis Rare manifestations Aspergillus endocarditis Aspergillus pneumonia Endophthalmitis

  8. ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS Type I immediate hypersensitivity reaction Type III antigen, antibody, immune komplex reaction Diagnosis Bronchial obstruction Fever Eosinophylia Skin test IgG se precipitating antibody  Total, specific IgE  X-ray Small, fleeting inflitrates Hilar, paratracheal adenopathy Chronic consolidation Alveolitis – fibrosis Bronchiectasis Therapy Chromoglycate Corticosteroid

  9. ASPERGILLOMA Saprophytic colonisation of fungi in pulmonary cavities Manifestation  No symptoms  Haemoptysis  Fever  Cachexia Chraracteristic x-ray picture! Therapy: surgery

  10. „Halo sign”

  11. INVASIVE ASPERGILLOSIS Immuncompromised host! Necrotising pneumonia Empyema Pulm., extrapulm. Dissemination Symptoms: fever, pleural pain, haemotysisTherapy: Amphotericin B or voriconazole itraconazole, caspofungin

  12. CANDIDIASIS Normal inhabitants of mucocutaneous body surfaces. 80% of all systemic fungal infection Manifestation Disease of skin and mucosa Gynecological disease Oesophagitis In the lung: Bronchitis Pneumonia Pleurisy Therapy: Amphotericin B, caspofungin, fluconazole, itraconazole, voriconazole

  13. CRYPTOCOCCOSIS It is the 4. Most common cause of opportunistic infections in AIDS patients in the US. Manifestations: asymptomatic colonisation ext. All. Alveolitis primary complex toruloma Diagnosis: Masson-Fontana staining Complication: meningoencephalitis Therapy: spontaneous healing, amphotericin B, fluconazole, flucytosine

  14. HISTOPLASMOSIS It is the most common systemic mycosis in the USA. Manifestation Subclinical Acute form: Influenzalike disease X-ray: small scattered, patchy infiltrates calcification Progressive, disseminated form Rare (AIDS) Chr. pulmonary form (COPD) Segmental, interstitial pneumonitis Chr cavitary disease Diagnosis: Wright’s or Giemsa staining Prognosis: good Therapy: itraconazole, amphotericin B

  15. COCCIDIOIDOMYCOSIS Acute, benign disease Primary infection: infuenzalike symptoms Radiological findings: Segmental pneumonia Minimal infiltrates Adenopathy, pleural effusion Nodular lesions, cavities Prognosis is good without any therapy. Diagnosis: eosinophilia, IgG Progressive, extrapum. manifestation

  16. COCCIDIOIDOMYCOSIS • Risk factors for dissemination ofCoccidioidesImmitis infection • Older age • Males • Non-caucasians, Filipinos • Immunsuppression • Gravidity • Therapy • Azoles • Fluconazole > Itraconazole • Ketoconazole: less effective 21

  17. Occupationallungdiseases Pneumoconiosis Hypersensitivity pneumonitis Obstructive airway diseases Toxic damages Malignant lung diseases Pleural diseases 22

  18. Common causes of occupational asthma

  19. Occupational asthma 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

  20. PNEUMOCONIOSIS Etiologic agents:inhalation of inorganic dusts metal dusts free silica coal dusts

  21. SILICOSIS The base of disease is the progressive concentric fibrosis with hyalinisation in the centre. Free silica:mining stone cutting road and building construction blasting

  22. DETERMINING FACTORS IN DEVELOPMENT OF SILICOSIS Silicic acid content Content of dusts in the place of work (200 000/m3) Size of dust (<2 micron) Time of exposure Individual inclination (smoking)

  23. SILICOSIS Symptoms: no symptoms dyspnoe hypoxaemia, hypercapnia=> ventilatory failure=> cor pulmonale X-ray: nodular dissemination silicomas (=>emphysematic bullae) hilar adenopathy calcification, egg shell pattern Complications: chr. bronchitis emphysema ptx Tb is more frequent Caplan’s syndroma Therapy:symptomatic Prophylaxis!

  24. Silicosis

  25. ASBESTOSIS • 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

  26. HYPERSENSITIVE PNEUMONITIS (Extrinicallergicalveolitis) It is an immunologicallyinducedinflammation of lungparenchymainvolvingalveolarwalls and terminalairwayssecondarytorepeatedinhalation of a variety of organicdusts and otheragentsbysusceptiblehost. Manifestations: Farmer’s lung (1932) – thermophylicactinomycetes Birdfancier’s breeder’sorhandler’slung Miller’s lung Bagassosis Byssinosis Air conditioner’s lung Coffeeworker’s lung

  27. HYPERSENSITIVE PNEUMONITIS Clinical forms: Acute: (type III. reaction) cough, fever, chills, malaise, dyspnoe may occur 6-8 hours after exposure and usually clear within few days Subacute: (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.

  28. HYPERSENSITIVE PNEUMONITIS Diagnosis: anamnesis x-ray: normal poorly defined patchy or diffuse infiltrates reticulonodular lesions lung function tests:impaired diffusing capacity, decreased comliance exercise induced hypoxaemia Se precipitins against suspected antigens BAL: acute : neutrophyls, monocytes(5%) chr: lymphocytes(60-70%) Lung biopsy: intersitial alveolar infiltrates bronchiolitis Therapy: avoidance of antigens corticosteroids

  29. Thank you for your attention!

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