aspergillosis

アスペルギルス症 　 　 　

WordNet

1. severe respiratory disease of birds that takes the form of an acute rapidly fatal pneumonia in young chickens and turkeys (同)brooder pneumonia
2. an opportunistic infection by a fungus of the genus Aspergillus; characterized by inflammation and lesions of the ear and other organs
3. disease especially in agricultural workers caused by inhalation of Aspergillus spores causing lumps in skin and ears and respiratory organs

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/01/14 03:52:12」(JST)

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Aspergillosis
Pulmonary invasive aspergillosis in a patient with interstitial pneumonia (autopsy material), using Grocott's methenamine silver stain
Classification and external resources
Specialty	Infectious disease
ICD-10	B44
ICD-9-CM	117.3
MedlinePlus	001326
eMedicine	med/174
Patient UK	Aspergillosis
MeSH	D001228

Aspergillosis is the name given to a wide variety of diseases caused by infection by fungi of the genus Aspergillus. The majority of cases occur in people with underlying illnesses such as tuberculosis or chronic obstructive pulmonary disease (COPD), but with otherwise healthy immune systems. Most commonly, aspergillosis occurs in the form of chronic pulmonary aspergillosis (CPA), aspergilloma or allergic bronchopulmonary aspergillosis (ABPA). Some forms are intertwined; for example ABPA and simple aspergilloma can progress to CPA.

Other, non-invasive manifestations include fungal sinusitis (both allergic in nature and with established fungal balls), otomycosis (ear infection), keratitis (eye infection) and onychomycosis (nail infection). In most instances these are less severe, and curable with effective antifungal treatment.

People with deficient immune systems—such as patients undergoing hematopoietic stem cell transplantation, chemotherapy for leukaemia, or AIDS—are at risk of more disseminated disease. Acute invasive aspergillosis occurs when the immune system fails to prevent Aspergillus spores from entering the bloodstream via the lungs. Without the body mounting an effective immune response, fungal cells are free to disseminate throughout the body and can infect major organs such as the heart and kidneys.

The most frequently identified pathogen is Aspergillus fumigatus—a ubiquitous organism that is capable of living under extensive environmental stress. It is estimated that most humans inhale thousands of Aspergillus spores daily, but they do not affect most people’s health due to effective immune responses. Taken together, the major chronic, invasive and allergic forms of aspergillosis account for around 600,000 deaths annually worldwide.

Symptoms

A fungus ball in the lungs may cause no symptoms and may be discovered only with a chest X-ray, or it may cause repeated coughing up of blood, chest pain, and occasionally severe, even fatal, bleeding. A rapidly invasive Aspergillus infection in the lungs often causes cough, fever, chest pain, and difficulty breathing.

Poorly controlled aspergillosis can disseminate through the blood stream to cause widespread organ damage. Symptoms include fever, chills, shock, delirium, seizures and blood clots. The person may develop kidney failure, liver failure (causing jaundice), and breathing difficulties. Death can occur quickly.

Aspergillosis of the ear canal causes itching and occasionally pain. Fluid draining overnight from the ear may leave a stain on the pillow. Aspergillosis of the sinuses causes a feeling of congestion and sometimes pain or discharge. It can extend beyond the sinuses.

In addition to the symptoms, an X-ray or computerised tomography (CT) scan of the infected area provides clues for making the diagnosis. Whenever possible, a doctor sends a sample of infected material to a laboratory to confirm identification of the fungus.

Diagnosis

On chest X-ray and CT, pulmonary aspergillosis classically manifests as a halo sign, and, later, an air crescent sign. In hematologic patients with invasive aspergillosis, the galactomannan test can make the diagnosis in a noninvasive way. False positive Aspergillus Galactomannan tests have been found in patients on intravenous treatment with some antibiotics or fluids containing gluconate or citric acid such as some transfusion platelets, parenteral nutrition or PlasmaLyte

On microscopy, Aspergillus species are reliably demonstrated by silver stains, e.g., Gridley stain or Gomori methenamine-silver. These give the fungal walls a gray-black colour. The hyphae of Aspergillus species range in diameter from 2.5 to 4.5 µm. They have septate hyphae, but these are not always apparent, and in such cases they may be mistaken for Zygomycota. Aspergillus hyphae tend to have dichotomous branching that is progressive and primarily at acute angles of about 45°.

Angio invasive pulmonary aspergillosis  Angio invasive pulmonary aspergillosis (closeup)  Aspergillus vesicle (HE stain).

Treatment

The current medical treatments for aggressive invasive Aspergillosis include voriconazole and liposomal amphotericin B in combination with surgical debridement. For the less aggressive allergic bronchopulmonary aspergillosis findings suggest the use of oral steroids for a prolonged period of time, preferably for 6–9 months in allergic aspergillosis of the lungs. Itraconazole is given with the steroids, as it is considered to have a "steroid sparing" effect, causing the steroids to be more effective, allowing a lower dose.,

Other drugs used, such as amphotericin B, caspofungin (in combination therapy only), flucytosine (in combination therapy only), or itraconazole, are used to treat this fungal infection. However, a growing proportion of infections are resistant to the triazoles. A. fumigatus, the most commonly infecting species, is intrinsically resistant to fluconazole.

Prevention

Prevention of Aspergillosis involves a reduction of mold exposure via environmental infection-control. Anti-fungal prophylaxis can be given to high-risk patients. Posaconazole is often given as prophylaxis in severely immunocompromised patients.

Infections in animals

Albeit relatively rare in humans, aspergillosis is a common and dangerous infection in birds, particularly in pet parrots. Mallards and other ducks are particularly susceptible, as they will often resort to poor food sources during bad weather. Captive raptors, such as falcons and hawks, are susceptible to this disease if they are kept in poor conditions and especially if they are fed pigeons, which are often carriers of "asper". It can be acute in chicks, but chronic in mature birds.

Aspergillosis has been the culprit in several rapid die-offs among waterfowl. From 8 December until 14 December 2006, over 2,000 Mallards died in the Burley, Idaho area of the USA, an agricultural community approximately 150 miles southeast of Boise. Mouldy waste grain from the farmland and feedlots in the area is the suspected source. A similar aspergillosis outbreak caused by mouldy grain killed 500 Mallards in Iowa, USA, in 2005.

While there is no connection between aspergillosis and the H5N1 strain of avian influenza (commonly called "bird flu"), rapid die-offs caused by aspergillosis can spark fears of bird flu outbreaks. Laboratory analysis is the only way to distinguish bird flu from aspergillosis.

In dogs, aspergillosis is an uncommon disease typically affecting only the nasal passages (nasal aspergillosis). This is much more common in dolicocephalic breeds. It can also spread to the rest of the body; this is termed disseminated aspergillosis and is rare, usually affecting individuals with underlying immune disorders.

See also

• Primary cutaneous aspergillosis
• Otomycosis

References

External links

• USGS National Wildlife Health Center
• Aspergillus — Aspergillus website
• Aspergillosis The National Aspergillosis Centre, UK
• Aspergillus The Aspergillus Website Blog
• Aspergillosis at DoctorFungus.org
• Adetunji, Jo (13 June 2008). "Man dies after inhaling fungal spores from garden compost". The Guardian. 
• Aspergillosis at Backyard Poultry

UpToDate Contents

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• 1. 侵襲性アスペルギルス症の疫学および臨床症状 epidemiology and clinical manifestations of invasive aspergillosis
• 2. 侵襲性アスペルギルス症の治療および予防 treatment and prevention of invasive aspergillosis
• 3. 慢性肺アスペルギルス症の治療 treatment of chronic pulmonary aspergillosis
• 4. 慢性肺アスペルギルス症の臨床症状および診断 clinical manifestations and diagnosis of chronic pulmonary aspergillosis
• 5. Clinical manifestations and diagnosis of allergic bronchopulmonary aspergillosis

English Journal

• Development and characterization of the voriconazole loaded lipid-based nanoparticles.

• Füredi P1, Pápay ZE1, Kovács K1, Kiss BD1, Ludányi K1, Antal I1, Klebovich I2.
• Journal of pharmaceutical and biomedical analysis.J Pharm Biomed Anal.2017 Jan 5;132:184-189. doi: 10.1016/j.jpba.2016.09.047. Epub 2016 Oct 1.
• The number of topical fungal infections is growing, mostly owing to immunosuppressive therapy. Several topical fungal infections, such as eye mycoses, can be treated by local administration of antimycotic drugs. One major group of the antifungal agents is triazole, such as voriconazole (VCZ), which
• PMID 27750101

• Diagnosis of Invasive Pulmonary Aspergillosis.

• Swoboda-Kopeć E1, Sikora M2, Piskorska K3, Gołaś M1, Netsvyetayeva I1, Przybyłowska D4, Mierzwińska-Nastalska E4.
• Advances in experimental medicine and biology.Adv Exp Med Biol.2017;944:27-33.
• Culturing strains from clinical samples is the main method to diagnose invasive pulmonary aspergillosis. Detecting the galactomannan antigen in serum samples is an auxiliary examination. The goal of this study was to determine the frequency with which Aspergillus fumigatus was cultured in clinical s
• PMID 27826887

• Novel targets of omalizumab in asthma.

• Sattler C1, Garcia G, Humbert M.
• Current opinion in pulmonary medicine.Curr Opin Pulm Med.2017 Jan;23(1):56-61.
• PURPOSE OF REVIEW: Omalizumab is a recombinant humanized anti-IgE monoclonal antibody approved in the US for moderate to severe persistent allergic asthma (severe persistent asthma in the European Union), uncontrolled despite treatment with inhaled corticosteroids and long-acting beta2 agonists. It
• PMID 27798419

• Allergic bronchopulmonary aspergillosis in asthma.

• Knutsen AP1.
• Expert review of clinical immunology.Expert Rev Clin Immunol.2017 Jan;13(1):11-14. Epub 2016 Sep 22.
• PMID 27599560

Japanese Journal

• アスペルギルス症 (今月の特集 深在性真菌症を学ぶ)

• 武田 和明,泉川 公一,河野 茂
• 臨床検査 58(1), 81-89, 2014-01
• NAID 40019926868

• 症例 慢性壊死性肺アスペルギルス症に合併したActinomyces naeslundiiによる肺放線菌症の1例

• 加藤 香織,今永 知俊,森脇 篤史 [他]
• 日本呼吸器学会誌 = Annals of the Japanese Respiratory Society 2(6), 751-755, 2013-11-10
• NAID 40019892561

• 慢性肺アスペルギルス症に対するイトラコナゾール注射/カプセルによる有効性・安全性の検討

• 斎藤 武文,工藤 翔二,小倉 剛 [他]
• 日本呼吸器学会誌 = Annals of the Japanese Respiratory Society 2(6), 724-729, 2013-11-10
• NAID 40019892442

• ICU・CCU : あんな症例,こんな症例(第20回)圧損傷を回避するためにNasal High Flowを使用した呼吸不全の1症例

• 小松 聖史,栗山 直英,河田 耕太郎 [他]
• ICUとCCU = Japanese journal of intensive care medicine : 集中治療医学 37(11), 858-860, 2013-11
• NAID 40019933292

Related Pictures

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★リンクテーブル★

リンク元	「真菌症」「アスペルギルス症」
拡張検索	「subacute invasive pulmonary aspergillosis」「central nervous system aspergillosis」「chronic necrotizing aspergillosis」「neuroaspergillosis」

「真菌症」

　　[★]

英

mycosis, mycotic disease

同

真菌感染症 fungal infection、真菌感染

関

真菌、抗真菌薬

• 表在真菌症
• 皮下真菌症 深部皮膚真菌症

• スポロトリコーシス sporotrichosis

• Sporothrix schenckii　

• クロモミコーシス chromomycosis 黒色真菌症

• Cladosporium carrionii
• Fonsecaea compacta
• Fonsecaea pedrosoi 日本では起因菌の70%以上を占める(SMB.351)
• Phialophora verrucosa
• Rhinosladiella aquaspersa

• 足菌腫 mycetoma マズラ菌症 maduromycosis

• 深在性真菌症 deep mycosis 全身性真菌症 systemic mycosis

• 地域流行型真菌症 endemic mycosis
• コクシジオイデス症 coccidioidomycosis

• Coccidioides immitis

• ヒストプラスマ症 histoplasmosis

• Histoplasma capsulatum

• ブラストミセス症 blastomycosis

• Blastomyces dematitidis

• 日和見真菌症 opportunistic fungal infection
• カンジダ症 candidiasis
• クリプトコッカス症 cryptococcosis
• アスペルギルス症 aspergillosis

• Rhizopus oryae

代表的な真菌症 CBT QB vol2 p.193

	白癬	スポロトリコーシス	皮膚カンジダ症	癜風
原因菌	皮膚糸状菌	Sporothrix schenckii	Candida albicans	Malassezia furfur
症状	頭部、顔面、体部、股部、足の白癬	皮下結節→潰瘍化	指趾間びらん、爪周囲炎、粘膜カンジダ	胸・背部に黒・白色斑
検査	KOH法	スポロトリキン反応、PAS染色法	KOH法	KOH法、Wood灯検査
治療	抗真菌薬外用、抗真菌薬内服	ヨードカリ内服、温熱療法、抗真菌薬内服	イミダゾール系抗真菌薬外用	抗真菌薬外用

「アスペルギルス症」

　　[★]

英

aspergillosis

関

アスペルギルス属

アスペルギルス症

• 肺アスペルギローマ
• 侵襲性アスペルギルス症
• アレルギー性気管支肺アスペルギルス症

「subacute invasive pulmonary aspergillosis」

　　[★] 亜急性侵襲性肺アスペルギルス症

「central nervous system aspergillosis」

　　[★] 中枢神経系アスペルギルス症

「chronic necrotizing aspergillosis」

　　[★] 慢性壊死性アスペルギルス症

「neuroaspergillosis」

　　[★]

神経アスペルギルス症