Aspergillosis history and symptoms: Difference between revisions

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==Overview==
==Overview==
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 and—rarely—severe, even fatal, bleeding. A rapidly invasive Aspergillus infection in the lungs often causes [[cough]], [[fever]], [[chest pain]], and [[difficulty breathing]].
Symptoms of aspergillosis are dependent on the clinical syndrome and extent of disease invasion.<ref name="mayo">Aspergillosis. MAYO CLINIC (2015) http://www.mayoclinic.org/diseases-conditions/aspergillosis/basics/risk-factors/con-20030330 Accessed on February, 8 2016</ref><ref name="pmid21881144">{{cite journal| author=Kousha M, Tadi R, Soubani AO| title=Pulmonary aspergillosis: a clinical review. | journal=Eur Respir Rev | year= 2011 | volume= 20 | issue= 121 | pages= 156-74 | pmid=21881144 | doi=10.1183/09059180.00001011 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21881144  }} </ref> Patients with allergic bronchopulmonary aspergillosis or sinusitis have symptoms typical of asthma and sinusitis, respectively. Symptoms of invasive pulmonary aspergillosis include spiking [[fever]], [[pleuritic]] [[chest pain]], productive [[cough]], [[dyspnea]], and [[hemoptysis]]. Symptoms of chronic pulmonary aspergillosis include chronic [[fever]], [[weight loss]], [[Cough|productive cough]], and [[hemoptysis]].


Aspergillosis affecting the deeper tissues makes a person very ill. Symptoms include [[fever]], [[chills]], [[shock]], [[delirium]], and [[blood clots]]. The person may develop [[kidney failure]], [[liver failure]] (causing [[jaundice]]), and breathing difficulties. Death can occur quickly.
==History==
* When evaluating a patient for aspergillosis, a detailed history of the presenting symptom (duration, onset, progression), other associated symptoms, and occupational history should be performed. Other specific areas of focus when obtaining the history are outlined below:<ref name="mayo">Aspergillosis. MAYO CLINIC (2015) http://www.mayoclinic.org/diseases-conditions/aspergillosis/basics/risk-factors/con-20030330 Accessed on February, 8 2016</ref><ref name="pmid21881144">{{cite journal| author=Kousha M, Tadi R, Soubani AO| title=Pulmonary aspergillosis: a clinical review. | journal=Eur Respir Rev | year= 2011 | volume= 20 | issue= 121 | pages= 156-74 | pmid=21881144 | doi=10.1183/09059180.00001011 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21881144  }} </ref>
:* Review past medical history for any previous immunodeficient states such as [[AIDS]], hematological cancers, and [[cystic fibrosis]]
:* Review past medical history for any previous cavitary [[pulmonary]] disease such as [[tuberculosis]] or [[sarcoidosis]], which may predispose to aspergilloma formation
:* Review surgical history for any [[organ transplant]] procedures
:* Patients medications review for any immune-suppressive drugs such as [[chemotherapy]] and long term [[corticosteroid]] use


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.
*The following algorithm demonstrates common clinical syndromes that develop following ''Aspergillus'' inhalation among different patient groups:<br><br>
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | | A01 | | | | | | | | |A01=Inhalation of ''Aspergillus'' spores }}
{{familytree | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| | | }}
{{familytree | B01 | | B02 | | B03 | | B04 | | B05 | | |B01=Healthy host |B02=Cavitary lung disease|B03=Chronic lung disease or mildly immunocompromised host|B04=Immunocompromised host|B05=Either asthma, cystic fibrosis, or atopy}}
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | }}
{{familytree | C01 | | C02 | | C03 | | C04 | | C05 | |C01=No sequelae|C02=Aspergilloma|C03=Chronic necrotizing aspergillosis|C04=Invasive pulmonary aspergillosis|C05=Allergic bronchopulmonary aspergillosis (ABPA)}}
{{familytree/end}}
<sup>Adapted from Kousha M, Tadi R, and Soubani AO. Pulmonary aspergillosis: a clinical review. Euro Respir Rev. 2011;20(121):156-74<ref name="pmid21881144">{{cite journal| author=Kousha M, Tadi R, Soubani AO| title=Pulmonary aspergillosis: a clinical review. | journal=Eur Respir Rev | year= 2011 | volume= 20 | issue= 121 | pages= 156-74 | pmid=21881144 | doi=10.1183/09059180.00001011 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21881144  }} </ref> / Soubani AO, Chandrasekar PH. The clinical spectrum of pulmonary aspergillosis. Chest. 2002;121(6):1988-99.<ref name="pmid12065367">{{cite journal| author=Soubani AO, Chandrasekar PH| title=The clinical spectrum of pulmonary aspergillosis. | journal=Chest | year= 2002 | volume= 121 | issue= 6 | pages= 1988-99 | pmid=12065367 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12065367  }} </ref>


==History and Symptoms==
==Symptoms==
The different kinds of aspergillosis can cause different symptoms. <ref>http://www.cdc.gov/fungal/aspergillosis/symptoms.html</ref>
* The specific clinical presentation of aspergillosis is determined by the exact clinical subtype of the disease:<ref name="mayo">Aspergillosis. MAYO CLINIC (2015) http://www.mayoclinic.org/diseases-conditions/aspergillosis/basics/risk-factors/con-20030330 Accessed on February, 8 2016</ref><ref name="pmid21881144">{{cite journal| author=Kousha M, Tadi R, Soubani AO| title=Pulmonary aspergillosis: a clinical review. | journal=Eur Respir Rev | year= 2011 | volume= 20 | issue= 121 | pages= 156-74 | pmid=21881144 | doi=10.1183/09059180.00001011 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21881144  }} </ref>
===Allergic Bronchopulmonary Aspergillosis (ABPA)===
::* [[Wheezing]]
::* [[Cough]]
::* [[Fever]] (in rare cases)


: Symptoms of '''[[allergic bronchopulmonary aspergillosis]]''' (ABPA) may include:
===Allergic Aspergillus Sinusitis / Rhinosinusitis===
::* Increased [[sinus]] drainage
::* Nasal stuffiness
::* [[Headache]]
::* Facial [[tenderness]]
::* [[Eosinophilic]] secretions


:* [[Wheezing]]
===Aspergilloma===
:* [[Coughing]]
::* Most patients with aspergilloma are asymptomatic
:* [[Fever]] (in rare cases)
::* Mild [[haemoptysis]] (most common symptom)
::* Cough
::* [[Dyspnea]]  
::* Fever (related to bacterial super-infection)


: Symptoms of '''invasive aspergillosis''' may include:
===Chronic Pulmonary Aspergillosis===
::* Chronic [[fever]] (1-6 months)
::* [[Malaise]]
::* [[Fatigue]]
::* [[Weight loss]]
::* Chronic productive [[cough]]
::* [[Dyspnea]]
::* [[Hemoptysis]] (may be severe)


:* Fever
===Invasive Pulmonary Aspergillosis===
:* [[Chest pain]]
::* Spiking [[fever]] (refractory to [[antibiotic]] therapy)
:* Coughing
::* [[Pleuritic]] [[chest pain]]
:* [[Shortness of breath]]
::* [[Cough]]
:* [[Aspergilloma]], or “fungus ball”
::* [[Dyspnea]]
::* [[Haemoptysis]]
::* [[Headache]]
::* [[Seizures]]


Other symptoms may develop if the infection spreads beyond the lungs. When invasive aspergillosis spreads outside of the lungs, it can cause symptoms in almost any organ
===Cutaneous Aspergillosis===
::* [[Fever]]
::* [[Cutaneous]] lesions ([[macule]]s, [[papule]]s, [[nodule]]s, or [[plaque]]s)
::* Central [[ulceration]] or [[eshcar]] formation


==References==
==References==
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[[Category:Fungal diseases]]
[[Category:Fungal diseases]]
[[Category:Infectious disease]]
[[Category:Needs content]]
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{{WS}}

Latest revision as of 17:01, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]; Yazan Daaboul, M.D.; Serge Korjian M.D.

Overview

Symptoms of aspergillosis are dependent on the clinical syndrome and extent of disease invasion.[1][2] Patients with allergic bronchopulmonary aspergillosis or sinusitis have symptoms typical of asthma and sinusitis, respectively. Symptoms of invasive pulmonary aspergillosis include spiking fever, pleuritic chest pain, productive cough, dyspnea, and hemoptysis. Symptoms of chronic pulmonary aspergillosis include chronic fever, weight loss, productive cough, and hemoptysis.

History

  • When evaluating a patient for aspergillosis, a detailed history of the presenting symptom (duration, onset, progression), other associated symptoms, and occupational history should be performed. Other specific areas of focus when obtaining the history are outlined below:[1][2]
  • The following algorithm demonstrates common clinical syndromes that develop following Aspergillus inhalation among different patient groups:

 
 
 
 
 
 
 
 
Inhalation of Aspergillus spores
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Healthy host
 
Cavitary lung disease
 
Chronic lung disease or mildly immunocompromised host
 
Immunocompromised host
 
Either asthma, cystic fibrosis, or atopy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No sequelae
 
Aspergilloma
 
Chronic necrotizing aspergillosis
 
Invasive pulmonary aspergillosis
 
Allergic bronchopulmonary aspergillosis (ABPA)
 

Adapted from Kousha M, Tadi R, and Soubani AO. Pulmonary aspergillosis: a clinical review. Euro Respir Rev. 2011;20(121):156-74[2] / Soubani AO, Chandrasekar PH. The clinical spectrum of pulmonary aspergillosis. Chest. 2002;121(6):1988-99.[3]

Symptoms

  • The specific clinical presentation of aspergillosis is determined by the exact clinical subtype of the disease:[1][2]

Allergic Bronchopulmonary Aspergillosis (ABPA)

Allergic Aspergillus Sinusitis / Rhinosinusitis

Aspergilloma

  • Most patients with aspergilloma are asymptomatic
  • Mild haemoptysis (most common symptom)
  • Cough
  • Dyspnea
  • Fever (related to bacterial super-infection)

Chronic Pulmonary Aspergillosis

Invasive Pulmonary Aspergillosis

Cutaneous Aspergillosis

References

  1. ↑ 1.0 1.1 1.2 Aspergillosis. MAYO CLINIC (2015) http://www.mayoclinic.org/diseases-conditions/aspergillosis/basics/risk-factors/con-20030330 Accessed on February, 8 2016
  2. ↑ 2.0 2.1 2.2 2.3 Kousha M, Tadi R, Soubani AO (2011). "Pulmonary aspergillosis: a clinical review". Eur Respir Rev. 20 (121): 156–74. doi:10.1183/09059180.00001011. PMID 21881144.
  3. ↑ Soubani AO, Chandrasekar PH (2002). "The clinical spectrum of pulmonary aspergillosis". Chest. 121 (6): 1988–99. PMID 12065367.
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