Professional Documents
Culture Documents
Prof.
G
FERRETTI
CHU
GRENOBLE
HANOI,
NOV
2015
Aspergillus
diseases
• Aspergillus
species
(A
fumigatus)
• saprophyAc,
aerobic
fungus
that
develops
on
dead
or
decaying
organic
maNer
and
produces
airborne
spores
that
can
be
inhaled
by
man
• Four
presentaAons
according
to
clinical
presentaAon
and
state
of
immunity
ü Hypersensi0vity
reac0on
(ABPA)
ü Aspergilloma
ü Semi-‐invasive
(chronic
necro0zing)
aspergillosis
ü Invasive
aspergillosis
Angioinvasive
vs.
Airway-‐
invasive
Godet
C
Respira0on
2014;88:162-‐174
1-‐
Allergic
bronchopulmonary
aspergillosis
(ABPA)
Secondary
to
anAgens
released
by
Aspergillus
fumigatus
that
colonizes
the
tracheobronchial
tree
Pathogenesis
:
Aspergillus-‐specific
IgE-‐mediated
Type
I
hypersensiAvity
reacAon
/
specific
IgG-‐mediated
Type
III
hypersensiAvity
reacAons
Progressive
disease
with
– recurrent
exacerbaAons
– bronchiectaAc
changes
– end-‐stage
fibrosis
• Under
diagnosed
disease
• Early
diagnosis
and
treatment
prevents
its
progression
and
alleviate
its
clinical
manifesta0ons.
• High
resolu0on
CT
of
the
chest
has
emerged
as
a
promising
inves0ga0on
for
its
diagnosis.
DW
Denning,
Clin
Transl
Allergy.
2014
Clinical
presentaAon
• Common
contribuAng
factor:
– asthma
(the
most
frequent)
– cysAc
fibrosis
– other
underlying
bronchiectaAc
diseases
10
Imaging
presentaAon
• Diagnosis
of
APBA
is
frequently
missed
on
chest
X
ray
which
is
normal
in
almost
50%
of
the
cases
Agarwal
R,
et
al.
Pictorial
essay:
Allergic
bronchopulmonary
aspergillosis.
Indian
J
Radiol
Imaging.
2011
Oct-‐Dec;
21(4):
242–52.
• In
a
proper
clinical
seZng,
the
diagnosis
of
CPA
can
be
suggested
on
CT
– unilateral
or
bilateral
areas
of
consolida0on,
frequently
with
one
or
several
cavita0ons
containing
fungus
balls
in
about
50%
of
cases
(most
frequent)
– thickening
of
the
walls
of
cavitaAon
and
pleura
– areas
of
consolidaAon
or
of
ground
glass
aNenuaAon
in
the
surroundings.
– pulmonary
nodules
of
varying
sizes
may
be
present
(tree-‐in-‐bud
sign)
– LocalizaAon:
upper
lobes,
that
frequently
appears
collapsed
15
10
2012
Differen0al
diagnosis
• Differen0al
diagnosis
– TB,
non-‐TB
mycobacterial
infecAon,
histoplasmosis
coccidiomycosis…
– lung
cancer,
rheumatoid
arthriAs,
sarcoidosis
• Before
considering
the
treatment
of
probable
CPA
and
in
the
absence
of
absolute
diagnos0c
criteria
for
CPA,
it
seems
necessary
to
eliminate
the
diagnosis
of
lung
cancer
or
other
associated
infecAons
by
any
means
(repeated
biology,
bronchoscopy,
CT)
angioinvasive bronchoinvasive
à J30
22
10
2013
Bronchoinvasive
Aspergillosis
• 3
types
Ø obstrucAve,
Ø ulceraAve
Ø Pseudomembranous
• co-‐exisAng
presentaAon++