Date: 26 November 2013
Born 75 years ago, Pt HK had 3 episodes of tuberculosis as a child and teenager, being treated with PAS and streptomycin. He suffered a ‘bad chest’ all his life and retired aged 54. Presenting with worsening and more frequent chest infections, he was referred with ‘bronchiectasis and Aspergillus sensitisation’. A diagnosis of chronic pulmonary aspergillosis was made in June 2009 on the basis of his chest radiograph and strongly positive Aspergillus precipitins (IgG antibodies) (titre 1/16). He also had Pseudomonas aeruginosa colonisation. His oxygen saturation was 87% and his pO2 6.8, pCO2 6.2 KPa.
His chest radiograph (see above, November 2009) was reported as showing; “ The lung fields are over-inflated. Bilateral apical fibrotic change secondary to old TB. No cavity seen.” At clinic, bilateral apical cavities were seen, with some associated pleural thickening at the left apex, without any evidence of a fungal ball.
He started posaconazole 400mg twice daily with therapeutic levels at subsequent visits. Sputum cultures never grew Aspergillus. Over the following 9 months he had no chest infections requiring antibiotics, his breathlessness worsened gradually and he remained easily fatigued. His Aspergillus antibody titres fell. Overall he felt better, but was concerned about declining respiratory status.
Copyright:
Fungal Research Trust
Notes: n/a
Images library
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Title
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Invasive pulmonary aspergillosis. Light microscopical appearance of invasive pulmonary aspergillosis showing vessel occlusion with thrombus and distal infarction (Haematoxylin and eosin, x100)
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Light microscopical appearance of vessel thrombus showing fungal element within it (Haematoxylin and eosin, x400).
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Medium power view (H&E) of lung tissue in patient with invasive pulmonary aspergillosis in which many of the fungal hyphae are seen in cross section.
Pulmaonary
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Light microscopical appearance of conidial head of A. fumigatus at an air interface in pulmonary tissue (Haematoxylin and eosin, x250).
