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
Legend
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Necrotic lung tissue in culture
Af=Colony of Aspergillus fumigatus
B=bacterial colonies
L=lung tissue
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A photograph of part of the upper lung lobe of an immunosuppressed patient. The lung tissue shows extenive areas of necrosis due to invasive colonisation.
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A photograph of a cavity in the upper lobe of the lung of a patient with ankylosing spondylitis. Such cavitation,which may be confused with prior tuberculosis, can follow fibrosis.
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Plugs stained with Methenamine/silverActively growing mycelia of the fungus are a deep brown/black. Counterstaining shows the dense mucus of the plugs as predominantly orange.
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Sputum from an asthmatic patient showing plugs(casts). The development of plugs coincided with an increased prevalence and severity of episodes of asthma
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microscopic characters Conidiophore stipes(C)1300-2800um long:Vesicles(V)40-70um wide,clavate:Phialides(Ph) uniseriate:Conidia(Con)3.5-4.0um long,smooth walled.
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microscopic characters Conidiophore stipes(C)225-350um arising from hyphae(Hy):Vesicles(Ves)15-25um wide:Phialides(Ph)uniseriate:Conidia(Con)2.4-3.0um spherical to ovoid,roughened.
