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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Single fungal ball, moving. Radiographic appearance of a fungus ball, showing movement as the patient’s position changes.
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Oxalate crystals in the cavity wall surrounding an Aspergillus niger fungus ball (H&E, dark field, x 25).
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Aspergilloma patient. Gross pathology appearance of a fungus ball.
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Conidiophores of Aspergillus fumigatus in the mass of the fungal ball surrounded by mycelia (H&E, x 400).
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Aspergillus niger fungal ball. Calcium oxalate crystals in Aspergillus niger fungal ball. Also shown are darkly pigmented, rough-walled conidia associated with Aspergillus niger infection.
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Aspergillus niger fungus ball within an old tuberculous cavern. This patient had diabetes, a disease commonly associated with A. niger infection.
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Conidial head and brown conidia in a section of a fungus ball caused by Aspergillus niger (H&E, x 400).
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