Fungal lung diseases Occupational lung diseases

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Fungal lung diseasesOccupational lung diseases

• Edit Csada, MD
• 19.11.2014.

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PATHOGEN FUNGI

• Facultative pathogens
•  Saprophyte Aspergillus fumigatus
• Aspergillus flavus
• Cryptococcus neoformans
• Mucoraceae
• Parasite Candida albicans
• Candida tropicalis
• Obligate pathogens Histoplasma capsulatum
• Coccidioides immitis
• Blastomyces dermatitidis
• Sporothrix shenckii

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RISK FACTORS

• Immuncompromised state, treatment
• Cytostatic treatment
• Antibiotic and steroid treatment
• Leukemy
• Neutropenic patients
• Malignancies
• Diabetes mellitus
• AIDS
• After intensive therapy
• After transplantation

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PATHOLOGICAL FINDINGS

• Epitheloid hyperplasia
• Histocyte granulomas
• Thrombotic arteriitis
• Caseation granuloma
• Fibrosis
• Calcification

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DIAGNOSTIC METHODS

• Microscopic examination
• native smear
• different stainings
• Culture
• Special culture media
• Histology
• culture
• Skin test
• Serology
• Differential diagnosis
• tumor
• tuberculosis
• chr pneumonia

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THERAPY

• Medical treatment
• Polyens Amphotericin B (Fungisone)
• Nystatin
• Pimafucin
• 5 fluorocytosin Ancotil
• Azoles Ketoconazole (Nizoral)
• Clotrimazole (Canesten)
• Caspofungin (cancidas)
• Fluconazole (Diflucan)
• Itraconazole (Orungal)
• Voriconazole (Vfend) (2. gen.)
• Surgery

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CLINICAL MANIFESTATION OF ASPERGILLOSIS

• Allergic aspergillosis
• Extrinsic allergic alveolitis
• hypersensitivity pneumonitis Allergic
  bronchopulmonary aspergillosis
• Aspergillomas
• Invasive aspergillosis
• Rare manifestations
• Aspergillus endocarditis
• Aspergillus pneumonia
• Endophthalmitis

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ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS

• Type I immediate hypersensitivity reaction
• Type III antigen, antibody, immune komplex
  reaction
• Diagnosis
• Bronchial obstruction
• Fever
• Eosinophylia
• Skin test
• IgG se precipitating antibody ?
• Total, specific IgE ?
• X-ray Small, fleeting inflitrates
• Hilar, paratracheal adenopathy
• Chronic consolidation
• Alveolitis fibrosis
• Bronchiectasis
• Therapy
• Chromoglycate
• Corticosteroid

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ASPERGILLOMA

• Saprophytic colonisation of fungi in pulmonary
  cavities
• Manifestation
• ? No symptoms
• ? Haemoptysis
• ? Fever
• ? Cachexia
• Chraracteristic x-ray picture!
• Therapy surgery

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INVASIVE ASPERGILLOSIS

• Immuncompromised host! Necrotising
  pneumonia Empyema Pulm., extrapulm.
  Dissemination
• Symptoms fever, pleural pain,
  haemotysisTherapy Amphotericin B or
  voriconazole
• itraconazole, caspofungin

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CANDIDIASIS

• Normal inhabitants of mucocutaneous body
  surfaces.
• 80 of all systemic fungal infection
• Manifestation
• Disease of skin and mucosa
• Gynecological disease
• Oesophagitis
• In the lung Bronchitis
• Pneumonia
• Pleurisy
• Therapy Amphotericin B, caspofungin,
  fluconazole, itraconazole, voriconazole

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CRYPTOCOCCOSIS

• It is the 4. Most common cause of opportunistic
  infections in AIDS patients in the US.
• Manifestations
• asymptomatic colonisation
• ext. All. Alveolitis
• primary complex
• toruloma
• Diagnosis Masson-Fontana staining
• Complication meningoencephalitis
• Therapy spontaneous healing, amphotericin B,
  fluconazole, flucytosine

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HISTOPLASMOSIS

• It is the most common systemic mycosis in the
  USA.
• Manifestation
• Subclinical
• Acute form Influenzalike disease
• X-ray small scattered, patchy infiltrates
• calcification
• Progressive, disseminated form
• Rare (AIDS)
• Chr. pulmonary form
• (COPD)
• Segmental, interstitial pneumonitis
• Chr cavitary disease
• Diagnosis Wrights or Giemsa staining
• Prognosis good
• Therapy itraconazole, amphotericin B

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COCCIDIOIDOMYCOSIS

• Acute, benign disease
• Primary infection infuenzalike symptoms
• Radiological findings
• Segmental pneumonia
• Minimal infiltrates
• Adenopathy, pleural effusion
• Nodular lesions, cavities
• Prognosis is good without any therapy.
• Diagnosis eosinophilia, IgG?
• Progressive, extrapum. manifestation

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COCCIDIOIDOMYCOSIS

• Risk factors for dissemination of Coccidioides
  Immitis infection
• Older age
• Males
• Non-caucasians, Filipinos
• Immunsuppression
• Gravidity
• Therapy
• Azoles
• Fluconazole gt Itraconazole
• Ketoconazole less effective

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Occupational lung diseases

• Pneumoconiosis
• Hypersensitivity pneumonitis
• Obstructive airway diseases
• Toxic damages
• Malignant lung diseases
• Pleural diseases

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Common causes of occupational asthma
Agents
Isocyanates
Flour
Epoxy resins
Animals (rats, mice)
Wood dusts
Azodicarbonamide
Persulphate salts
Latex
Drugs
Grain dust

Occupational exposure
Spray paints, varnishes, adhesives, polyurethane foam manufacture
Bakers
Hardening agents, adhesives
Laboratory workers
Sawmill workers, joiners
Polyvinyl plastics manufacture
Hairdressers
Healthcare workers
Pharmaceutical industry
Farmers, millers, bakers

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Occupational asthma

• Diagnosis
• Asthma diagnosis
• Causative connection between asthma and working
  place
• Clinical manifestations
• Immediate asthmatic response
• Delayed asthmatic response
• Combined response
• Therapy
• Avoidance of exposition
• Protective devices
• Asthma treatment

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PNEUMOCONIOSIS

• Etiologic agents inhalation of inorganic
  dusts
• metal dusts
• free silica
• coal dusts

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SILICOSIS

• The base of disease is the progressive concentric
  fibrosis with hyalinisation in the centre.
• Free silica mining
• stone cutting
• road and building construction
• blasting

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DETERMINING FACTORS IN DEVELOPMENT OF SILICOSIS

• Silicic acid content
• Content of dusts in the place of work
• (200 000/m3)
• Size of dust (lt2 micron)
• Time of exposure
• Individual inclination (smoking)

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SILICOSIS

• Symptoms no symptoms
• dyspnoe
• hypoxaemia, hypercapniagt
• ventilatory failuregt
• cor pulmonale
• X-ray nodular dissemination
• silicomas (gtemphysematic bullae)
• hilar adenopathy
• calcification, egg shell pattern
• Complications chr. bronchitis
• emphysema
• ptx
• Tb is more frequent
• Caplans syndroma
• Therapy symptomatic
• Prophylaxis!

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Silicosis
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ASBESTOSIS

• Hydrosilicate fibre, thread
• Pulmonal clearence depends on the ratio of length
  and diameter of fibers
• 50-100 asbest particula/cm3 ? mesothelioma
• Basal and subpleural fibrosis

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HYPERSENSITIVE PNEUMONITIS

• (Extrinic allergic alveolitis)
• It is an immunologically induced inflammation of
  lung parenchyma involving alveolar walls and
  terminal airways secondary to repeated inhalation
  of a variety of organic dusts and other agents by
  susceptible host.
• Manifestations
• Farmers lung (1932) thermophylic
  actinomycetes
• Bird fanciers breeders or handlers lung
• Millers lung
• Bagassosis
• Byssinosis
• Air conditioners lung
• Coffee workers lung

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HYPERSENSITIVE PNEUMONITIS

• Clinical forms
• Acute (type III. reaction) cough, fever,
  chills, malaise, dyspnoe may occur 6-8 hours
  after exposure and usually clear within few days
• Subacute (type IV reaction) symptoms appear
  over a period of week( cough, dyspnoe, cyanosis).
  Symptoms disappear within weeks, or months, if
  causative agent is no longer inhaled.
• Chronic (type IV reaction) gradually
  progressive intersistial disease associated with
  cough, exertional dyspnoe without a prior history
  of acute or subacute disease.

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HYPERSENSITIVE PNEUMONITIS

• Diagnosis
• anamnesis
• x-ray normal
• poorly defined patchy or diffuse
  infiltrates
• reticulonodular lesions
• lung function testsimpaired diffusing
  capacity,
• decreased comliance
• exercise induced hypoxaemia
• Se precipitins against suspected antigens?
• BAL acute neutrophyls, monocytes?(5)
• chr lymphocytes?(60-70)
• Lung biopsy intersitial alveolar infiltrates
• bronchiolitis
• Therapy
• avoidance of antigens
• corticosteroids

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Thank you for your attention!