1. FUNGAL LUNGS DISEASES

1. Defination
1. its an infection transmitted through inhalation of the SPORES of the fungus.[like seeds]
2. In the hierarchy of sizes of infective contagion fungus is much bigger than BACTERIA(a protein contagion with both RNA and DNA able to self propagate by binary fision).
3. Bigger than VIRUS(Protein contagion with either RNA, or DNA making the host cell to produce more viruses), Bacterial( self producing with both RNA and DNA)

Fungal spores bud into hyphael “branches”/ mycellium roll as a ball.

• Fungal infectivity is low and therefore but often in nature as a commensal, but when host immune system deteriorates, then can become disease.

2. TYPES OF COMMON FUNGAL LUNGS DISEASES

1. Candida albicans

infection( candidiasis)

- Natural commensal in Pharynx, Vulva, GIT

- Evolves into Oro-pharyngeal candidosis called Oral thrush. Cheesy white specks on tongue and buccal and pharyngeal mucosa. Scrapping shows hyperaemic surface then are inflamed and painful. Ditto the vulva immune depression commonly due to malnutrition in children; xs antibiotic treatment. Diabetes Mellitus; Reticular Endothelium system diseases e.g Hodgkins, Leukaemias; cancers, Anti cancer chemotherapy, Anti-Graft Rejection treatment, Radiation treatment, HIV infection.

• Occasionally becomes Pneumonic.

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DIAGNOSIS: Fungi seen in screpings, sputa

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TREATMENT: Topical Nystatin, miconazole, Fluconazole; Oral for more severe infections. Parenteral Amphoteracin B in brocho-pneumonia case

3. Types of common fungal lungs diseases. cont

2. HISTOPLASMOSIS

• Infection of Histoplasmin capsulatum via inhalation of spores – during moist soil/ hay work, cows milking, birds dropping and bats. Worldwide but more Mississippi Valley in USA
• Acute phase of fever, cough, chills, myalgia- just like primary TB with sub pleural Ghon focus at apex of lung .
• Chronic pulm. Histoplasmosis like pulm TB. Infiltrates, fibrotic streaks, cavities, wide spread broncho-Pulmonary infiltrates.Cavity can house fungal mesh just like in aspegilloma

DIAGNOSIS

• Histoplasmin intra-dermal test like PPD for TB
• serology- antibodies CFT, counter current immuno electrophoresis
• Culture; Histology of tissue

TREATMENT:

Symptomatic treatment then oral –ketaconazole or itraconazole then systemic Amphotericin B

- Surgical Excission of Histoplasmomas like for Aspergilloma.

4. Types of common fungal lungs diseases.

3. ASPERGILLOSIS

Infection of fungus Aspergillus fumigatus. Commonly associated with decaying fodder, hay, trees. Quite ubiquitous.

1. Allergic Bronchopulmonary Aspergillosis

Fungus growth in bronchial tree. Fleeting bronchial shadows. Sputum have fungal hyphael filaments. Causes Bronchiectasis and even segmental lobe collapse. and Pulmonary interstitial fibrosis.

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. Clical features therefore include Extrinsic Asthma , Bronchiectasis, and even Fibrosing lung disease. Blood Eosinophilia, IgE elevation.

2. Aspergilloma

fungal spores settle in previous Tuberculous cavity. Grows into fungal ball- tumour like with radio-luscent halo surrounding the radio dense tumour mass. Causes streaks of haemoptysis or even massive. Requires surgical excition.

3. Invasive Aspergillosis
1. Occurs in highly immune compromised.
2. Wide spread organs involvement
3. Granulomatous liver lesion, Brain abscess, Meningitis, lytic bone lesions, Pneumonic lung lesion.

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5. DIAGNOSIS/ TREATMENT ASPERGILLOSIS

• Guided by presentation, history.

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• Antigen skit test positive in Allergic Bronchopulmonary but negative in Invasive and in Aspergilloma
• Precipitin positive .Chest X rays, FBC.
• Fungal hyphae in Sputum, and culture.

Treatment includes: supportive, e.g. brochodilators, corticosteroids, anti-fungal agents oral- itroconizole, fluconizole and parenteral amphotericin B. Surgical excision of aspergillomata

6. OTHER PULM. FUNGAL INFECTIONS ASSOCIATED WITH SEVERE IMMUNE SUPPRESSION IN HIV/ AIDS

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1. CRYPTOCOCCOSIS

Spores inhaled. Yeast like fungi from pigeons dropping sub-acutely with hitar lymph nodes cough, Pleural effusion and cavitation and fibrosis. Commonly meningitis.

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2. COCCIDOMYCOSIS
1. Spores inhaled, non budding soil saprophyte Coccidiodes immitis. Windstorms. Fever within 10 days. Malaise, erythema nodosum, allergic conjunctivitis, cough, pleural effusion. Pulm cavitation ,high infectivity.

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DIAGNOSIS/ TREATMENT

• History of exposure
• Skin tests with specific antigen. Serology : Precipitin tests and complement fixation tests.

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7. OTHERS COMMONLY ASSOCIATED WITH IMMUNE SUPPRESSION IN HIV/ AIDS

C). Pneumocystis carinii

• One of the atypical Pneumonias. Contagion like fungus genetically but it’s intra-cellular. Amoeboid-like trphozoite that multiply into sack of merozoites then raptures into trophozoites again. Causes insidious SOB, fever, cough,. Alveolar damage with poor gas exchange and stiff lungs
• CXR may not show but CT scan peri-hilar infiltrates becoming generalised ground glass, associated with very low CD4 count less than 200.
• Its consequent to failure of prophylaxis in HIV patient whose immunity is severely compromised

TREATMENT

• Supportive. Plus Intra venous Co-trimoxazole 100mg/kg/day or
• Pentamidine or
• Atovaquone or
• Clindamycin/ Primaquine combination.

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8. SUMMARY FUNGAL LUNG DISEASES

1. INFECTION:
1. Inhalation of Spores( Fungal spores) often associated with wet, dampy soil, decaying grass/ hay fodder, trees.
2. Spread via droppings of Birds especially pigeons.
3. Carried into houses via wet, soggy shoes, socks and windstorms.
4. wise to wear face mask when working on hay, fodder, fire wood.
5. The fungal pulmonary disease can be as severe as Broncho-Pulmonary Tuberculosis. Worse when immune compromised.

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9.Aspergillosis infection

10. Electron- microscopy photograhp of candida �- albicans treated with subfraction

11. Microscopic dessiminated histoplasmosis