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Fungal lung diseases Occupational lung diseases

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Title: K ROKOZ K Author: Capricorn Last modified by: Rozsa Created Date: 11/30/2001 5:11:12 PM Document presentation format: Diavet t s a k perny re – PowerPoint PPT presentation

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Title: Fungal lung diseases Occupational lung diseases


1
Fungal lung diseasesOccupational lung diseases
  • Edit Csada, MD
  • 19.11.2014.

2
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

3
RISK FACTORS
  • Immuncompromised state, treatment
  • Cytostatic treatment
  • Antibiotic and steroid treatment
  • Leukemy
  • Neutropenic patients
  • Malignancies
  • Diabetes mellitus
  • AIDS
  • After intensive therapy
  • After transplantation

4
PATHOLOGICAL FINDINGS
  • Epitheloid hyperplasia
  • Histocyte granulomas
  • Thrombotic arteriitis
  • Caseation granuloma
  • Fibrosis
  • Calcification

5
DIAGNOSTIC METHODS
  • Microscopic examination
  • native smear
  • different stainings
  • Culture
  • Special culture media
  • Histology
  • culture
  • Skin test
  • Serology
  • Differential diagnosis
  • tumor
  • tuberculosis
  • chr pneumonia

6
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

7
CLINICAL MANIFESTATION OF ASPERGILLOSIS
  • Allergic aspergillosis
  • Extrinsic allergic alveolitis
  • hypersensitivity pneumonitis Allergic
    bronchopulmonary aspergillosis
  • Aspergillomas
  • Invasive aspergillosis
  • Rare manifestations
  • Aspergillus endocarditis
  • Aspergillus pneumonia
  • Endophthalmitis

8
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

9
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

17
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

18
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

19
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

20
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

20
21
Occupational lung diseases
  • Pneumoconiosis
  • Hypersensitivity pneumonitis
  • Obstructive airway diseases
  • Toxic damages
  • Malignant lung diseases
  • Pleural diseases

21
22
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

23
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

23
24
PNEUMOCONIOSIS
  • Etiologic agents inhalation of inorganic
    dusts
  • metal dusts
  • free silica
  • coal dusts

25
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

26
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)

27
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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31
Silicosis
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33
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

36
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

40
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