Fungal lung diseases
Occupational lung diseases
Edit Csada, MD
19.11.2014.
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
RISK FACTORS
Immuncompromised state, treatment
Cytostatic treatment
Antibiotic and steroid treatment
Leukemy
Neutropenic patients
Malignancies
Diabetes mellitus
AIDS
After intensive therapy
After transplantation
PATHOLOGICAL FINDINGS
Epitheloid hyperplasia
Histocyte granulomas
Thrombotic arteriitis
Caseation granuloma
Fibrosis
Calcification
DIAGNOSTIC METHODS
Microscopic examination
native smear
different stainings
Culture
Special culture media
Histology
+ culture
Skin test
Serology
Differential diagnosis
tumor
tuberculosis
chr pneumonia
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
CLINICAL MANIFESTATION OF
ASPERGILLOSIS
Allergic aspergillosis
Extrinsic allergic alveolitis
hypersensitivity pneumonitis
Allergic bronchopulmonary aspergillosis
Aspergillomas
Invasive aspergillosis
Rare manifestations
Aspergillus endocarditis
Aspergillus pneumonia
Endophthalmitis
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
ASPERGILLOMA
Saprophytic colonisation of fungi in pulmonary cavities
Manifestation
 No symptoms
 Haemoptysis
 Fever
 Cachexia
Chraracteristic x-ray picture!
Therapy: surgery
INVASIVE ASPERGILLOSIS
Immuncompromised host!
Necrotising pneumonia
Empyema
Pulm., extrapulm. Dissemination
Symptoms: fever, pleural pain, haemotysis
Therapy:
Amphotericin B
or voriconazole
itraconazole, caspofungin
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
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
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: Wright’s or Giemsa staining
Prognosis: good
Therapy: itraconazole, amphotericin B
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
COCCIDIOIDOMYCOSIS
• Risk factors for dissemination of Coccidioides
Immitis infection
• Older age
• Males
• Non-caucasians, Filipinos
• Immunsuppression
• Gravidity
• Therapy
• Azoles
• Fluconazole > 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
Occupational exposure
Isocyanates
Spray paints, varnishes,
adhesives, polyurethane
foam manufacture
Flour
Bakers
Epoxy resins
Hardening agents,
adhesives
Animals (rats, mice)
Laboratory workers
Wood dusts
Sawmill workers, joiners
Azodicarbonamide
Polyvinyl plastics
manufacture
Persulphate salts
Hairdressers
Latex
Healthcare workers
Drugs
Pharmaceutical industry
Grain dust
Farmers, millers, bakers
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:
dusts
inhalation of inorganic
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 (<2 micron)
Time of exposure
Individual inclination (smoking)
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SILICOSIS
Symptoms:
no symptoms
dyspnoe
hypoxaemia, hypercapnia=>
ventilatory failure=>
cor pulmonale
X-ray:
nodular dissemination
silicomas (=>emphysematic bullae)
hilar adenopathy
calcification, egg shell pattern
Complications:chr. bronchitis
emphysema
ptx
Tb is more frequent
Caplan’s 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:
Farmer’s lung (1932) – thermophylic actinomycetes
Bird fancier’s breeder’s or handler’s lung
Miller’s lung
Bagassosis
Byssinosis
Air conditioner’s lung
Coffee worker’s 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 tests:impaired 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
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corticosteroids
Thank you for your attention!
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