Chronic pulmonary aspergillosis

Aspergillus fumigatus 01

Chronic Pulmonary Aspergillosis (CPA) is a long-term infection of the lungs caused by the fungus Aspergillus. This condition often develops in individuals with pre-existing lung diseases such as tuberculosis, chronic obstructive pulmonary disease (COPD), or lung cancer, but it can also affect individuals with otherwise healthy lungs. CPA is characterized by a slow, progressive destruction of lung tissue, leading to significant morbidity and, if left untreated, mortality.

Symptoms

The symptoms of CPA are nonspecific and can include chronic cough, hemoptysis (coughing up blood), weight loss, fatigue, and fever. Due to the overlap of these symptoms with those of other lung conditions, CPA can be challenging to diagnose without specific tests.

Diagnosis

Diagnosis of CPA involves a combination of clinical assessment, radiological findings, and microbiological evidence of Aspergillus infection. Computed tomography (CT) scans of the chest are crucial for identifying the characteristic abnormalities of CPA, such as cavities or fungal balls (aspergillomas). Serological tests for Aspergillus antibodies and cultures of respiratory specimens can provide microbiological evidence of infection.

Treatment

Treatment of CPA typically involves antifungal medications, with voriconazole and itraconazole being the most commonly used agents. The duration of treatment can vary from several months to lifelong therapy, depending on the severity of the disease and the patient's response to treatment. In some cases, surgical removal of aspergillomas or other damaged lung tissue may be necessary.

Epidemiology

CPA affects a wide range of individuals worldwide, with a higher prevalence in regions with a high burden of tuberculosis or other chronic lung diseases. The exact incidence and prevalence of CPA are difficult to determine due to underdiagnosis and the overlap of its symptoms with those of other lung conditions.

Complications

Complications of CPA include severe hemoptysis, which can be life-threatening, and progressive lung damage leading to respiratory failure. Additionally, individuals with CPA are at increased risk of developing chronic pulmonary hypertension.

Prevention

Prevention of CPA involves the management of underlying lung conditions and the avoidance of exposure to Aspergillus spores, particularly for individuals with weakened immune systems or chronic lung diseases. This can include measures such as using air filters in homes and avoiding activities that disturb soil or decaying vegetation where Aspergillus spores are commonly found.

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