JMJ Marist Brothers Notre Dame of Dadiangas University Marist Avenue, Gen.

Santos City

Bed Side Clinic for

ASPERGILLOM A
Presented by: Kimberly N. Alberca, SN (Group 2)

Presented to: Melody D. Nimer, RN (Clinical Instructor)

June 22, 2011 Patient: Ubpon, D. Room: 2003 Chief Complaint: Body Weakness Diagnoses: DM type II, PTB Physician: Dr. Herminio Japsay ASPERGILLOMA Definition:
Also known as a mycetoma or fungus ball.is a clump/mass of fungus which exists

in a body cavity such as the lung. A variety of bronchopulmonary aspergillosis characterized by a ball-like mass of the fungus Aspergillus fumigatus in an existing cavity in the lung. Also called fungus ball. Causes: Aspergillomas are formed when the fungus aspergillus grows in a clump in a lung cavity, or invades previously healthy tissue, causing an abscess. Aspergillus is a common fungus. It grows on dead leaves, stored grain, bird droppings, compost piles, and other decaying vegetation. Cavities in the lung may have been caused by:

Coccidioidomycosis Cystic fibrosis Histoplasmosis Lung abscess Lung cancer Sarcoidosis Tuberculosis

Symptoms: Many patients have no symptoms. When symptoms do develop, they can include:

Chest pain Cough Coughing up blood (seen in up to 75% of patients) Fatigue Fever Unintentional weight loss Malaise Shortness of breath Wheezing

Diagnoses:

Chest x-ray Chest CT Sputum culture Bronchoscopy or bronchoscopy with lavage (BAL) Serum precipitins for aspergillus (blood test to detect antibodies to aspergillus) Blood test for presence of aspergillus in the body (galactomannan)

Treatment: Many patients never develop symptoms. Often, no treatment is needed, unless you are coughing up blood. Occasionally, antifungal medications may be used. Sometimes, injecting dye into the blood vessels (angiography) may be used to find the site of bleeding. The bleeding is stopped by shooting tiny pellets into the bleeding vessel.
Surgery is often the only choice if there is life-threatening bleeding.

Surgical Treatment:

Lobectomy or pneumonectomy for recurrent haemoptysis

Possible Complications:

Difficulty breathing that gets worse Massive bleeding from the lung Spread of the infection (see acute invasive aspergillosis)

Prevention People who have had related lung infections or who have weakened immune systems should try to avoid environments where the aspergillus fungus is found. Actual medications: Appebus / Appeten 1 capsule OD Zalvos 20 mg IVTT q 4 hrs ANST ( ) Myrin P forte 1 tablet TID Inox 100 mg/ cap, 2 capsules OD Buscopan 1 tablet TID Paracetamol 500 mg 1 tablet q 4 hrs for fever prn

Aspergillus species are ubiquitous molds found in organic matter. The transmission of fungal spores to the human host is via inhalation. Aspergillus may cause a broad spectrum of disease in the human host, ranging from hypersensitivity reactions to direct angioinvasion. Aspergillus primarily affects the lungs, causing 4 main syndromes, including allergic bronchopulmonary aspergillosis necrotizing aspergillosis. (ABPA), pulmonary chronic necrotizing Aspergillus [CNPA]), patients in pneumonia who are (or and chronic invasive severely aspergillosis aspergilloma,

However,

immunocompromised, Aspergillus may hematogenously disseminate beyond the lung, potentially causing endophthalmitis,endocarditis, as a cause of fungal and abscesses in the myocardium, kidney, liver, spleen, soft tissue, and bone. Aspergillus is second to Candida species endocarditis. Aspergillus -related endocarditis and wound infections occur in the context of cardiac surgery.

An aspergilloma is a fungus ball (mycetoma) that develops in a preexisting cavity in the lung parenchyma. Underlying causes of the cavitary disease may include treated tuberculosis or other necrotizing infection, sarcoidosis, CF, and emphysematous bullae. The ball of fungus may move within the cavity but does not invade the cavity wall; however, it may cause hemoptysis.

Invasive aspergillosis is a rapidly progressive, often fatal infection that occurs in patients who are severely immunosuppressed, including those who are profoundly neutropenic, those who have received bone marrow or solid organ transplants, and patients with advanced AIDS or chronic granulomatous disease. This infectious process is characterized by invasion of blood vessels, resulting in multifocal infiltrates, which are often wedge-shaped, pleuralbased, and cavitary. Dissemination to other organs, particularly the central nervous system, may occur

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individuals who are immunocompetent, invasive Aspergillus infection almost always occurs in patients who are immunosuppressed by virtue of underlying lung disease, immunosuppressive drug therapy, or immunodeficiency.

Aspergillus hyphae are histologically distinct from other fungi in that the hyphae have frequent septae, which branch at 45 angles. The hyphae are best visualized in tissue with silver stains. Although many species ofAspergillus have been isolated in nature, A fumigatus is the most common

cause of infection in humans. A flavus and A niger are less common. Likely, this relates to the ability of A fumigatus, but not most other Aspergillusspecies, to grow at normal human body temperature.