Pneumomycosis
Description:
Pneumomycoses (pneumomycosis; singular; Greek pneumon easy + mycoses) - the diseases of a respiratory organs caused by pathogenic fungi. On localization of pathological process distinguish a fungal infection of pulmonary fabric (actually a pneumomycosis), tracheas (tracheomycosis) and bronchial tubes (bronchomycosis).
Symptoms of Pneumomycoses:
At massive single infection with pathogenic fungi the disease develops sharply in the form of tracheitis, bronchitis or pneumonia. At the weakened patients or at repeated inhalations of small doses of fungi the disease accepts хрон. the current which is characterized by alternation of phases of an aggravation and remission. The pneumomycosis is accompanied by intoxication, including connected with impact on an organism of mycotoxins. At a chronic current of a pneumomycosis in pulmonary fabric it is excessive connecting fabric develops, at the same time emergence of an asthma is possible, quite often in a phlegm blood streaks, perhaps profuse pulmonary bleeding are noted. The mixed and combined pneumomycoses proceed heavier, than fungal monoinfection. The pneumomycoses caused by various fungi have nek-ry a wedge. features.
Fungi of Aspergillus can lead to development of a tracheobronchitis, pneumonia and an aspergilloma of lungs. As a rule, these diseases develop for the second time. The Aspergillezny tracheobronchitis is shown by pristupoobrazny cough - dry or with a phlegm. A phlegm mucous or mucopurulent with impurity of dense lumps; the quantity reaches it 100 ml a day. Periodically there are bronchospasm attacks with a picture of bronchial asthma. Long subfebrile condition, allergic rhinitis, increase in number of eosinophils in blood, increase in SOE are characteristic. At рентгенол. a research of lungs strengthening of the pulmonary drawing, consolidation and a tyazhistost of roots of lungs are defined. At a bronkhoskopiya reveal a focal or diffusion tracheobronchitis.
Aspergillosis pneumonia is characterized by almost constant pristupoobrazny cough, sometimes dry and painful, but is more often with the mucopurulent or purulent phlegm (to 200 ml a day) containing dense lumps; spasmodic fervescences from oznoba and night sweats arise a pneumorrhagia, stethalgias, an asthma, feeling of weight in lungs, suffocation attacks, long subfebrile condition, against the background of to-rogo. Gradually the condition of patients worsens, weakness increases, there is anorexia, the cachexia develops. The disease accepts хрон. current. In lungs multiple dry and wet mixed rattles are listened. Radiological decide not homogeneous shadow on indistinct contours and enlightenments between them; the sites of the coarse drawing reminding violent cavities; pneumosclerosis, deformation of roots of lungs. At a bronkhoskopiya find a catarral and purulent inflammation of a mucous membrane of bronchial tubes, in a gleam of segmental bronchi - the friable or dense greenish-gray masses (accumulation of fungal colonies).
The aspergilloma of lungs (the most frequent damage of lungs at an aspergillosis) represents the localized form of a disease and is characterized by existence in easy for the cavity supporting colonies of fungi and which is reported with a gleam of bronchial tubes. As a rule, the aspergilloma results from infection with fungi of the cavity which is already existing in easy (e.g., after treatment of cavernous tuberculosis or abscess of a lung). Often it proceeds asymptomatically and comes to light accidentally (e.g., at fluorography). Perhaps acute beginning of a disease with a fever, fervescence, perspiration, pristupoobrazny cough, a plentiful phlegm, a pneumorrhagia. Radiographic reveal a cavity (two cavities and more are more rare) to dia. 2-5 cm (sometimes 10-15 cm); in a cavity there is roundish shading, between it and a wall of a cavity the crescent nimbus of an enlightenment is defined, to-ry it can be displaced at change of position of a body of the patient. At a bronkhoskopiya find a catarrh of a mucous membrane and deformation of bronchial tubes; if the bronchoscope gets to an aspergilloma, the white, gray, yellow or greenish plaque which is densely spliced with cavity walls comes to light.
Fungi of Actinomyces can cause damages of a trachea, bronchial tubes, pulmonary fabric, a pleura and a chest wall (a thoracic actinomycosis). In the beginning in the struck fabrics dense infiltrate (actinomycoma) is formed, in the central part to-rogo find druses of actinomycetes. Then the actinomycoma is exposed to abscessing with formation of a set of cavities and fistulas.
Actinomycotic tracheitis can be the first display of an infection or develop as a result of distribution патол. process of a gullet. Gradually breath difficulty accrues, periodically there are suffocation attacks. Further can arise throat hypostasis, fistulas of a trachea, a gullet, process extends in soft tissues of a neck, outside fistulas form. At a research of function of external respiration disturbance of tracheal passability on obstructive type comes to light. At рентгенол. a research on a wall of a trachea find tumorous education - the actinomycoma narrowing a trachea gleam. Reduction of a gleam and deformation of a trachea are caused by also considerable development in its wall of granulyatsionny and cicatricial fabrics.
Actinomycotic bronchitis can develop because of the previous damage of bronchial tubes (e.g., at measles, occupational disease, etc.), in this case патол. process is limited to bronchial tubes. Primary actinomycotic bronchitis is the beginning of a widespread actinomycosis of lungs. Actinomycotic bronchitis is characterized by persistent cough, high temperature of a body, then temperature becomes subfebrile or intermittent, the phlegm appears (mucous in the beginning, then mucopurulent, with blood streaks). Complaints to the constant pricking thorax pains are frequent, is more often in interscapular area. The pulmonary heart is possible. By means of a bronkhoskopiya at a long current reveal an endobronchitis, granulations and exudate, rigidity, deformation and narrowing of a gleam of bronchial tubes. Radiological define emphysema of lungs, strengthening of the pulmonary drawing, intensive radiarny infiltration of pulmonary fabric, fibrosis in a radical zone. In a phlegm (in washing waters of bronchial tubes) find a mycelium and druses of a radiant fungus (Actinomyces).
At localization of an actinomycoma in the central sites of a lung the disease begins gradually: there is dry cough, then the scanty mucous or mucopurulent phlegm (to 20-30 ml a day), sometimes with streaks of blood and dense grains (conglomerates of druses of actinomycetes) begins to depart. Subfebrile condition or the wrong fever, bystry fatigue, an indisposition, a fever, perspiration, pains on the party of defeat are characteristic. If the actinomycoma is located in a lung top, irradiation of pains in a shoulder, a shovel is possible. Over an actinomycoma the dullness is defined, the weakened breath, non-constant small-bubbling rattles are listened. Radiological in lungs reveal low-intensive, with indistinct borders a shadow and a path of the condensed perivascular fabric to a lung root. Increase mediastinal лимф is possible. nodes.
The subpleural arrangement of an actinomycoma causes the acute course of a disease with high temperature of a body, dry and painful cough, a thermalgia in a chest wall, a pleura thickening in a defeat zone.
At a long current of an actinomycosis of lungs are noted deterioration in the general state up to an adynamia, a cachexia, strengthening of density of the center of shading in a lung and its mramornost due to emergence of sites of an enlightenment. In an abscessing stage a wedge. symptoms are same, as at lung abscess. Radiological in cavities of the center it is possible to find liquid levels. In 3-7 days before emergence of fistula there comes the sharp aggravation of symptoms of the patient. Fistulas can open in a gleam of a bronchial tube, trachea, gullet (internal fistulas), on skin of a chest wall (outside fistulas) or in hypodermic cellulose (blind fistulas). After an otkhozhdeniye cream (at the expense of blood impurity) suppurating a condition of the patient improves. In allocations from fistula find small yellowish-grayish or yellowish-greenish grains - colonies (druse) of a radiant fungus.
Distribution of process on a mediastinum and a chest wall leads to development in soft tissues dense, without clear boundary of infiltrates, to-rye abscess with formation of fistulas. In the field of defeat of a chest wall narrowing of intercostal spaces is noted, damage of edges and a backbone (an ossifying periostitis, osteomyelitis) is possible. Cases of distribution of process on mammary glands, a pericardium and a myocardium are described.
Fungi of Candida can cause damage of a trachea, bronchial tubes and pulmonary fabric.
The candidosis tracheobronchitis develops as a result of distribution of fungal process of an oral cavity, a throat, a throat or as a complication at aspiration of a foreign body, the emetic masses containing Candida fungi. Wedge. symptoms: cough, the complicated breath, feeling of an itch and (or) burning (sometimes painful) behind a breast. At aggravations there are subfebrile condition, symptoms of a mycogenic allergy. Bronchoscopic reveal a hyperemia, infiltration and a skladchatost of a mucous membrane of a trachea and bronchial tubes, dot and (or) blyashechny plaques of whitish or grayish-yellowish color; erosion, at a severe form - ulcers. Extensive and (or) massive plaques sharply narrow, obturirut a bronchial tube gleam that leads to development of pneumonia, a hypoventilating or obturatsionny atelectasis of a lung. From bronchial tubes the candidosis infection can extend to pulmonary fabric (candidosis pneumonia).
Primary candidosis pneumonia develops usually against the background of prolonged treatment by antibacterial, cytostatic drugs, glucocorticoid hormones. It is shown by deterioration in health, weakness, headaches and other symptoms of intoxication at normal body temperature. Sometimes the disease begins sharply with fervescence, cough (is more often than dry), hoarseness of a voice, stethalgias. In lungs dry, then wet rattles are listened. Increase in SOE is noted. At рентгенол. a research reveal strengthening of the pulmonary drawing, non-constant infiltrates in pulmonary fabric. Process is usually bilateral. At early children's age candidosis pneumonia quite often accepts a recurrent current and is a harbinger хрон. granulematozny generalized candidiasis. Presence of the milkwoman (candidiasis of a mucous membrane of an oral cavity) allows to assume the candidosis nature of pneumonia.
Secondary candidiasis of lungs develops in an end-stage of oncological or other primary (background) disease, proceeds hard. Fever, almost constant cough, suffocation attacks are characteristic, plentiful it is purulent - mucous or is purulent - a bloody phlegm, vomiting, dehydration. The lung atelectasis, miliary Dissimination are possible. Disintegration of the candidosis centers leads to formation of thin-walled cysts, cavities.
Reasons of Pneumomycoses:
Eurysynusic mold (Aspergillus, Cephalosporium, Mucor, Penicillium, etc.), radiant (Actinomyces, Nocardia asteroides) and drozhzhepodobny (Candida, Cryptococcus neoformans, Geotrichum candidum, etc.) fungi, and also endemic fungi can be the cause of a pneumomycosis (Blastomyces dermatitidis, Coccidioides immitis. Histoplasma capsulatum, Paracoccidioides brasiliensis, etc.). Fungi of Aspergillus, Actinomyces, Candida most often occur among activators P. in the USSR. Quite often the mixed pneumomycoses caused by various fungi (e.g., mold and drozhzhepodobny), and the combined pneumomycoses arising at infection with fungi and other microorganisms (bacteria, viruses) meet.
The pathogenic fungi causing pnevmomika contain in the soil, production dust, including in dust to lay down. institutions (e.g., in dust from mattresses); they can be found on insufficiently disinfected surgical instruments, the medical equipment and materials. Insects participate in transfer of fungi (flies, cockroaches, etc.). Pathogenic fungi get into airways in preferential aerogenic way (exogenous pneumomycoses). Besides, they can get into airways from other centers of mycosis existing in an organism. E.g., at an abdominal actinomycosis from an abdominal cavity through a diaphragm or retroperitoneal cellulose - in lungs or a pleural cavity. At candidiasis of a mucous membrane of an oral cavity the trachea and bronchial tubes can be surprised owing to distribution on them инф. process. Perhaps hematogenous innidiation of the causative agent of a fungal infection from its extra pulmonary centers. Some fungi (e.g., the sorts Candida) relating to opportunistic flora and constantly living in respiratory tracts at decrease in resistance of an organism can gain pathogenic properties and cause endogenous pneumomycoses.
At hit of pathogenic fungi in respiratory tracts from the outside usually there is a temporary carriage. In case of decrease in body resistance the carriage becomes resistant, and then the disease develops. Pneumomycoses quite often develop at the persons receiving hormonal, cytostatic or radiation therapy. They are revealed approximately at 3% of patients with a syndrome of the acquired immune deficit. P.'s emergence is promoted by the dysbacteriosis connected with irrational use of antibiotics. Pneumomycoses can develop as primary патол. process (especially at massive implementation of an infection) or as secondary, complicating the course of primary (background) disease - tuberculosis, an endocrinopathy, tumoral process, etc.
Treatment of Pneumomycoses:
Appoint antifungal drugs: Amphotericinum In, амфоглюкамин, Mycoheptinum, Nizoral (at the pneumomycoses caused by mold and drozhzhepodobny fungi), iodine drugs (at the pneumomycoses caused by mold fungi), nystatin, levorinum (at the pneumomycoses caused by drozhzhepodobny fungi), актинолизат (at the pneumomycoses caused by radiant fungi).
According to indications carry out the stimulating, immunocorrective, disintoxication therapy. At the combined fungal and bacterial infection appoint antibiotics to short term, in the presence of allergic manifestations - hormonal drugs. In case of the localized damage of lungs (e.g., at an aspergilloma, an actinomycoma) operation is shown. Special attention is paid to a balanced diet and regime of patients, LFK in the fresh air is recommended. Alcoholic drinks and smoking should be excluded.
Forecast. At primary acute pneumomycosis caused by Aspergillus fungi, the forecast favorable, but tendency to inflammatory processes of upper respiratory tracts, a mycogenic sensitization can remain. In certain cases postaspergillezny changes (a pneumosclerosis, etc.) can cause disability of the patient. Early identification of P. caused by Actinomyces fungi, and its correct treatment lead to an absolute recovery. At late recognition formation of a pneumosclerosis, bronchiectasias, cavities, massive pleural шварт, etc. is possible. The forecast at primary candidiasis of lungs favorable, in some cases develops a resistant mycogenic sensitization. At secondary candidiasis of lungs the forecast depends on weight of a basic disease against the background of which fungal process developed.
Prevention includes sealing технол. the processes which are followed by release of dust; use of respirators on productions with the increased dust content of air, including in agriculture; микол. control of the environment; increase in body resistance; prevention of dysbacteriosis; observance of rules of disinfection and sterilization (mold, radiant and drozhzhepodobny fungi perish at boiling - in 30-40 min., influence of 5% of solutions carbolic to - you, lysol, chloroamine, 10-25% of solutions of formalin, 0, 1% of solution of corrosive sublimate, synthetic detergents). Dispensary observation of the persons working in the conditions of the increased dust content of air at insufficient sealing технол is necessary. process: workers of agriculture, weaving and tea mills, the enterprises using fungi producers (e.g., mold fungi for production of citric acid, drozhzhepodobny fungi for receiving biovitamin concentrates), road makers, archeologists, cave explorers, etc.
