If I Have A Persistent Cough And Fever Why Would My Healthcare Provider Ask Me Where I Have Been Traveling And What Activities I Have Been Doing
Some fungi are found in distinct geographical regions, such in the southwestern U.S. or midwestern U.S. If you have been around excavation or spelunking in caves, you may have been exposed to fungal spores. This can be true, even if travel was not recent. Lung infections caused by some fungi may emerge months to even years after exposure.
Is There More Than One Type Of Aspergillosis
There are several types of aspergillosis.
Pulmonary aspergillosis is most likely to develop in people who have chronic lung disorders or damaged lungs. These people are likely to have abnormal spaces in their lungs where the fungus can grow. The fungus can also rarely infect sinuses and ear canals. The mold spores can colonize inside lung cavities that developed as a result of chronic diseases, such tuberculosis, emphysema, or advanced sarcoidosis. The fibers of fungus might form a lump by combining with white blood cells and blood clots. This lump or ball of fungus is called an aspergilloma or mycetoma. In some cases, a fungus ball may be present in other organs of the body.
Invasive aspergillosis, the most severe type, occurs when the infection travels from the lungs into the bloodstream. Other organs, such as the kidneys, liver, skin or brain, may become infected. This is a very serious condition that may result in death if not treated. People with very weakened immune systems are more susceptible to invasive aspergillosis. Other risk factors include a low white blood cell count, long-term use ofcorticosteroids, or hospitalization.
How Do Fungi Affect The Lungs
In general, lungs do not like fungi! Breathing in tiny bits of fungus irritates the lungs and can cause something called allergic alveolitis: a bit like asthma. It can make you breathless and give you a cough that just won’t go away. Some people who live in damp, mouldy accommodation can develop this. The fungus called Aspergillus is often the one that causes these problems in the UK.
The other way fungi can affect lungs is by infection: a small collection of fungus gathers in a particular part of your lungs and gradually grows, squashing the surrounding lungs.
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Fungal Infections In Lungs And Cancer: Common Symptoms
When an individual suddenly develops symptoms such as fever, chest pain, and cough, the healthcare provider may initially prescribe antibiotics. However, if symptoms do not improve after a course of antibiotics, they may undergo further imaging tests to determine the source of the symptoms.
These imaging studies may show nodules or other abnormal findings in the lungs, and these findings may appear suspicious for lung cancer. If this is the case, they may be referred to a lung doctor for further evaluation and possibly a biopsy. A biopsy can determine if the suspicious area found on the imaging is in fact lung cancer, or if it is an infection.
Why Do I Need A Fungal Culture Test
Some fungal infections can be treated with over-the-counter powders, creams, and ointments. If you are prone to superficial fungal infections like athlete’s foot, you may be able to diagnose and treat an infection yourself. However, if your symptoms get worse or don’t go away in a matter of weeks, you may need to see a healthcare provider for more intensive treatment.
A fungal culture will help your healthcare provider identify the specific type of fungi causing your infection, tailor your treatments, or see if current treatments are working.
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International Distribution And Incidence Of Fungal Infection
These fungi have caused several pneumonia outbreaks in Argentina and other areas of Central and South America. P brasiliensis is restricted to Central and South America. African histoplasmosis, which is caused by H capsulatum duboisii, is limited to equatorial Africa between 20Â° N and 10Â° S, which includes Gabon, Uganda, and Kenya.
The other opportunistic organisms are ubiquitous, are usually found worldwide, and tend to cause disease in hosts with abnormal immune defenses. For instance, C neoformans can affect people with intact immune systems at a rate of 0.2 cases per million population per year. Prior to the advent of highly active antiretroviral therapy , approximately 80-90% of patients with acquired immunodeficiency syndrome developed cryptococcosis.
Therapeutic Monitoring Of Antifungal Agents
Serum concentrations of antifungals may be influenced by a broad range of factors , hence drug monitoring is recommended to avoid toxicity or insufficient drug levels. Monitoring is recommended for flucytosine, itraconazole, voriconazole, and posaconazole no indications exist for amphotericin B or the echinocandins., Voriconazole monitoring is specifically suggested in children, when shifting from intravenous to oral, and for dose optimization in case of long-term treatment. Limited data are currently available for isavuconazole.
A precise mycological diagnosis is only possible with laboratory testing. Conventional microbiological and microscopic techniques remain the cornerstone of diagnosis with serological and molecular testing improving the diagnostic outcome. To choose the right diagnostic tests depends on the local fungal epidemiology, implemented treatment guidelines, availability of the laboratory, prevalence of aspergillosis, and at least on the underlying diseases .
Aspergillosis is more common among immunocompromised patients with neutropenia or immunosuppression due to corticosteroid use.
Infections are typical of the lung or sinuses.
Educate your doctors to provide proper specimens with adequate collection and transportation. BALs and lung biopsies are the specimens of choice.
Choose laboratory tests according to local epidemiology and patient population.
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What Are The Symptoms Of Aspergillosis
The signs and symptoms of aspergillosis vary depending on the specific form.
Allergic bronchopulmonary aspergillosis has symptoms similar to asthma. They include coughing, wheezing and shortness of breath.
In chronic pulmonary aspergillosis, it usually takes a while for patients to develop symptoms. When they finally do emerge, symptoms include wheezing, shortness of breath, fatigue and weight loss. It is also common for chronic pulmonary aspergillosis patients to develop a tangled mass of fungus fibers called an aspergilloma or fungus ball in cavities within the lungs. Symptoms that accompany this growth are frequent and bloody coughing as well as shortness of breath.
Because patients with invasive aspergillosis usually suffer from other medical conditions, it can be hard to identify symptoms related to the aspergillosis infection. Symptoms may also differ depending on what organs are affected as the infection spreads. However, they commonly include coughing up blood, fever and chills, headaches, chest pain and shortness of breath.
Additionally, Aspergillus can cause localized infections of the nails, eyes, skin, sinuses or ear canals.
Aspergillosis Is Rare In Healthy People
You’re usually only at risk of aspergillosis if you have:
- a lung condition such as asthma, cystic fibrosis or chronic obstructive pulmonary disease
- a weakened immune system for example, if you have had an organ transplant or are having chemotherapy
- had tuberculosis in the past
- severe flu or coronavirus and need artificial ventilation
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Sputum Examination And Potassium Hydroxide Stain
This study may show fungal hyphae or yeasts. However, the results must correlate with the clinical situation, because saprophytic colonization occurs in the oropharyngeal or respiratory tract of some patients and may not necessarily indicate invasive infection.
Carefully transport, process, and culture specimens that may be contaminated by bacteria, may be saprophytic yeasts endogenous to the oral cavity, and may be airborne conidia of saprophytic fungi.
The diagnosis of pulmonary cryptococcal infection is confirmed if the organism is grown in culture from sputum or BAL fluid in a patient who has clinical symptoms and radiographic finding compatible with cryptococcosis.
Histoplasmosis is definitively diagnosed by growth of the organism in sputum BAL fluid, lung tissue, or mediastinal nodes can be cultured.
In pulmonary sporotrichosis, the recovery of the fungi by culture of sputum and/or positive bronchoscopy are required for diagnosis.
Cultures from sputum samples collected by fiber optic bronchoscopy are not valuable for the diagnosis of pneumonia by Candida. To make the diagnosis, a biopsy is required to demonstrate tissue invasion. Colonization of the respiratory tract by Candida is very frequent in critically ill patients with mechanical ventilation, but pneumonia by Candida is extremely rare because the innate defense mechanisms of the lungs make them relatively resistant to candida invasion.
Fungal Blood Cultures: When Should They Be Ordered
Alison Chan, DO, Pathology ResidentAnna Romanelli, PhD, Medical Director of Clinical Microbiology Laboratory
In every patient with a suspected infection, the prompt detection and identification of the organism is of utmost importance. The UC Davis Microbiology Lab offers several laboratory tests to identify the infectious organism, which ultimately guides clinicians to initiate the appropriate treatment to the patient . Commonly, several routine tests are ordered upon the initial patient encounter, such as complete blood counts, chemistry panels, routine blood cultures, as well as fungal blood cultures. When a fungal blood culture is requested, a fungal Isolator tube is required to collect the blood for special lab processing. Since this lab test may be inappropriately ordered, the fungal blood culture requires the approval from the Director of Clinical Microbiology Laboratory or a Pathology resident in order to receive the fungal Isolator tube to complete the lab test. We will review the tests currently available to detect fungemia and when a fungal blood culture request is appropriate.
Lab Best Practice:
A list of situations where a fungal blood culture is likely to be approved is provided below:
- A patient has had multiple negative routine blood culture sets and the patient has shown little to no improvement.
- The patient is immunocompromised.
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Immunologic And Biochemical Diagnostics
Serum antibody detection has been used predominantly for the diagnosis of dimorphic fungal infections. Techniques used for antibody detection, include, but are not limited to complement fixation, tube precipitins, and immunoenzyme assays. Variants of these assays may employ immunodiffusion in agar. Tube precipitins antibodies indicate IgM activity, whereas complement-fixing antibodies represent IgG. In general, tube precipitins antibodies are detectable early in illness and, at times during recurrence, but wane quickly while complement-fixing antibodies are usually detectable after 23 weeks of illness and frequently only with more severe disease.16 The complement-fixing antibody titer has prognostic implications, with high titers portending severe or disseminated disease and decreases in titer with recovery from the infection. Testing for antibodies can be complicated in the immunosuppressed patient, depending on the etiology of the immunosuppression and the element of the immune system that is predominantly affected. In the immune compromised host, significant antibody increases simply come too late, if at all, and tests for IgM often remain negative.
Asperigllus Galactomannan Antigen Test
Galactomannan is a polysaccharide cell-wall component of Aspergillus that can be measured in serum and other body fluids to evaluate for evidence of invasive aspergillosis. Approval by the U.S. Food and Drug Administration in 2003 for testing serum to aid in the diagnosis of invasive aspergillosis was based on data in hematopoietic stem cell transplant and leukemia patients, with a reported sensitivity of 81% and a specificity of 89%.30 But as demonstrated in a meta-analysis by Pfeiffer et al31, the serum test has variable results in other populations. A compilation of 27 studies from 1995 to 2005, the meta-analysis found the sensitivity of the assay to be 70% and specificity 92% in patients with hematologic malignancy. In HSCT recipients, sensitivity was 82% and specificity 86%. This is in stark contrast to data from the solid organ transplant population in which sensitivity was only 22% and specificity 84%.
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What Is Being Tested
Fungi are microbes that exist in nature as one-celled yeasts or as branching filamentous molds . Only about 20 to 25 species of fungi are common causes of infection. Fungal tests detect infections and sometimes identify the fungus and help guide treatment.
Fungal infections range from superficial skin infections to serious deep tissue, blood, lung, or systemic diseases.
- Superficial fungal infections are very common. They may cause nail infections or itchy, red, scaly skin infections such as those commonly known as athletes foot, jock itch, and ringworm, or yeast infections that cause white patches in the mouth or vaginal itching and discharge. According to the Centers for Disease Control and Prevention , almost 75% of women will have at least one yeast infection in their lifetime.
- Lung, blood, and systemic infections: less commonly, fungi cause serious lung infections, blood infections , or systemic infections that can affect any organ in the body. Fungal lung infections typically start with the accidental inhalation of microscopic fungal spores. While anyone can get a serious lung or systemic fungal infection, most affected people will only experience mild to moderate flu-like symptoms. However, people who are immunocompromised, such as those with HIV/AIDS, organ transplant recipients, and people with an underlying condition such as diabetes or lung disease are at an increased risk of having a severe fungal infection, a systemic infection, and/or recurrent infections.
Diagnosis And Testing For Aspergillosis
How is aspergillosis diagnosed?
Healthcare providers consider your medical history, risk factors, symptoms, physical examinations, and lab tests when diagnosing aspergillosis. You may need imaging tests such as a chest x-ray or a CT scan of your lungs or other parts of your body depending on the location of the suspected infection. If your healthcare provider suspects that you have an Aspergillus infection in your lungs, he or she might collect a sample of fluid from your respiratory tract to send to a laboratory. Healthcare providers may also perform a tissue biopsy, in which a small sample of affected tissue is analyzed in a laboratory for evidence of Aspergillus under a microscope or in a fungal culture. A blood test can help diagnose invasive aspergillosis early in people who have severely weakened immune systems.
Select regional labs in the AR Lab Network perform screening to monitor and track the emergence of azole-resistant A. fumigatus in the United States. Testing is available to all states. For more information on antifungal resistance, please see CDCs Antifungal Resistance page.
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Who Can Get Fungal Lung Infections
- Generally, healthy people will hardly ever get a fungal lung infection .
- If you have travelled to areas like South America, Central America or Africa where fungi are more common, you could possibly pick up an infection but even that is unlikely if you are normally healthy.
- People with a weakened immune system from other illnesses like HIV, tuberculosis, or cystic fibrosis are those who are most affected by fungal lung infections.
- People who take medications that suppress their immune system, like steroids or immunosuppressants.
How Can Aspergillosis Be Prevented
Due to the prevalence of aspergillus mold in the environment, it is very difficult to avoid exposure. It is best to avoid locations with excessive amounts of dust or mold, such as construction sites or compost piles. People with weakened immune systems or mold allergies should avoid activities such as gardening or lawn mowing. If exposure to airborne dust or mold is likely, considering wearing a face mask or N95 mask. In some cases, your doctor might recommend the use of an antifungal medicine to prevent infection.
Last reviewed by a Cleveland Clinic medical professional on 10/09/2019.
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How Is Aspergillosis Managed
The treatment for aspergillosis depends on the type you have:
- Allergic bronchopulmonary aspergillosis – you may need to take steroid and antifungal medicines for some months. Some patients may be eligible for new monoclonal antibody treatment, only available via respiratory specialists in a hospital.
- Chronic pulmonary aspergillosis this is a long-term infection so you may need long-term treatment with antifungal medicines.
- Acute Invasive pulmonary aspergillus – you will be treated in hospital with antifungal medicines given directly into a vein.
- Aspergilloma if appropriate, you may need to have surgery to remove the ball of mould, often after antifungal therapy.
It is important to get treatment as, without treatment, aspergillosis can progress and cause lung damage.
What Is The Outlook
If you are normally healthy and have caught a fungal infection from travel abroad, then generally the treatments can be very successful. But if you have a weak immune system from another illness then fungal lung infections are usually bad news: they can require long-term specialist treatment, particularly in people with HIV.
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How Are Fungal Lung Infections Diagnosed
The diagnosis will usually be made by a specialist doctor:
- A chest X-ray might show an area of shadowing, caused by the infection.
- Special blood cultures might grow the fungus in the bloodstream.
- A sample of the sputum you have coughed up can be sent to a laboratory for testing.
- Blood tests can sometimes show your immune system fighting off the fungus.
- A small camera put into your lungs can allow a doctor to see the fungus and take a sample to grow in a laboratory.
Fungal Infection In The Lungs: Causes Symptoms And Treatment
The infection in the lungs caused by fungi is known scientifically as aspergillosis. This name is due to the fungus that causes the pathology, which is known as Aspergillus . Due to this alteration, blood clots, white cells and the fiber of the fungus can accumulate in the lungs. Although this fungus appears more frequently in the lung cavities, it can rarely appear in other organs such as the kidneys or the brain, so it must be treated quickly.
As it is a fungus and not a virus or bacteria, the treatment is different and it is important that a specialist find the correct process to eliminate them, so it is essential to carry out a medical consultation. If you dont know much about this disorder, in the following FastlyHealarticle you will find information about fungal infection in the lungs: symptoms .
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