Aspergillosis

Aspergillosis is a large spectrum of fungi infection diseases caused by members of the genus Aspergillus. The three principal entities are: allergic bronchopulmonary aspergillosis, pulmonary aspergilloma and invasive aspergillosis. Colonization of the respiratory tract is also common. The clinical manifestation and severity of the disease depends upon the immunologic state of the patient. Lowered host resistance due to such factors as underlying debilitating disease, neutropenia chemotherapy, disruption of normal flora, and an inflammatory response due to the use of antimicrobial agents and steroids can predispose the patient to colonization, invasive disease, or both. Aspergillus spp. are frequently secondary opportunistic pathogens in patients with bronchiectasis, carcinoma, other mycoses, sarcoid, and tuberculosis.

Aspergillosis also dangerous for our livestock. At 1960 in England happened the epidemic which caused big loss at turkey ranch over there. With study known the the epidemic caused of existence of mikotoksin at feed livestock yielded by mushroom of Aspergillus flavus. Start the moment that's emerging various research of concerning the micotoxin. At 1972 Wookey find in New Guinea of feed substance which is a lot of contaminated by aflatoxin are peanut, sorgum,dan maize with the rate until 500 ppb.In Thailand in the year 1982 found the fact that peanut and maize over there a lot of impure of aflatoxin that is each 77% and 60% with the rate 12,5 - 20 ppb Shotwell and Hasseltine 1983 in Virginia there are 25% impure maize of aflatoxin with the rate 21 - 137 ppb. Culvenor 1974 said expressing peaceful aflatoxin for chicken with the maximal rate 200 ppb, for human being maximal peaceful rate 30 ppb. Pursuant to various research of other;dissimilar contamination rate very depend on climate and weather; in moment of rain season contaminat rate can 2-3 times in drought season.

Forms of the disease Sites
Colonization, allergic bronchopulmonary aspergillosis and toxicoses involved sinuses, lungs
Pulmonary aspergilloma involved Pre-existing lung cavity

Invasive aspergillosis

Pulmonary aspergillosis, CNS aspergillosis, Sinonasal aspergillosis, Osteomyelitis Endophthalmitis, Endocarditis, Renal abscesses, Cutaneous (burns, post surgical wounds, IV insertion sites, etc).

Others : Otomycosis, Exogenous endophthalmitis, Allergic fungal sinusitis and Urinary tract fungus balls

Change of patologis organ for example hiperplasia bile tract, vacuoliszation of hepar cell, megalositosis, fibrosis at hepar tissue

Prognosis
Prognosis depends upon the type and severity of disease as well as the immunological status of the patient. Allergic aspergillosis is typically a chronic entity, but evolves from episodes of acute corticosteroid-responsive asthma to fibrotic end-stage lung disease. Allergic aspergillosis has been successfully treated with corticosteroids, and intraconazole. The prolonged use of steroids in cases of chronic aspergillosis should be approached with caution.
Treatment TheraphyAspergillomas may be treated by surgical resection. However, this approach may cause significant morbidity and mortality, therefore it should be reserved for patients at high risk to develop severe hemoptysis.Invasive aspergillosis may be treated with voriconazole, amphotericin B (deoxycholate and lipid preparations), and itraconazole. The ability of voriconazole to effectively treat invasive aspergillosis and to reduce associated mortality was recently demonstrated by a large well-conducted randomized trial and is particulary noteworthy. A large number of new investigational drugs (posaconazole, ravuconazole, caspofungin, FK463, and anidulafungin (LY303366)) have activity against Aspergillus spp. and are being extensively evaluated. Caspofungin was also recently licensed in the United States for treatment of invasive aspergillosis in patients who are refractory to, or intolerant of other therapies (i.e., amphotericin B, lipid formulations of amphotericin B, and/or itraconazole). However, despite these advances in therapy, the invasive forms of aspergillosis are often associated with significant morbidity and mortality.Selection of therapy also needs to consider the certainty of the diagnosis. Voriconazole, itraconazole, the investigational azoles with anti-mould activity, and amphotericin B all possess a reasonably broad-spectrum of activity against Aspergillus and the related hyaline moulds. Their activity does, however, vary for the agents of zygomycosis, with posaconazole being the azole with the most reliable activity against this class of fungi. The echinocandin glucan synthesis inhibitors (caspofungin, FK463, and anidulafungin) possess a narrower spectrum of activity and should only be used if the infection is known to be due to Aspergillus spp. Usage of hydrated of sodium of calcium alumunium silicate can prevent the absorbtion aflatoxin in digestion and degrade negativity effect.