Aspergillosis

Aspergillosis

Q. 1

Aspergillus causes all except ‑

 A

Bronchopulmonary allergy

 B

Otomycosis

 C

Dermatophytosis

 D

 Allergic sinusitis

Q. 1

Aspergillus causes all except ‑

 A

Bronchopulmonary allergy

 B

Otomycosis

 C

Dermatophytosis

 D

 Allergic sinusitis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Dermatophytosis


Q. 2

Aspergilloma has –

 A

Septate hyphae

 B

Pseudohyphae

 C

Metachromatic hyphae

 D

No hyphae

Q. 2

Aspergilloma has –

 A

Septate hyphae

 B

Pseudohyphae

 C

Metachromatic hyphae

 D

No hyphae

Ans. A

Explanation:

Ans. is ‘a’ i.e., Septate hyphae

Aspergillus is a mould with septate branching hyphae.


Q. 3

Best for systemic aspergillosus infection ‑

 A

Ketoconazole

 B

Itraconazole

 C

Fluconazole

 D

Flucytocine

Q. 3

Best for systemic aspergillosus infection ‑

 A

Ketoconazole

 B

Itraconazole

 C

Fluconazole

 D

Flucytocine

Ans. B

Explanation:

Ans is ‘b’ i.e., ltraconazole

o First choice drug for aspergillosis Voriconazole/Amphotericin B

o Second choice drug for aspergillosis —> ltraconazole


Q. 4

Satellite lesions in eye is caused by

 A

Herpes zoster

 B

Herpes simplex

 C

Aspergillosis

 D

Trachoma

Q. 4

Satellite lesions in eye is caused by

 A

Herpes zoster

 B

Herpes simplex

 C

Aspergillosis

 D

Trachoma

Ans. C

Explanation:

C i.e. Aspergillosis


Q. 5

Common causes of otitis externa:

 A

Aspergillus

 B

Mucor

 C

Candida

 D

a and c

Q. 5

Common causes of otitis externa:

 A

Aspergillus

 B

Mucor

 C

Candida

 D

a and c

Ans. D

Explanation:

 

  • Otitis externa is an inflammatory and infectious process of the external auditory canal which is seen in all ages and both sexes.
  • M/C organism causing otitis externa are

Pseudomonas aeruginosa

Staphylococcus aureus

  • Less commonly isolated organisms are ‑
  1. Proteus species
  2. Staphylococcus epidermidis
  3. Diphtheroids
  4. E. coli

Fungal Otitis Externa/Otomycosis

  • In 80% of cases organism is aspergillus
  • 2nd M/C organism is candida

Other more rare fungal pathogens include

  • Phycomycetes
  • Rhizopus
  • Actinomyces
  • Penicillium



Q. 6

Which of the following is the most common etiological agent in paranasal sinus mycoses?

 A

Aspergillus sp

 B

Histoplasma

 C

Conidiobolus coronatus 

 D

Candida albicans

Q. 6

Which of the following is the most common etiological agent in paranasal sinus mycoses?

 A

Aspergillus sp

 B

Histoplasma

 C

Conidiobolus coronatus 

 D

Candida albicans

Ans. A

Explanation:

.

A. fumigatus > A. niger> A. ficivus are the most frequent offenders.



Q. 7

Diagnostic features of allergic bronchopulmonary aspergillosis (ABPA) include all of the following except:

 A

Changing pulmonary infiltrates

 B

Peripheral eosinophilia

 C

Serum precipitins against Aspergillosis fumigants

 D

Occurrence in patients with old cavitatory lesions.

Q. 7

Diagnostic features of allergic bronchopulmonary aspergillosis (ABPA) include all of the following except:

 A

Changing pulmonary infiltrates

 B

Peripheral eosinophilia

 C

Serum precipitins against Aspergillosis fumigants

 D

Occurrence in patients with old cavitatory lesions.

Ans. D

Explanation:

Answer is D (Occurrence in patients with old cavitatory lesions):

Definitive major and minor diagnostic criteria have been. defined for diagnosis of Allergic bronchopuhnonary aspergillosis.

Occurance in patients with old cavitatory lesion is not a part of either of these.

Allergic bronchopulmonary aspergillosis is a pulmonary hypersensitivity disorder caused by allergy to fungal antigens that colonize the tracheobronchial tree.

It most commonly occurs in atopic asthmatic individuals in response to antigen of aspergillus species.

Main diagnostic criteria

  • Clinical history of Asthma Q
  • Pulmonary infiltrates (transient /fleeting or fixed)Q
  • Peripheral eosinophilia (> 1000 /,uL)Q
  • Immediate skin reactivity to Aspergillus antigen (wheal and flare response)
  • Serum precipitins to A. fumigatus
  • Elevated serum IgE levelsQ(>100Ong/ml)
  • Central /proximal bronchiectasisQ

Secondary diagnostic criteria

  • History of brownish plugs in sputum
  • Indentification / culture of A., fumigatus from sputum
  • Late skin reactivity to aspergillus antigen – CMDT
  • Elevated IgE (and IgG) class antibodies specific for A. fumigatus – Harrisons

Note

Elevated IgE (and IgG) class antibodies specific for A. fumigatus has been mentioned as a secondary diagnostic criteria in Harrison’s textbook while Fishman’s textbook includes this as a main/major diagnostic criteria.


Q. 8

Diagnostic criteria for Allergic Bronchopulmonary Aspergillosis include all, except

 A

Peripheral eosinophilia (>0.1 x 109/mm3)

 B

Central bronchiectasis

 C

Episodic Asthma

 D

Detection of Aspergillus in sputum

Q. 8

Diagnostic criteria for Allergic Bronchopulmonary Aspergillosis include all, except

 A

Peripheral eosinophilia (>0.1 x 109/mm3)

 B

Central bronchiectasis

 C

Episodic Asthma

 D

Detection of Aspergillus in sputum

Ans. A

Explanation:

Answer is A (Peripheral eosinophilia (>0.1 x 109/mm3):

Peripheral blood eosinophilia with eo.sinophil count >1000/mm3 is included in the primary diagnostic criteria (and not an eosinophil count > 0.1 x 109/mm3)

Criteria for the Diagnosis of ABPA Primary

Primary

  • Episodic bronchial obstruction (asthma)
  • Peripheral blood eosinophilia (>1000/mm3)
  • Elevated serum IgE concentrations (>100Ong/m1)
  • Immediately type skin reactivity to Aspergillus antigens
  • Precipitating serum antibodies (precipitants) against Aspergillus antigens
  • Elevated serum IgE and/or IgG antibodies specific to A. fumigatus *
  • History of pulmonary infiltrates (transient/fleeting or fixed) on chest radiographs or CT scans
  • Central proximal bronchiectasis on chest CT

Secondary

  • A. fumigatus in sputum (by repeated culture or microscopic examination)
  • History of expectoration of brown plugs or flecks
  • Arthus reactivity (late skin reactivity) to Aspergillus antigen

 

*Elevated IgE (and IgG) class antibodies specific for A. fumigatus has been mentioned as a secondary diagnostic criteria in Harrison’s textbook while Fishman’s textbook includes this as a main/major diagnostic criteria.


Q. 9

All the following are true about bronchopulmonary aspergillosis except:

 A

Central bronchiectasis

 B

Pleural effusion

 C

Asthma

 D

Eosinophilia

Q. 9

All the following are true about bronchopulmonary aspergillosis except:

 A

Central bronchiectasis

 B

Pleural effusion

 C

Asthma

 D

Eosinophilia

Ans. B

Explanation:

Answer is B (Pleural effusion):

Pleural effusion is not seen as part of allergic bronchopulmonary Aspergillosis

  • ABPA occurs in patients with preexisting asthma and cystic fibrosis. – Harrisons
  • ABPA causes intermittent episodes of wheezing, pulmonary infiltrates, sputum and blood eosinophilia, low grade fever and brownish or greenish flecks in the sputum.
  • Patients with repeated exacerbations develop central bronchiectasis and progressive loss of pulmonary function.

Q. 10

Which is not true about aspergillosis-

 A

Aspergillus Niger is the cause of fungal otitis externa

 B

It is highly contagious

 C

Aspergilloma is common in preexisting TB, or cystic disease

 D

Aspergillus fumigatus is a cause of bronchial aspergillosis

Q. 10

Which is not true about aspergillosis-

 A

Aspergillus Niger is the cause of fungal otitis externa

 B

It is highly contagious

 C

Aspergilloma is common in preexisting TB, or cystic disease

 D

Aspergillus fumigatus is a cause of bronchial aspergillosis

Ans. B

Explanation:

Answer is B (It is highly contagious):

Human Aspergillosis mostly results front inhalation of conidia and is not a contagious disease. Person to person transmission does not occur – Current diagnosis and Treatment in Infections Disease

Aspergillosis is not a contagious disease

  • It is not a contagious disease and person to person transmission does not occur
  • Routes of transmission include

– Inhalation of conidia(maj or route)-Environmental Exposure

– Direct inoculation into skin

– Direct inoculation into blood amongst drug abusers

  • Nosocomial infection may occur amongst hospitalized, immunocompromised patients

Aspergillosis is common in preexisting tuberculosis and cystic disease

  • ‘Patient with chronic pulmonary aspergillosis have a wide spectrum of underlying pulmonary disease including tuberculosis and sarcoidosis’ – Harrisons
  • Preexisting cavitatory lesions predispose to the formation of Aspergilloma or fungal ball’ (CIDT)

Aspergillus niger more commonly colonizes the upper respiratory tract and causes otitis externa (Harrison)

  • The most common species of Aspergillosis causing pulmonary infections is Aspergillus Fumigatus.
  • The most common species of Aspergillosis causing otitis externa is Aspergillus niger.

Q. 11

A diabetic with orbital cellulitis and maxillary sinusitis shows hyaline, narrow, septate and ranching hyphae with invasion of the blood vessels fungus on microscopy. Which is the causative fungus ?

 A

Candida

 B

Rhizospora

 C

Aspergillus

 D

Histoplasma

Q. 11

A diabetic with orbital cellulitis and maxillary sinusitis shows hyaline, narrow, septate and ranching hyphae with invasion of the blood vessels fungus on microscopy. Which is the causative fungus ?

 A

Candida

 B

Rhizospora

 C

Aspergillus

 D

Histoplasma

Ans. C

Explanation:

Ans. is ‘c’ i.e., Aspergillus

Diagnosis of Aspergillus infection:

Histologic examination of affected tissue reveals either infarction, with invasion of blood vessels by many fungal hyphae, or acute necrosis, with limited inflammation and hyphae.

Aspergillus hyphae are hyaline, narrow, and septate, with branching at 45°; no yeast forms are present in infected tissue.

Hyphae can be seen in cytology or microscopy preparations, which therefore provide a rapid means of presumptive diagnosis.


Q. 12

40 year old patient with history of prolonged exposure to Aspergillus presents with repeated episodes of breathlessness.CT Chest represent the following as shown below.Skin hypersensitivity test is positive for Aspergillus antigen Peripheral blood picture shows normal eosinophil count and serum IgE levels are normal The most likely diagnosis is ? 

 A

Allergic bronchial Asthma.


 B

Allergic Bronchopulmonary Aspergillosis (ABPA).

 C

Extrinsic Allergic Alveolitis.

 D

Invasive Pulmonary Aspergillosis.

Q. 12

40 year old patient with history of prolonged exposure to Aspergillus presents with repeated episodes of breathlessness.CT Chest represent the following as shown below.Skin hypersensitivity test is positive for Aspergillus antigen Peripheral blood picture shows normal eosinophil count and serum IgE levels are normal The most likely diagnosis is ? 

 A

Allergic bronchial Asthma.


 B

Allergic Bronchopulmonary Aspergillosis (ABPA).

 C

Extrinsic Allergic Alveolitis.

 D

Invasive Pulmonary Aspergillosis.

Ans. C

Explanation:

CT Chest as shown above with normal levels of IgE and absence of peripheral eosinophilia is characteristic of Extrinsic Allergic Alveolitis.

Hypersensitivity Reaction to Aspergillus

Hypersensitivity Lung diseases that result from exposure to A. Fumigatus allergens include Bronchial Asthma, ABPA and Extrinsic Allergic Alveolitis (Hypersensitivity Pneumonitis)

In Atopic Individual

Allergic Bronchial Asthma and ABPA

Allergic Bronchial Asthma and ABPA are seen in atopic individuals and immune response is IgE mediate.

In Non atopic Individuals

Extrinsic Allergic Alveolitis (Hypersensitivity penumonitis)

Extrinsic Allergic Alveolitis or Hypersensitivity penumonitis is seen in non atopic individuals and immune response is not IgE mediated.

Immune response may involve cell mediated (type IV) or immune complex (Type III) reactions.


Q. 13

Histopatholoical examination of lung is shown in the image.What can be the most probable diagnosis?

 A

Aspergillosis

 B

Candidiasis

 C

Mucormycosis

 D

Histoplasmosis

Q. 13

Histopatholoical examination of lung is shown in the image.What can be the most probable diagnosis?

 A

Aspergillosis

 B

Candidiasis

 C

Mucormycosis

 D

Histoplasmosis

Ans. A

Explanation:

Ans:Aspergillosis.

Image shows: Acute angled septate hyphae lying in necrotic debris and acute inflammatory exudates in lung.

FUNGAL INFECTIONS OF LUNG

1. Aspergillosis.

  • Aspergillosis is the most common fungal infection of the lung caused by Aspergillus fumigatus that grows best in cool, wet climate.
  • The infection may result in allergic bronchopulmonary aspergillosis, aspergilloma and necrotising bronchitis.
  • Grossly, pulmonary aspergillosis may occur within preexisting pulmonary cavities or in bronchiectasis as fungal ball.
  • Microscopically, the fungus may appear as a tangled mass within the cavity.
  • The organisms are identified by their characteristic morphology— thin septate hyphae with dichotomous branching at acute angles which stain positive for fungal stains such as PAS and silver impregnation technique.
  • The wall of the cavity shows chronic inflammatory cells.

2. Mucormycosis.

  • Mucormycosis or phycomycosis is caused by Mucor and Rhizopus.
  • The pulmonary lesions are especially common in patients of diabetic ketoacidosis.
  • Mucor is distinguished by its broad, non-parallel, nonseptate hyphae which branch at an obtuse angle. Mucormycosis is more often angioinvasive, and disseminates; hence it is more destructive than aspergillosis.

3. Candidiasis.

  • Candidiasis or moniliasis caused by Candida albicans is a normal commensal in oral cavity, gut and vagina but attains pathologic form in immunocompromised host. Angioinvasive growth of the organism may occur in the airways.

4. Histoplasmosis.

  • It is caused by oval organism, Histoplasma capsulatum, by inhalation of infected dust or bird droppings.
  • The condition may remain asymptomatic or may produce lesions similar to the Ghon’s complex.

5. Cryptococcosis.

  • It is caused by Cryptococcus neoformans which is round yeast having a halo around it due to shrinkage in tissue sections. The infection occurs from infection by inhalation of pigeon droppings. The lesions in the body may range from a small parenchymal granuloma in the lung to cryptococcal meningitis.

6. Coccidioidomycosis.

  • Coccidioidomycosis is caused by Coccidioides immitis which are spherical spores. The infection in human beings is acquired by close contact with infected dogs. The lesions consist of peripheral parenchymal granuloma in the lung.

7. Blastomycosis.

  • It is an uncommon condition caused by Blastomyces dermatitidis. The lesions result from inhalation of spores in the ground. Pathological features may present as Ghon’s complex-like lesion, as a pneumonic consolidation, and as multiple skin nodules.

Q. 14

The fungus with septate hyphae and dichotomous branching is ‑

 A

Aspergillus

 B

Penicillium

 C

Mucor

 D

Rhizopus

Q. 14

The fungus with septate hyphae and dichotomous branching is ‑

 A

Aspergillus

 B

Penicillium

 C

Mucor

 D

Rhizopus

Ans. A

Explanation:

Ans. is ‘a’ i.e., Aspergillus 


Q. 15

Most common cause of otomycosis ‑

 A

Histoplasma

 B

Rhinosporidium

 C

Aspergillus

 D

Actinomyces

Q. 15

Most common cause of otomycosis ‑

 A

Histoplasma

 B

Rhinosporidium

 C

Aspergillus

 D

Actinomyces

Ans. C

Explanation:

Ans. is ‘c’ i.e., Aspergillus

Otomycosis

  • Otomycosis, also called acute fungal otitis externa, describes a fungal or yeast infection of the external auditory meatus.
  • Saprophytic fungi potentially residing in the ear canal include Aspergillus, Candida albicans, Phycomycetes, Rhizopus, Actinomyces, and Penicillium.
  • Under certain conditions of increased heat, humidity, glucose concentration (diabetes), immunosuppression, or overuse of systemic or topical antibiotics and steroids, these saprophytic fungi can become pathogenic.
  • Aspergillus niger accounts for 90% of otomycosis infections.
  • Other common organisms are candida albicans (2″a most common) and Aspergillus fumigatus.
  • Less common organisms are Phycomycetes, Rhizopus, Actinomyces and Penicillium

Q. 16

Most common cause of fungal sinusits ‑

 A

Aspergillus fumigatus

 B

Aspergillus niger

 C

Aspergillus flavus

 D

Candida

Q. 16

Most common cause of fungal sinusits ‑

 A

Aspergillus fumigatus

 B

Aspergillus niger

 C

Aspergillus flavus

 D

Candida

Ans. A

Explanation:

Ans. is ‘a’ i.e., Aspergillus fumigatus 

Fungal sinusitis

  • The sinuses are moist dark cavities and are a natural home to the invading fungi. When this occurs, fungal sinusitis results. Most common fungal infection of paranasal sinus is Aspergillus (A fumigatus > A niger > A flavus). Other offending fungi are Alternaria, Mucor and Rhizopus.
  • Types of fungal sinusitis
  • There are four types of fungal sinusitis :‑

1.  Mycetoma fungal sinusitis (fungal ball) :- Produces clumps of spores, a “fungal ball”, within a sinus cavity, most frequently in maxillary sinus. The patient maintains an effective immune system. The non-invasive nature of this disorder requires a treatment consisting of simple scraping of infected sinus. An anti fungal therapy is generally not prescribed.

2.  Allergic fungal sinusitis (AFS) :- It is a non-invasive condition which is believed to be an allergic reaction to the environmental fungi that is finely dispersed into the air. Patient is usually immunocompetent with normal immune system. Treatment consists of endoscopic surgical clearance of the sinus along with pre-and post­operative systemic steroids. Anti-inflammatory medical therapy and immunotherapy are typically prescribed to prevent recurrence.

3.  Chronic indolent invasive sinusitis :- It is an invasive form of fungal sinusitis in immunocompetant patients. This is characterized by a granulomatous inflammatory infiltrates. Treatment consists of surgical removal of the involved mucosa, bone and soft tissue followed by iv amphotericin B.

4.  Acute fulminant sinusitis :- It is usually seen in the immunocompromized patients. This disease leads to progressive destruction of the sinuses and can invade the bony cavities containing the eyeball and brain. Treatment is similar as for chronic indolent invasive sinusitis i.e. surgical removal followed by systemic antifungal.



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