Fungi is one of the most fascinating organisms on this planet. They quietly reside in the darkest place, humbly work on the dead materials, provide the essentials for many giant beautiful plants. Apart from symbiosis with Kingdom of Plants, residents of Kingdom of Fungi also work closely with the human beings. They provide fertilisers, antibiotics and most importantly, FOOD. From core ingredients of beers to expensive luxurious truffles, most fungi are absolutely our good friends. Without fungi the ecosystem is not complete. Without fungi this cache cannot be reached.
However, not all fungi are so benign. Some of them catch you when you’re at your weakest moment. They look for the dead tissue in your body, carefully hide themselves away from your army of immunity and start to digest your cells for their own good. Scary enough? Don’t worry. If you know your enemy, you will know how to fight it.
So now it’s the fungal challenge. Solve the puzzles, get the coordinates and grab the joy of being part of the Kingdom of Fungi! There are many different types of fungi on our planet, mostly classified as mold, yeast, or dimorphic (having two forms) ones. Read the following article on a particular fungus called Aspergillus carefully and you will know what to do next.
Aspergillus is a genus consisting of several hundred molds species found in various climates worldwide.
Aspergillosis is the group of diseases caused by Aspergillus. The most common subtype among paranasal sinus infections associated with aspergillosis is A. fumigatus. The symptoms include fever, cough, chest pain, or breathlessness, which also occur in many other illnesses, so diagnosis can be difficult. Usually, only patients with already weakened immune systems or who suffer other lung conditions are susceptible.
In humans, the major forms of disease are:
• Allergic bronchopulmonary aspergillosis, which affects patients with respiratory diseases such as asthma, cystic fibrosis, and sinusitis
• Acute invasive aspergillosis, a form that grows into surrounding tissue, more common in those with weakened immune systems such as AIDS or chemotherapy patients
• Disseminated invasive aspergillosis, an infection spread widely through the body
• Aspergilloma, a "fungus ball" that can form within cavities such as the lung
Symptoms
A fungus ball in the lungs may cause no symptoms and may be discovered only with a chest X-ray, or it may cause repeated coughing up of blood, chest pain, and occasionally severe, even fatal, bleeding. A rapidly invasive Aspergillus infection in the lungs often causes cough, fever, chest pain, and difficulty breathing.
Poorly controlled aspergillosis can disseminate through the blood stream to cause widespread organ damage. Symptoms include fever, chills, shock, delirium, seizures and blood clots. The person may develop kidney failure, liver failure (causing jaundice), and breathing difficulties. Death can occur quickly.
Aspergillosis of the ear canal causes itching and occasionally pain. Fluid draining overnight from the ear may leave a stain on the pillow. Aspergillosis of the sinuses causes a feeling of congestion and sometimes pain or discharge. It can extend beyond the sinuses.
In addition to the symptoms, an X-ray or computerised tomography (CT) scan of the infected area provides clues for making the diagnosis. Whenever possible, a doctor sends a sample of infected material to a laboratory to confirm identification of the fungus.
Diagnosis
On chest X-ray and CT, pulmonary aspergillosis classically manifests as a halo sign, and, later, an air crescent sign. In hematologic patients with invasive aspergillosis, the galactomannan test can make the diagnosis in a noninvasive way. False positive Aspergillus Galactomannan test have been found in patients on intravenous treatment with some antibiotics or fluids containing gluconate or citric acid such as some transfusion platelets, parenteral nutrition or PlasmaLyte
On microscopy, Aspergillus species are reliably demonstrated by silver stains, e.g., Gridley stain or Gomori methenamine-silver. These give the fungal walls a gray-black colour. The hyphae of Aspergillus species range in diameter from 2.5 to 4.5 µm. They have septate hyphae, but these are not always apparent, and in such cases they may be mistaken for Zygomycota. Aspergillus hyphae tend to have dichotomous branching that is progressive and primarily at acute angles of about 45°.
Treatment
The current medical treatments for aggressive invasive Aspergillosis include voriconazole and liposomal amphotericin B (but it’s hell expensive!!) in combination with surgical debridement. For the less aggressive allergic bronchopulmonary aspergillosis findings suggest the use of oral steroids for a prolonged period of time, preferably for 6–9 months in allergic aspergillosis of the lungs. Itraconazole is given with the steroids, as it is considered to have a "steroid sparing" effect, causing the steroids to be more effective, allowing a lower dose.
Other drugs used, such as amphotericin B, caspofungin (in combination therapy only), flucytosine (in combination therapy only), or itraconazole, are used to treat this fungal infection. However, a growing proportion of infections are resistant to the triconazoles.
No clues? No worries, answer following questions and check your solution. You will be on your way to the fungi world.
1. How long do we use oral steroid minimally as part of the treatment of ABPA? (A)
2. At what degree do aspergillus hyphae usually branch? (BC)
3. What would you give your patient if you come across with a case of invasive aspergillosis? (DE)
4. What shouldn’t be used as diagnostic tool for suspected aspergillosis if the patient has frequent platelet transfusion? (DF)
Final coordinates: N 22 22.A(Bx2)F E 114 (DE).0(C+F)F
Source: Wikipedia