zoonoses and communicable diseases common to ... - PAHO/WHO

ASPERGILLOSIS 307chitis, bronchiectasis, tuberculosis). This form is relatively benign, but it occasionallyproduces hemoptysis.Other clinical forms are otomycosis (often caused by A. niger) and invasion of theparanasal sinuses by the fungus. Though rare, the cutaneous form of the disease mayappear in immunodeficient patients.The invasive form is usually very serious. The fungi penetrate the blood vesselsand can spread throughout the body. Cases of pulmonary aspergillosis have alsobeen described in patients who are not immunodeficient. There is general insistencethat the invasive form of the disease occurs only in patients with neutropenia.Neutrophil polymorphonuclear leukocytes are very important in the defense againstaspergillosis or in those who have serious defects in cell-mediated immunity (Karamand Griffin, 1986). Karam and Griffin describe three cases over five years in a universityhospital and cite 32 cases found in the literature. Of the 32 cases cited, 14had no underlying disease.Surgical intervention in the case of pulmonary or pleuropulmonary aspergillosismay be indicated to treat pleural empyemas and bronchopleural fistulae. In thesecases, myoplasty, thoracomyoplasty, and omentoplasty are the procedures most recommended(Wex et al., 1993). Surgical removal is also justified in the case of invasiveaspergillosis in the brain and paranasal sinuses, as well as in noninvasive colonizationof the paranasal sinuses (Bennett, 1990). When colonization is invasive, itis advisable to discontinue or reduce the use of immunosuppressants and to starttreatment with intravenous amphotericin B or itraconazole.Several small outbreaks have occurred during the renovation, expansion, orremodeling of hospitals and the construction of highways near hospitals. Duringthese projects, large numbers of conidia are made airborne, and may become concentrateddue to ventilation systems with defective filters. Between July 1981 andJuly 1988, 11 immunodeficient patients in a military hospital contracted disseminatedaspergillosis and died as a result. The hospital’s project involved the renovationof the intensive care unit and several other rooms. The infection spread no furtherafter several simultaneous measures were taken, such as installingfloor-to-ceiling partitions in the construction area, negative pressure in the samearea, antifungal decontamination using copper 8-hydroxyquinoline, and high-efficiencyparticulate air (HEPA) filters in air conditioning units and in rooms withimmunodeficient patients (Opal et al., 1986). However, a certain percentage ofpatients with lymphoma who received bone marrow transplants and were located insingle-occupancy rooms with positive air pressure and high efficiency air filters didacquire aspergillosis. Of 417 lymphoma patients studied, 22 (5.2%) contracted invasiveaspergillosis. These 22 patients were treated with amphotericin B, 17 of themprior to being diagnosed with aspergillosis; seven survived. All of the patients withdisseminated aspergillosis died (Iwen et al., 1993).The Disease in Animals: Although aspergillosis occurs sporadically in manyanimal species, where it primarily causes respiratory system disorders, the followingdiscussion only deals with the disease in cattle, horses, dogs, and fowl.CATTLE: It is estimated that 75% of mycotic abortions are due to Aspergillus, particularlyA. fumigatus, and 10% to 15% to fungi of the order Mucorales. As brucellosis,campylobacteriosis, and trichomoniasis are brought under control, the relativerole of fungi as a cause of abortions increases. Mycotic abortion is seen mainly in