ABPA - Allergic Broncho-Pulmonary Aspergillosis

Allergic broncho-pulmonary aspergillosis chirwere chinoita kuti murwere atange kusawirirana nespores (conidia) Aspergillus molds. ABPA inonyanya kuwanikwa muvarwere vane asthma, kunyange izvi zvisiri izvo nguva dzose. Zvisinei, mamiriro acho anogonawo kukanganisa avo vane cystic fibrosis uye bronchiectasis. 

Muvanhu vane immune system inoshanda zvizere uye mapapu ane hutano, iyo inhaled spores inokurumidza kucheneswa kubva mumhepo. Munyaya yeABPA, chirwere chinotanga nekuti fungal spores haina kunyatso kucheneswa. Iyo spores pachayo haishande uye haikonzeri chirwere ipapo. Nekudaro, kana dzisina kubviswa kubva mumuviri dzine nguva yekushanda, kuzvimba uye kugadzira tambo refu-senge zvimiro zvinonzi hyphae izvo zvinoburitsa muchetura unokuvadza. Izvi zvinokonzeresa kuwanda kwekuzvimba immune system inokonzeresa zviratidzo.

Hapasati pasati pave nemushonga wakakwana weABPA, saka inotungamirwa uchishandisa steroids uye antifungals kuitira kudzivirira chero kukuvara kwemapapu kunoitika. Fungi inogara mumapapu uye inokura munzvimbo dzemhepo mukati memukati. Iyo fungus haipindi munyama yemapapu pachayo (iri kwete-invasive) asi inoisa tsime rekusingaperi rekushatirwa uye kusawirirana.

Vanorwara neABPA vanowana chero kupi kwakawedzera mwero wemold spores inogona kukonzeresa kusagadzikana kweasthmatic - semuenzaniso mirwi yemacompost, zvivakwa zvakanyorova uye kunyangwe mweya wekunze mune dzimwe nzvimbo dzimwe nguva dzegore. Kudzivisa kunyanya kuratidzwa - kugara mumba kana kushandisa N95/FFP2 facemask zvinogona kukurudzirwa kana iri dambudziko kwauri.

CT scan ye thorax yemurwere ane yakanyanya ABPA. Yakatorwa kubva ku aspergillus.org

CT scan ye thorax yemurwere ane yakanyanya ABPA. Yakatorwa kubva ku aspergillus.org

kuongorora chirwere

8 maitiro eABPA akatanga kutsanangurwa muna 1977 uye achiri kushandiswa zvakanyanya nhasi mukuongorora ABPA. Aya maitiro ndeaya:

  • Episodic wheezing (asthma)
  • Eosinophilia (kuwedzera kwenhamba yemamwe masero machena eropa anorwisa zvirwere)
  • Pakarepo ganda bvunzo reactivity kuti Aspergillus maantigen
  • Precipitating (IgG) masoja ekudzivirira chirwere Aspergillus
  • Yakakwira yakazara IgE
  • Yakakwidziridzwa Aspergillus-specific IgE
  • Central bronchiectasis (kuwedzera kwemhepo)
  • Nhoroondo yepulmonary infiltrates (inoonekwa paX-ray)

Kana murwere aine ese masere ari pamusoro, kuongororwa ndeyechokwadi.
Kana murwere aine manomwe, kuongororwa kweABPA kunowanzoitika.

Kana murwere aine asima, eosinophilia uye nhoroondo yekupinza saka ABPA inofanirwa kutariswa sezvinobvira uye mimwe miedzo inogona kuitwa kuedza kusimbisa.

Kana murwere aine asingasviki manomwe ekuongororwa ari pamusoro anova asina chokwadi. Kana mhinduro yekukurumidza ichidiwa kana kudiwa uye kana hutano hwemurwere huchibvumira ipapo biopsy inopa nzira yakanaka kwazvo yekusarudza kuongororwa.

Kuongororwa kweCystic Fibrosis kwakasiyana zvishoma.

Mitsva yekuongorora maitiro

Nepo nzira idzi dzakabatsira mukuratidza ABPA, boka rinoshanda renyanzvi - International Society for Human and Animal Mycology (ISHAM), yakaongorora zvinyorwa uye muna 2013 yakaronga nzira itsva dzekuongorora uye kurongedza izvo zvine chinangwa chekuvandudza chokwadi mukuongorora ABPA.

Iyo ichangobva kuvandudzwa ISHAM yekuongorora maitiro ndeaya anotevera:

Predisposing conditions:

  • Bronchial asima
  • Cystic Fibrosis

Zvinosungirwa maitiro (ese ari maviri anofanirwa kunge aripo):

  • Positive type I ganda test to Aspergillus maantigen or yakakwirira A.fumigatus chaiwo IgE mazinga
  • Yakakwira yakazara IgE mazinga (anopfuura 1000 IU/mL)

Zviviri kubva muzvitatu zvezvinotevera zvinofanirwa kuve zviripo:

  • Serum inokonzeresa IgG masoja ekudzivirira chirwere Aspergillus fumigatus
  • Radiographic pulmonary opacities inoenderana neABPA
  • Yese eosinophil inoverengera pamusoro pe500 masero / µL mune steroid naïve varwere

Kunyangwe pasina chiyero chakajeka chegoridhe maererano nekuongororwa, zvidzidzo zvinoratidza kuti maitiro aya anoita seakanyanya kurongeka mukuongorora ABPA pane yekutanga maitiro.

Dzvanya iyi link kuti uverenge yakazara ISHAM wongororo - https://bit.ly/3q1rhFX

Staging

Makore mashoma mushure meiyo yekutanga nzira yekuongorora yakatsanangurwa, nhanho dzeABPA dzakakurudzirwawo. Aya aive 1) acute, 2) kuregererwa, 3) kuwedzera, 4) corticosteroid-inotsamira asima uye 5) fibrotic chirwere chemapapu.

ISHAM boka rinoshanda rakashanyirazve nhanho dze5 dzeABPA kutsanangura matanho zvakajeka. Vakaunza danho rezero rinotsanangura murwere ane asthma inodzorwa ari asymptomatic yeABPA asi anowanikwa achizadzisa maitiro ekuongorora pakuferefetwa. Boka reISHAM rinokurudzira kuti kugara uchiongorora asthmatic yeABPA kwaizobatsira mukutanga kuongororwa. Iwo matanho matsva akatsanangurwa se 0) asymptomatic, 1) acute, 2) mhinduro, 3) kuwedzera, 4) kuregererwa 5) yakaoma kudzora ABPA / asima uye 6) yepamusoro.

Zvimwe wakaudzwa kuti ABPA yako iri pane imwe nhanho uye hauzive kuti izvi zvinorevei, kuti uone tsananguro dzechikamu chimwe nechimwe tarisa patafura iri pazasi;

Stage tsananguro Features
0 Asymptomatic Inodzorwa asima, asymptomatic ABPA
1 Acute Acute kune subacute zviratidzo zveABPA
1a Ne mucoid impaction Yakanyorwa mucoid impaction pachipfuva radiograph, CT kana bronchoscopy
1b Pasina mucoid impaction Hapana yakanyorwa mucoid impaction pachipfuva radiograph, CT kana bronchoscopy
2 Response Nekurapwa kune kuvandudzwa kwezviratidzo, kubviswa kweradiographic opacities uye kuderera kwe25% muIgE nemavhiki masere.
3 Kuwedzera Kuwedzera kwechirwere (kuwedzera kwemazinga eIgE ne50%, kuwedzera kwekliniki), zvichida kune varwere vane aspergilloma kana HAM (high-attenuation mucus)
4 Kuregererwa Hapana kuwedzera kweABPA pamusoro pemwedzi mitanhatu mushure mekumisa kurapwa, mazinga eIgE akayera mwedzi yese ye6-3 kwegore rekutanga uyezve pagore asi anoramba akakwira kupfuura akajairwa.
5 Zvakaoma kudzora ABPA/asthma  
5a Kurapa-kunoenderana Murwere anoda akadzokororwa makosi e steroid kana azoles ekudzora ABPA
5b Glucocorticoid-inotsamira Murwere anoda glucocorticoids yekudzora asima
6 enderera Yakapararira bronchiectasis uye/kana fibrosis ine mhando II kutadza kufema uye/kana cor pulmonale (mamiriro ezvinhu anoita kuti rutivi rworudyi rwemwoyo rukundikane)

Genetics

Zvimwe zvidzidzo zvinoratidza kuti panogona kunge paine genetic risk factor yeABPA, kunyangwe zviitiko zveABPA muhama kana vana vevabereki vane ABPA hazviwanzo. Poshi kudzidza inoshuma kubatana kwemhuri kwe5% (iyo yakati wandei) asi chidzidzo ichi chakavakirwa kuIndia uko aspergillosis inozivikanwa kuva yakawanda nekuda kwenharaunda. Zvinonyatsozivikanwa kuti asthma inomhanya mumhuri uye asthma inogona kunge iri pre-kurasa mamiriro eABPA, asi pane inofungidzirwa kuti kune imwezve genetic njodzi inodiwa kukonzera ABPA nekuti havasi vese vane asthmatics vanokura ABPA kunyangwe ichiiswa munzvimbo imwechete neiyo. izvo zvinoita, zvichireva kuti pane genetic element inobatanidzwa zvakare.

Zvidzidzo zvinoratidza kuti kune mamwe majini chaiwo, anonyanya kuenderana nemasero emasoja emuviri, anowanzo kukanganiswa muvarwere veABPA zvichienzaniswa nevanhu vasina ABPA. Rimwe jini rakadaro ndereiyo macode emorekuru anonzi major histocompatibility complex (MHC) II. Iyi molecule inopa maantigen (akadai se Aspergillus maantigen) pamusoro payo kuitira kuti mamwe masero edziviriro anogona kuvaparadza. Kana jini iri rikashandurwa saka maantigen haaunzwa kune mamwe maseru edziviriro uye haaparadzwe zvinobudirira. Nekuda kweizvozvo, panogona kuve nenjodzi yekugarwa nhaka kana kuchinja kwemajini aya kwakapfuudzwa, asi kumwe kutsvagisa kunodiwa munzvimbo iyi kuti uone kuti njodzi iyi inosanganisirei uye kuti yakakura sei njodzi.

Kana iwe uchida kuziva zvimwe, chidzidzo ichi chinopa muchidimbu zvimwe zvemajini zvinosanganisirwa muABPA - https://bit.ly/2ZNawmO

Pakupedzisira, kana uine ABPA haufaniri kunetseka nezvemhuri yako sezvo njodzi yekugara nhaka yechirwere ichi yakaderera zvikuru.

mabatiro

Kurapa kunosanganisira kushandiswa kwenguva refu kwesteroids (semuenzaniso kuuchi) kuderedza kuzvimba uye kukuvara kwemapapu. Kune akati wandei anogona kuomerwa nekushandiswa kwe steroid mishonga kwenguva refu asi kushandiswa kwavo kwakakosha kudzivirira chirwere ichi.

Tinogona kazhinji kuderedza huwandu hwema steroid anotorwa nevarwere veABPA nekupa murwere mushonga weantifungal senge itraconazole (semuenzaniso. Sporanox, asi ikozvino kune akati wandei mazita emhando). Izvi zvinoratidzika kuchengetedza zviratidzo pasi pesimba uye vamwe vanhu vanogona kurega kutora steroid zvachose kwenguva.

Imwe nzira yekudzikisa kudiwa kwe steroid ndeye kuderedza kuzvimba kuburikidza nedzimwe nzira. A biologic Mushonga unogona kubatsira kuvarwere vanga vachitora kurapwa uye vasati vaona kuvandudzwa kwehutano hwavo, kana kuona kuramba kuchiipa. Kune varwere vane ABPA, omalizumab inogona kupihwa. Mushonga uyu unoshanda nekuvharisa IgE, antibody inogadzirwa ne immune system inokonzera kuzvimba uye inokonzeresa mamwe maseru edziviriro kuburitsa makemikari akadai histamine. Varwere vane ABPA vane IgE yakawandisa uye kuzvimba kwenzira dzemhepo kunotevera. Mushonga uyu unoderedza mazinga eIgE uye nekudaro unogona kurerutsa kuzvimba uye zviratidzo zveasthmatic.

Zvinozivikanwa kuti vazhinji vane asthmatics vane fungal senitivity, chikamu cheava vane ABPA, vamwe vangangove vasina kuzivikanwa. Huwandu hweavo vakaonekwa vaine asthma yakanyanya uye vakapinzwa muchipatara huri kuramba huchikura.

Vechidiki vane Cystic Fibrosis vanowanzotamburawo neABPA, zvichiisa mamwe matambudziko mukurapwa kwavo.

Prognosis

Ikozvino hakuna mushonga weABPA, asi manejimendi ekuzvimba uye mavanga uchishandisa itraconazole uye steroid inowanzobudirira mukudzikamisa zviratidzo kwemakore mazhinji.

ABPA haigone kufambira mberi kusvika CPA.

Ichi chirwere 'chidiki' (chakatanga kushumwa muna 1952) chine nguva yakareba yehutachiona saka zvinotora nguva kuti mhedzisiro yenguva refu yekuvandudzwa kwekuchengetedza kuve pachena. Kuzivikanwa kwechinhu chefungal mune mamwe akanyanya asthmas anoratidza kuti ABPA inogona kunge yakanyanya kufanana yaifungidzirwa. ABPA iri kutanga kurasikirwa nechimiro chayo chechirwere chisingawanzo uye chisina kujairika uye netarisiro izvo zvinozotungamira mukuwedzera kuziva uye nekuvandudza manejimendi echirwere.

Zvimwe Zvinyorwa

 
Yakagadziridzwa naKaty McGuinness - Mbudzi 2021

Yakapedzisira Kuvandudzwa munaNovember 3, 2021 na Katy McGuinness