CPA - Chronic Pulmonary Aspergillosis

Chronic pulmonary aspergillosis inguva refu Aspergillus utachiona hwemapapu; Aspergillus fumigatus ndiyo inenge nguva dzose rudzi runokonzera. Vanorwara neCPA vane immune immune system iyo, mumamiriro ezvinhu akajairwa, inopedza hutachiona zvachose. Nekuda kweizvozvo fungus haigone kukurumidza kupinda murwere, asi inokwanisa kugara munzvimbo dzemuviri kwainogona kuwana toehold.

Nzvimbo dzakakodzera dzemuviri kune hutachiona ndiyo iyo fungus yakatanga kukwanisa kuwana; nzira dzemhepo kana sinuses zvinowanzoitika, sezvo fungal spores inofamba zvakanaka mumhepo. Chechipiri, inoda kunzvenga immune system, saka inowanzogara mumakomba uko kune kushomeka kwekubatana ne immune system - seyakakuvadzwa matishu emapapu akasiiwa neTB kana hutachiona hwakafanana. Marara akasiiwa neutachiona hwepakutanga anopa 'toehold' inodiwa nefungus.

Kana yangosimbiswa, fungus inogona kukura zvishoma nezvishoma, ichiganhurwa nenyama yakatenderedza gomba (uko immune system yemurwere inogona kuramba ichirwisa hutachiona). Inogona kuvanda yakavanzwa kwemakore ichipa zviratidzo zvishoma asi, mune dzimwe nguva inogona kutanga kukanganisa nyama yakakomberedza - zvichida nekuda kwevanga rinokonzerwa nekuzvimba uko fungus inobata mativi egomba. Izvi ndizvo zvinoita a fungal bhora, anonziwo an aspergilloma, inovandudza. Havasi vese varwere veCPA vanogadzira aspergilloma.

Izvi hazvisi kukurumidza kutyisidzira hutano, kunze kwekunge tsinga huru yeropa yakukurwa uye kubuda ropa kuchiitika. Dzimwe nguva kurasikirwa kweropa kunorema kunogona kuitika; iyi inonzi haemoptysis uye kukurumidza kurapwa kuchipatara kunodiwa.

NB: Chronic Pulmonary Aspergillosis (CPA) uye Chronic Invasive Pulmonary Aspergillosis (CIPA) zvose zvakashandiswa kare uye izvi zvakakonzera kuvhiringidzika. CIPA parizvino haichashandisi zviri pamutemo kutsanangura chirwere ichi. Invasive aspergillosis chirwere chakasiyana.

Chisingaperi Pulmonary Aspergillosis inosanganisira zvikamu zvitatu zvechirwere chisingaperi:

  • Chisingaperi Cavitary Pulmonary Aspergillosis (CCPA) iyo inotsanangurwa neimwe kana kupfuura cavities, ine kana isina fungal bhora iripo.
  • Aspergilloma ndiro izwi rinoshandiswa kureva fungal bhora richikura mugomba. Murwere weCPA ane aspergilloma anogona kuona kuvandudzwa kana shanduko shoma mumakore mashoma. Panogona kunge paine zviratidzo zvishoma kana kungokosora.
  • Chronic Fibrosing Pulmonary Aspergillosis (CFPA) iCCPA yakasvika padanho rekunonoka mukukura kwayo uye mapapu ane vanga rakanyanyisa.
CT scans kubva kuvarwere vane marudzi akasiyana-siyana echisingaperi pulmonary aspergillosis. (A) Nyore aspergilloma; (B) Chronic cavitary pulmonary aspergillosis; (C) Chronic fibrosing pulmonary aspergillosis; (D) Aspergillus nodule. Mufananidzo wakatorwa kubva kuKosmidis C, Denning DW, The Clinical spectrum of pulmonary aspergillosis, Thorax 2015; 70: 270-277

CT scans kubva kuvarwere vane marudzi akasiyana-siyana echisingaperi pulmonary aspergillosis. (A) Nyore aspergilloma; (B) Chronic cavitary pulmonary aspergillosis; (C) Chronic fibrosing pulmonary aspergillosis; (D) Aspergillus nodule. Mufananidzo wakatorwa kubva kuKosmidis C, Denning DW, The Clinical spectrum of pulmonary aspergillosis, Thorax 2015;70:270-277

zviratidzo

Varwere vane aspergillomas vane zviratidzo zvishoma, asi 50-90% vanoona kumwe kukosora kweropa.
Kune vamwe vane CPA, zviratidzo zvinogona kusanganisira kuonda, kuneta, kukosora, haemoptysis (kubuda ropa mumapapu) uye kufema, kazhinji kwenguva inodarika mwedzi mitatu.

kuongorora chirwere

Vazhinji varwere vane CPA vane chirwere chemapapu chiri pasi. Izvi zvinosanganisira TB, kurapwa kwekare kwegomarara remapapu, sarcoidosis, emphysema uye COPD. Chifuva X-rays kana CT scans inogona kuratidza imwe kana kupfuura mapapu mhango, uye kuongororwa ropa kunogona kuve kwakanaka Aspergillus antibodies. A galactomannan assay ndiyo yakavimbika bvunzo ye Aspergillus kusadziviririka. Sample yesputum inogona kugadzirwa mukuyedza kuona kana Aspergillus inokura. Dzimwe nguva biopsy inotorwa uye kuongororwa.

Kuongororwa kwakaoma uye kazhinji kunoda nyanzvi. Iyi ndeimwe yemasevhisi makuru anopihwa neiyo National Aspergillosis Center muManchester, UK, uko mazano anogona kutsvakwa.

Dzvanya pano kuti uwane rumwe ruzivo nezve Diagnosis

mabatiro

Varwere vane single aspergillomas vanowanzoita zvakanaka nekuvhiyiwa uye vanopihwa zvakanyanya pre- uye post-operative antifungals kudzivirira mamwe matambudziko. Kune mamwe makesi akaomarara (CCPA), kushandiswa kwehupenyu hwese kweantifungals kwakajairwa, pamwe chete neyakajairwa X-rays yekuona kufambira mberi. Izvo zvakakosha kuti utarise huwandu hweropa hweantifungals kuti ive nechokwadi chekutora dosing, sezvo vanhu vachisiyana mumabatiro anoita miviri yavo mishonga iyi.

Kana kubuda ropa kuri kuitika uye kuvhiyiwa kusingagoneke saka mamwe marapirwo anogona kushandiswa kuderedza kurasikirwa kweropa. Semuyenzaniso, tranexemic acid inogona kupiwa kukurudzira kugwamba. Kana izvo zvikaramba, uye kubuda ropa kunowedzera, embolisation inoitwa kuburikidza necatheter (ona nhaurwa pamusoro pekudzikamisa kurasikirwa kweropa naConsultant Radiologist paNational Aspergillosis Center Ray Ashleigh).

Dzvanya pano kuti uwane rumwe ruzivo nezveMarapirwo

Prognosis

Kune varwere vazhinji CPA ichava chirwere chehupenyu hwese. 84% yevarwere vanoita zvakanaka mushure mekuvhiyiwa, kana iri sarudzo. Mune isingasviki 10% yezviitiko chirwere chinongoerekana chanyangarika. Ruzhinji rwevarwere vane CPA vanoda chirwere chisingaperi chekutonga. Muzhinji, chinangwa chikuru chekurapa ndechekuderedza zviratidzo uye kudzivirira kufambira mberi kwechirwere.

Dzimwe nguva varwere vese vanenge vasina symptomatic uye havafambire mberi kunyangwe pasina kurapwa. Kune imwe mugumo we spectrum kune varwere vane zviratidzo zvakanyanya, vane chirwere chinoratidzika kufambira mberi pasinei nepamusoro-soro antifungal therapy, dzimwe nguva pamwe nekubatanidza immunotherapy. Kusunga kufambira mberi, uye kunyanya kuderedza kurasikirwa kwebasa remapapu, ndicho chinangwa chikuru chekurapa, zvinosuruvarisa kuti hazviitike nguva dzose; saizvozvowo kuwedzera uremu, kudzikiswa kwekuneta, kuderera kwechikosoro, kugadzirwa kwesputum, haemoptysis uye kufema zvese zvakakosha zvenguva refu antifungal therapy, zvakare isingawanzo kuwanikwa.

Kuwedzera mamwe mashoko

Pane bepa inotsanangura ese maficha eCPA pa Aspergillus Webhusaiti. Yakanyorwa naProfessor David Denning (Director we National Aspergillosis Center) uye vaunoshanda navo, inoitirwa vanhu vane kudzidziswa kwekurapa.

Kuti uwane rumwe ruzivo nezve marudzi e aspergillosis uye zviratidzo zvavo uye kurapwa shanyira zvinotevera zvinongedzo:

Yakapedzisira Kuvandudzwa munaNovember 1, 2020 na Megan