Aspergilosis

Noor Hadi
Definisi
• Penyakit infeksi paru yang disebabkan oleh jamur spesies
aspergilus, paling sering aspergilus fumigatus
• Terdapat 5 tipe
• Saprophytic aspergilosis (aspergiloma)
• Hypersensitivity reaction (allergic bronchopulmonary
aspergillosis),
• Semi-invasive (chronic necrotizing) aspergillosis,
• Airway-invasive aspergillosis (acute tracheobronchitis,
bronchiolitis, bronchopneumonia, obstructing bronchopulmonary
aspergillosis),
• Angioinvasive aspergillosis.
Saprophytic aspergillosis (aspergilloma)
• Infeksi jamur aspergillus tanpa adanya invasi jaringan paru
• Tanpa invasi jaringan paru jamur aspergillus berkembang dalam
kavitas atau bronkus yang ectasia
• Gambaran khas : Fungus ball, Cresent sign (Monod Sign)
Saprophytic aspergillosis (aspergilloma)

Figure 4. Aspergilloma with the air crescent sign in a 67-year-old woman

with residual tuberculosis. Thin section CT scan (mediastinal window)
shows extensive scarring in the upper lobes. A large aspergilloma is seen
in the left upper lobe, with a characteristic air crescent between the
aspergilloma and the cavity wall. Note the marked pleural thickening
surrounding the cavity containing the aspergilloma (arrowheads).
Punctate bilateral pleural calcifications are also visible.
Saprophytic aspergillosis (aspergilloma)
Hypersensitivity reaction (Allergic
Bronchopulmonary Aspergillosis)
• Paling sering ditemukan pada pasien dengan asma bronkial kronis
• Adanya infeksi jamur aspergillosis pada bronkus akan menyebabkan
reaksi imun untuk melawan antigen dari jamur
• Adanya reaksi imun akan menyebabkan area nekrosis bronkus dan
produksi mucus berlebih yang tertahan dan menimbulkan mucus plug
• Gambaran x ray dan CT scan yang khas : Finger in glove sign
Hypersensitivity reaction (Allergic
Bronchopulmonary Aspergillosis)
Figure 7. Allergic bronchopulmonary
aspergillosis in a 32-year-old asthmatic
patient. Linear tomogram (magnified view)
of the right lung reveals multiple tubular
shadows extending in a distribution
corresponding to the bronchovascular
bundles. These Y-shaped shadows are
caused by inspissated mucus within
markedly dilated bronchi. (Courtesy of
Joaquin Ferna´ndez-Cruz, MD, Hospital
Virgen del Rocı ´o, Seville, Spain.)
 Hypersensitivity reaction (Allergic
Bronchopulmonary Aspergillosis)

• Figure 8. Allergic bronchopulmonary aspergillosis in a 43-year-old asthmatic man. (a, b)

Thin-section CT scans (b obtained at a lower level than a) show multiple tubular areas
of increased attenuation in the left upper lobe. (e) On a CT scan obtained 2 months
later, cystic bronchiectasis is clearly depicted.
Semi invasive (Chronic Necrotizing
Aspergilosis)
• Ditandai dengan adanya jaringan nekrotik pada pemeriksaan
histopathology
• Paling sering dijumpai pada pasien DM, malnutrisi, lansia,
alkoholisme, penggunaan steroid terus menerus dan COPD
• Temuan radiologis tidak khas, lesi bilateral/unilateral, berupa
konsolidasi, kavitasi, nodul maupun penebalan pleura
Semi invasive (Chronic Necrotizing
Aspergilosis)
Semi invasive (Chronic Necrotizing
Aspergilosis)
• Figure 11. Necrotizing bronchial
aspergillosis in a 54-year-old man
who presented with cough and
sputum production. (a) Chest CT
scan (mediastinal window) obtained
at the level of the carina shows a
thickened, narrowed right main
bronchus with associated right
upper lobe collapse.
Airway invasive aspergilosis
• Ditandai dengan temuan jamur pada pemeriksaan histopatologi di
membran airway/saluran nafas
• Paling sering dijumpai pada pasien immunocompromised
• Gambaran Foto polos dan CT : trakheobronkiolithis, bronkiolithis,
bronkopneumonia
Airway invasive aspergilosis
• Figure 12. Invasive
bronchiolar aspergillosis in a
patient who had undergone
bone marrow
transplantation. (a) Thin-
section CT scan (lung
window) shows peripheral
branching structures
associated with focal areas of
consolidation in the right
lower lobe. (b) Photograph of
the corresponding autopsy
specimen shows multiple
yellowish acinar nodules.
Airway invasive aspergilosis
• Figure 13.Bronchopneumonia
aspergillosis. (a) Conventional
CT scan through the upper
lungs shows a segmental area
of consolidation in the right
upper lobe with visible air
bronchogram
Angioinvasive aspergillosis
• Terjadi eksklusif pada pasien immunocompromised/HIV-AIDS
• Secara histologis tampak hifa jamur aspergilosis yang menginvasi
pembuluh arteri paru
• Gambaran CT scan :
• Nodul dengan hallo sign
• Pleural based-wedge shaped consolidation (menggambarkan infark paru
akibat inlitrasi jamur ke pembuluh arteri paru)
Angioinvasive aspergillosis
Angioinvasive aspergillosis