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Treatment options for aspergillosis

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Hello Doctor, I am 55 year old mother of two from US. I have spend a couple of years in Southeast Asia recently. Recently I have been diagnosed to have Apergilloma ( Aspergillosis ). I already had TB few years back and was declared cured at that time. It all started 2 months back when I coughed up blood without any warning signs. It was alarming and equally shocking to see almost 2cups of blood just like that. My GP ran few tests and referred me to the Pulmonologist. The Pulmonologist who treated me was very supportive and suggested me to get a Surgery done as soon as possible. He is saying surgery is much better than drugs and even he is suspicious whether the Aspergillosis has gone into my blood. I am just waiting and discussing about the possible options I have. Dear Doctor, Can you please confirm whether the diagnosis is correct? IF it is so , can you please elaborate on the treatment options I have? What would be your recommendation? (PS: I have attached the CT images and blood investigation results via the site’s upload option – Please go through them)

Category: Pulmonologist

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Category: Family Physician-GP
Dr. Cecelia J. Russ is online now

Expert:  Dr. Cecelia J. Russ replied 4 Days.

Hello, Thank you for asking your question at Doctorspring.com Sorry to know about your condition. I will try to help you in the best ways possible. I have gone through your medical history, Investigation reports, biopsy reports and the 2 CT scan films you have uploaded. The diagnosis of aspergillosis is never an easy one. Partially because there is no one sure shot test which can say it is there or not. But in your case after reviewing all the investigation reports and your clinical history, a diagnosis of Pulmonary Apergilloma is the most probable one. The X-ray and CT images you provided show some characteristic findings of the disease. In addition to that the culture, PCR and galactomannan antigen detection is also positive. An international consensus panel has recommended that a diagnosis of probable invasive fungal infection in patients with risk factors (eg, cancer patients and hematopoietic stem cell transplant recipients) can be made without a culture yielding Aspergillus if there are clinical findings suggestive of aspergillosis along with either microscopic evidence of septate hyphae on examination of bronchoalveolar lavage fluid or sputum or a positive serum galactomannan or beta-D-glucan assay. Aspergillosis is a common fungi found in plenty in the environment. Normally It’s harmless. But once you have some defect in your immunity you become more susceptible for infection with the fungi. You are having a form of Apsergillosis called Aspergilloma. In this form of apsergillosis the fungi forms like a ball in a cavity in the lungs. Normal lungs do not have any cavities. Since you had Tb previously it might have caused a cavity in the lungs. Regarding the treatment options, I strongly recommend surgical treatment followed up by medical options like antifungal. Meanwhile any immunity suppressing conditions should be treated. Thank you.

Expert:  Dr. Cecelia J. Russ replied 3 Days.

Please find the detailed reports attached. Report - pdf Report - .docx - MS word file Thank you

Dr. Cecelia J. Russ
Category: Family Physician-GP
- Medical School - New York Institute of Technology, New York College of Osteopathic Medicine
- Duke University Medical Center, Residency in Family Medicine
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