Diagnosis and treatment of lung fungus

The article is professionally consulted by Master, Doctor Nguyen Huy Nhat - Department of Medical Examination & Internal Medicine - Vinmec Danang International General Hospital.

Lung fungus is a rare disease in people with good immune systems. Pneumonia is a lung infection that is difficult to diagnose and easily confused with other pneumonias. If not diagnosed and treated promptly, patients with pneumonia are at high risk of death.

It is difficult to accurately diagnose lung fungal disease, because the signs and symptoms of the disease are easily confused with some other diseases, even when the patient has been X-rayed, it is not possible to confirm. determine whether the patient has a fungal infection or not.
There are three types of fungi that cause lung disease most commonly, including: Aspergillus, Candida and Cryptococcus.
1.1. Lung fungus caused by Aspergillus fungus Aspergillus fungus causes disease in the lungs, there are 3 types: allergic bronchopneumonia, lung mycosis and invasive lung fungus.

1.1.1 Lung mycoma
Diagnosis of lung fungal tumor is based on clinical symptoms. Patients with lung fungal tumors often show some symptoms such as:
The patient loses weight, has high fever Chest pain Tiredness Coughing up blood In addition, the doctor will ask to perform a standard chest X-ray, in order to allow It is better to detect more clearly the ratchet-shaped fungal cavernous lesions with the upper air crescent accompanied by other lesions or not. Can direct examination or culture of sputum, bronchoalveolar lavage fluid to find Aspergillus fungus.
1.1.2 Allergic bronchopneumonia
Diagnosis of allergic bronchial pneumonitis is based on clinical symptoms: Patients with allergic bronchial pneumonitis often have some of the following symptoms:
For these patients In the presence of Atopi, the symptoms of bronchial asthma develop in episodes, such as sinusitis, allergic rhinitis... Asthma in patients with allergic bronchopneumonia often persists and persists. must depend on corticosteroids. Subclinical diagnosis:
Chest X-ray to identify infiltrative lesions in the lungs Leukemia in the peripheral blood > 500 mm3 IgE in the blood increased over 2000 UI/ml

1.1.3 Invasive lung fungus
Diagnosis of invasive Aspergillus based on clinical symptoms. Patients with invasive lung fungi often have the following signs
For patients with weakened immune systems or low white blood cells: High fever persists, persistent cough, may cough up blood, cough may decrease when taking corticosteroids. Besides, the patient also feels chest pain, fatigue, weight loss, loss of appetite.... Subclinical diagnosis:
Take chest X-ray to assess the damage, bleeding should occur. shadow around the nodule, possibly with necrotizing pneumonia or abscess. Some patients have pneumothorax, pleural effusion. Perform bronchoscopy to confirm fungal invasion on biopsies or computed tomography of chest wall biopsy specimens.

1.2. Candida pulmonary disease Patients with candidiasis are diagnosed based on the following characteristics:
Clinical: Patients with candida pulmonary disease will have some symptoms such as:
Fever erratic, prolonged hoarseness Hoarseness Cough with phlegm or dry cough Damaged mouth and throat (covering the entire surface of the tongue is a white layer that makes it difficult for the patient to swallow). Breathe hard

Subclinical:
Take a chest X-ray to identify opacities Perform a bronchoscopy Perform a bronchoscopy to determine the invasion of fungi on the biopsy piece or computed tomography of the specimen chest wall biopsies. Perform blood culture with Candida fungus Perform esophagoscopy, stomach is damaged by Candida 1.3. Cryptococcus pneumonia Patients with Cryptococcus pneumonia are diagnosed based on the following features:
Clinical: Patients with Cryptococcus pneumonia often present some of the following symptoms.
Headache Fever Dizziness Confusion Disorder Convulsions Coma Increased cranial pressure Persistent cough Shortness of breath Chest pain Burns and ulcers appear

Subclinical:
X-ray Immunoassay: Quantifying Precipitin in the blood is a fairly specific test for patients with lung fungus caused by Cryptococcus Perform a test to look for fungus Perform a test for specific antibodies.

Patients with pneumonitis are often difficult to diagnose, easily confused with other inflammatory diseases of the lungs because the manifestations of the disease are often atypical and very similar to the symptoms of other pneumonia conditions.
Surgery is often the required treatment for patients with pneumothorax.
For emergency cases, the patient is coughing up blood uncontrollably, the doctor will prescribe a blood vessel embolization method to stop the bleeding. The bronchial artery supplying blood to the lungs is usually chosen as the artery to be occluded.

The majority of patients diagnosed with pulmonary fungal infection are indicated for treatment with pneumonectomy. When performing this treatment, the patient has a high chance of losing a lot of blood. The main purpose of a pneumonectomy is to remove a lobe of the lung or a limited portion of the lung that is causing the hemoptysis. Only remove an entire lung when the lesion in the patient has spread, the mycoma has spread to one lung, or the entire lung around the fungal tumor is destroyed by the tuberculosis lesion.
Doctor Nguyen Huy Nhat has many years of experience in the field of respiratory disease treatment at Hue Central Hospital, Hoan My General Hospital, .. before being a doctor of General Internal Medicine Department of General Hospital. Vinmec Danang International.
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