Text C. Allergic Bronchopulmonary Aspergillosis.

Allergic bronchopulmonary aspergillosis is an al­lergic lung disorder that often mimics pneumonia and is characterized by asthma, airway and lung inflammation, and increased numbers of eosino­phils in the blood; it's caused by an allergic reaction to a fungus, most commonly Aspergillus fumigatus.

Aspergillus is a fungus that flourishes in the soil, decaying vegetation, foods, dusts, and water. A person who inhales the fungus may become sen­sitized and develop allergic asthma. In some peo­ple, a more complex allergic reaction in the air­ways and lungs can eventually develop. Although the fungus doesn't actually invade the lungs or directly destroy tissue, it colonizes the asthmatic mucus in the airways and causes recurrent aller­gic inflammation in the lung. The tiny air sacs of the lungs (alveoli) become packed primarily with eosinophils. Increased numbers of mucus-producing cells may also appear. In advanced cases, inflammation may cause the central air­ways to widen permanently, a condition called bronchiectasis. Eventually, the lungs become scarred.

Other forms of aspergillosis can occur. Asper­gillus can invade the lungs and cause serious pneumonia in people with suppressed immune systems. This is an infection, not an allergic reaction. The fungus can also form a fungus ball, called an aspergilloma, in cavities and cysts of lungs already damaged by another disease, such as tuberculosis.

Symptoms and Diagnosis

The first indications of allergic bronchopul­monary aspergillosis are usually progressive symptoms of asthma, such as wheezing and shortness of breath, and a mild fever. The person usually doesn't feel well. Brownish flecks or plugs may appear in coughed-up sputum.

Repeated chest x-rays show areas that look like pneumonia, but they move around, most com­monly in the upper parts of the lungs. With long­standing disease, computed tomography (CT) may show widened airways. The fungus itself, along with excess eosinophils, may be seen when the sputum is examined under the microscope.

The blood contains high levels of eosinophils and certain antibodies to Aspergillus. Skin testing can show whether the person is allergic to Aspergillus, but it doesn't distinguish between allergic bronchopulmonary aspergillosis and a simple allergy to Aspergillus, which may occur in allergic asthma without aspergillosis.

Treatment

Because Aspergillus appears in many places in the environment, it's difficult to avoid. Antiasthma drugs, especially corticosteroids, are used to treat allergic bronchopulmonary aspergillosis. Prednisone taken initially in high doses and over a long period of time in lower doses may prevent pro­gressive lung damage. Because the ill effects aren't caused by infection, antifungal drugs aren't help­ful. Receiving allergy shots (desensitization) isn't recommended.

Because the lung damage may worsen without causing any noticeable symptoms, a doctor reg­ularly monitors the disease, using chest x-rays, pulmonary function tests, and antibody mea­surements. As the disease is controlled, the anti­body levels fall.

Notes:

invade вторгаться

flecks прожилки

plugs пробки

widen расширять

 

Text D. Pulmonary Wegener's Granulomatosis.

Wegener's granulomatosis, a potentially fatal dis­ease, is characterized by severe inflammation of blood vessel walls (granulomatous vasculitis), si­nuses, lungs, kidneys, and skin with lumps called granulomas. In some cases, only the nasal pas­sages, airways, and lungs are affected.

In this condition, blood vessels in the lungs be­come inflamed, and some lung tissue may be de­stroyed. The cause of Wegener's granulomatosis is unknown, but allergic reactions may be in­volved.

Symptoms and Diagnosis

Pulmonary Wegener's granulomatosis may not cause any symptoms, or it may produce fever, weight loss, tiredness, cough, shortness of breath, and chest pain.

A chest x-ray may show cavities or dense areas in the lungs that look like cancer. A definite diag­nosis can be made only by microscopic examination of a small piece of tissue, which may be taken from an affected area such as the skin, nasal passages, airways, or lungs. A distinctive anti­body, called antineutrophil cytoplasmic anti­body, often can be detected in the blood of people with Wegener's granulomatosis.

Treatment

Without treatment, the disease can worsen rap­idly and cause death, so treatment should start immediately after the diagnosis is made. Pulmo­nary Wegener's granulomatosis may respond to corticosteroids alone, but many people also need another immunosuppressive drug, such as cyclophosphamide.

Notes:

lump опухоль, шишка

respond отвечать, реагировать

dense плотный, сжатый, густой, частый

 

Infiltrative Lung Diseases

Several diseases with similar symptoms result from abnormal accumulations of inflammatory cells in lung tissue. Early in the course of these diseases, white blood cells and protein-rich fluid accumulate in the lungs' air sacs (alveoli), causing inflammation (alveolitis). If the inflammation per­sists, the fluid may solidify, and scarring (fibrosis) may replace lung tissue. Extensive scarring of the tissue around the alveoli can progressively de­stroy the functioning alveoli and leave cysts in their place.