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New medical technologies have been developing
very quickly in the last decades. A significant success was achieved in
treatment of oncological and oncohematological diseases. Development of
transplantology increases chances of oncologic patients for recovery. However
application of cytostatic and immune suppressing medications, ensuring
functioning of transplantates, leads to severe decreasing of immunity and
appearance of complications in a form of opportunistic infections. Besides,
group of infections development risk includes patients suffering from acquired
immune deficiency syndrome (AIDS), complications after abdominal surgical
interventions, major severe burns, and premature newborns or newborns subjected
to aggressive medical therapy within the first days of life (parenteral feeding
and massive antibacterial therapy). Among contributive risk factors of invasive
mycoses development are intake of antibiotic with a wide spectrum for more than
two weeks, total intravenous nutrition, continuous artificial lung ventilation,
shock, preceding mycotic infections.
Results of 8124 autopsies show that incidence
of mycotic infections in clinics of Frankfurt on the Main has increased from
2.2% in 1978 to 5.3% in 2004. This increase happened mainly due to aspergillus
infection, incidence of which has increased 10 times within this period of
time.
A peculiarity of aspergillus infection course
is a variety of its clinical manifestations. Therapists single out invasive and
non-invasive aspergillosis.
Invasive pulmonary aspergilliosis (IPA) is
the most severe form of the disease, when dissemination of the process into
other organs (CNS, parenchymatous organs of abdominal cavity) is possible. Often
the first symptom of invasive mycotic infection is a fever, refractory to
broad-spectrum antibiotics. Absence of a result at treatment with antibacterial
preparations at clinical picture of acute pneumonia in patients with expressed
immune suppression must be regarded as a possibility of IPA development. When
such clinical manifestations are registered diagnostic maneuvers must be
fulfilled. Speed and intensity of IPA manifestations depend on degree of immune
suppression. IPA signs reveal themselves distinctly after granulocytopaenia,
Sometimes IPA diagnosis may be made basing on results of a biopsy only, but a
risk of haemorrhagic complications in patients with hemoblastoses may be one of
barriers for biopsy.
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