Today’s topic is aspergillosis nursing care, an opputunistic infection in human. Aspergilosis is an opputunistic infection and sometime this infection can threat life, this infection is a fungus infection from aspergillus genus like A. Fumigarus, A. Flavus, or A. Niger.
This infection only infect low imune system people like people with antibiotic therapy, glucocorticoid therapy, or other immunosuppresant medication. Other diseases can be a cause of this disease like radiation effect, HIV/AIDS, Hodgkin, Leucemia, azotemia, alcoholism, sarcoidosis, bronchitis, bronchiectasis, organ transplantation, aspergiloma caused by tuberculosis or other lung disease.
This disease can appear in four main types:
- Aspergilloma: it causes fungus ball inside lung (it usually called miketoma)
- Aspergillosis Allergis: it is hypertensive toward allergen aspergillus
- Asergilosis endoftalmitis: it is infection in anterior and posterior cavity of the eye, it can cause blindness
- Dissemination aspergillosis; it is an acute infection that develop to septisemia, thrombosis, and organ infarction especially heart infarction, lung, brain, and kidney
Aspergillosis can cause ear infection (otomycosis), kornea (keratitis mycotic), prosthetic heart valve (endocarditis), pneumonia (especially for patient with immunosuppressant therapy or high dose steroid therapy), sinusitis, and brain abses.
The prognosis is depend on types. Sometime aspergilloma causes fatal hemoptysis.
Aspergillus, generally found in fermented compost and damp straws. It transmits through spore inhalation or wound and injury (aspergillosis endoftalmitis).
Sign and Symptoms
Aspergillus in bronchial causes obstruction and atelectasis and fungal filament, fibrin, and exudate in a disease scar like tuberculosis remains. This disease does not show symptoms or sometime this disease looked like tuberculosis (productive cough, purulent and blood sputum, dyspnea, empyema, and lung abses)
Aspergillosis alergi: dyspnea, vocal problems, cough with sputum, pleural pain, and fever
Aspergillosis endoftalmitis (2-3 weeks post-surgery): cloudy vision, eye pain, redness conjunctiva. After the eye posterior and anterior infection, the exudate will be looked purulent
Disseminated aspergillosis: thrombosis, infarction, septicemia sign and symptoms (fever, hypotension, and delirium), azotemia, hematuria, urinary tract obstruction, headache, seizure, bone pain, and tissue inflammation. This disease develops to fatal disease.
To make correct diagnosis for aspergillosis, diagnosis examination is a must. It also help in aspergillosis nursing care. So some of the diagnosis examination are as follows;
- For patient with aspergilloma, chest x-ray shows cresent radiolucent form that surrounding the wadding circular , but this diagnosis examination does not determine aspergillosis
- For endofthalmitis aspergillosis, ocular trauma or operation history and culure, or exudate aspergillosis can support the aspergillosis diagnosis
- For patient with aspergillosis allergy, sputum examination shows high level of eosinophil
- Scraping culture of mouth and sputum test that shows aspergillus can not ensure aspergillosis disease, because all of healthy people bring this fungus
- For patient with disseminated aspergillosis, microscopic and culture test in a tissue can ensure the diagnosis, but commonly it uses biopsy for the diagnosis.
In aspergillosis nursing care, we should collaborate with doctors in nursing care plans. Some of the treatment that is usually performed for aspergillosis patients are as follows;
- Aspergillosis patient is not necessary to be isolated
- Aspergillosis treatment needs local excision at the lesion and supportive therapy, like chest physiotherapy, effective cough, to increase the lung function. Severe hemoptysis which is caused by fungus in lung can do a lobectomy
- Aspergillosis allergy needs desensitization and aspergillosis endoftalmitis needs intravenous amphotericin β for 2 to 3 weeks (with immunosuppressant therapy stoppage)
- Disseminated aspergillosis generally resists amphotericin β therapy and develops in fast until death
Iitraconazole can be used to inhibit aspergillosis development for patient with immune competence.
Aspergillosis Nursing Care
Aspergillosis nursing care is easy to perfom, there are three steps for nursing care plans below;
- Help patient with chest physiotherapy and ask patient to do effective cough
- Monitor patient’s vital sign, intake and output, and diagnosis examination
- Give patient an emotional support. Prepare grieving counseling if patient with disseminated aspergillosis that is not effective toward therapy.