Invasive aspergillosis is caused by filamentous fungi of the Aspergillus species, which are found ubiquitously in soil. Inhalation of the aerosolized conidia (spores) causes the infection.
Mostly affects immunocompromised patients (e.g., stem cell transplant recipients, prolonged severe neutropenia, immunosuppressive therapy). It is rare in immunocompetent hosts.
Clinical findings are nonspecific and include fever, cough, and pleuritic pain. High index of suspicion is required for early diagnosis. Lungs, sinuses, brain, and skin are sites of involvement.
High-resolution CT scan and serum Aspergillus galactomannan antigen test are useful tests for early diagnosis.
Voriconazole is the antifungal agent of choice; an alternate drug is the lipid formulations of amphotericin B.
Early diagnosis and therapy significantly improve prognosis of patients with invasive aspergillosis.
Aspergilloma forms in preformed lung cavities. It is usually asymptomatic. Diagnosis is generally made by CXR or CT scan. Antifungal drugs have been shown not to be beneficial. Surgery may be required in patients with severe hemoptysis.
Morphology of conidiophores and conidia of Aspergillus fumigatus
From the collection of Dr P. Chandrasekar
- pleuritic chest pain
- pleural rub
- nasal ulcer
- skin rash
- facial pain
- congestion or sinus tenderness
- altered mental status
- cranial nerve palsy
- weight loss
1st Tests To Order
- high-resolution chest CT scan
- high-resolution sinuses CT scan
- high-resolution brain CT scan
- MRI sinuses
- MRI brain
- serum Aspergillus galactomannan (GM) antigen by enzyme immunoassay (EIA)
- sputum smear
- sputum culture
Other Tests to Consider
- bronchoscopy with bronchoalveolar lavage (BAL) fungal stain
- bronchoscopy with BAL fungal culture
- tissue biopsy
- tissue fungal stain
- tissue fungal culture
- serum (1-3)-beta-D-glucan
- BAL Aspergillus galactomannan (GM) antigen
suspected invasive aspergillosis
- liposomal amphotericin B or echinocandin
confirmed invasive aspergillosis
- antifungal agents
- reversal of the underlying immune deficiency
- surgical resection of the infected focus
- with life-threatening hemoptysis
- stabilization with IV fluids and blood transfusion + surgical resection
prior invasive aspergillosis: prophylactic therapy