Last reviewed: 5 Jul 2021
Last updated: 11 Nov 2020

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • pleuritic chest pain
  • pleural rub
  • nasal ulcer
  • skin rash

Other diagnostic factors

  • cough
  • headache
  • fever
  • congestion or sinus tenderness
  • haemoptysis
  • dyspnoea
  • facial pain
  • seizure
  • altered mental status
  • cranial nerve palsy
  • malaise
  • weight loss

Risk factors

  • allogeneic stem cell transplantation
  • prolonged severe neutropenia (>10 days)
  • immunosuppressive therapy
  • chronic granulomatous disease (CGD)
  • solid organ transplantation (SOT)
  • acute leukaemia
  • aplastic anaemia
  • pre-existing cavity (aspergilloma)
  • advanced chronic lung disease
  • influenza infection
  • primary immunodeficiency
  • HIV infection
  • diabetes mellitus
  • cystic fibrosis
  • severe burns
  • malnutrition
  • multiple myeloma
  • immunocompetent patients
  • age >55 years
  • smoking

Diagnostic investigations

1st investigations to order

  • CXR
  • 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 culture
  • sputum smear

Investigations to consider

  • BAL Aspergillus galactomannan (GM) antigen
  • bronchoscopy with bronchoalveolar lavage (BAL) fungal stain
  • bronchoscopy with BAL fungal culture
  • polymerase chain reaction
  • serum (1-3)-beta-D-glucan
  • serum IgG
  • tissue biopsy
  • tissue fungal culture
  • tissue fungal stain

Treatment algorithm

Contributors

Authors

Mayur Ramesh, MD
Mayur Ramesh

Senior Consultant

Division of Infectious Diseases

Henry Ford Hospital

Detroit

MI

Disclosures

MR declares that he has no competing interests.

Pranatharthi Chandrasekar, MD
Pranatharthi Chandrasekar

Professor

Division of Infectious Diseases

Wayne State University

Detroit

MI

Disclosures

PC is an author of references cited in this topic.

Peer reviewers

Paul Verweij, MD

Professor of Medical Microbiology

Department of Medical Microbiology

Radboud University

Nijmegen

The Netherlands

Disclosures

Not disclosed.

Changa Kurukularatne, MD

Attending Physician/Consultant

Ochsner Medical Center

Department of Infectious Diseases

New Orleans

LO

Disclosures

CK is a member of the Speakers Bureau for Pfizer Inc., the manufacturer of voriconazole and anidulafungin.

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