Last reviewed: 1 Sep 2020
Last updated: 28 Jan 2018



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
  • 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 smear
  • sputum culture
More 1st investigations to order

Investigations to consider

  • serology
  • bronchoscopy with bronchoalveolar lavage (BAL) fungal stain
  • bronchoscopy with BAL fungal culture
  • tissue biopsy
  • tissue fungal stain
  • tissue fungal culture
More investigations to consider

Emerging tests

  • serum (1-3)-beta-D-glucan
  • BAL Aspergillus galactomannan (GM) antigen
  • PCR
More emerging tests

Treatment algorithm


Mayur Ramesh

Senior Consultant

Division of Infectious Diseases

Henry Ford Hospital




MR declares that he has no competing interests.

Pranatharthi Chandrasekar


Division of Infectious Diseases

Wayne State University




PC is an author of references cited in this monograph.

Peer reviewersVIEW ALL

Professor of Medical Microbiology

Department of Medical Microbiology

Radboud University


The Netherlands


Not disclosed.

Attending Physician/Consultant

Ochsner Medical Center

Department of Infectious Diseases

New Orleans



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

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