Aspergillosis

Invasive aspergillosis (IA) 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 computer tomography (CT) scan and serum Aspergillus galactomannan antigen test are useful tests for early diagnosis.

Isavuconazonium and voriconazole are the antifungal agents of choice. Lipid-based formulations of amphotericin B are an alternative.

Early diagnosis and therapy significantly improve prognosis of patients with IA.

Aspergilloma forms in preformed lung cavities. It is usually asymptomatic. Diagnosis is generally made by chest x-ray or CT scan. Antifungal drugs have been shown not to be beneficial. Surgery may be required in patients with severe hemoptysis.

Filamentous fungi of the Aspergillus species are ubiquitously found as soil inhabitants. Inhalation of the aerosolized conidia (spores) causes the infection. The clinical spectrum varies from colonization, allergy (e.g., allergic bronchopulmonary aspergillosis), asthma, or aspergilloma (fungal ball) to invasive disease depending on host immune impairment. Neutropenia and compromised T-lymphocyte/macrophage function are key immune deficiencies predisposing to tissue invasion.

This topic covers invasive aspergillosis and aspergilloma. Allergic bronchopulmonary aspergillosis is covered elsewhere.