Aspergillosis

Last reviewed: 4 Jun 2022
Last updated: 11 Nov 2020

Summary

Definition

History and exam

Key diagnostic factors

  • pleuritic chest pain
  • pleural rub
  • nasal ulcer
  • skin rash
More key diagnostic factors

Other diagnostic factors

  • cough
  • headache
  • fever
  • congestion or sinus tenderness
  • hemoptysis
  • dyspnea
  • facial pain
  • seizure
  • altered mental status
  • cranial nerve palsy
  • malaise
  • weight loss
Other diagnostic factors

Risk factors

  • allogeneic stem cell transplantation
  • prolonged severe neutropenia (>10 days)
  • immunosuppressive therapy
  • chronic granulomatous disease (CGD)
  • solid organ transplantation (SOT)
  • acute leukemia
  • aplastic anemia
  • 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
More risk factors

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
More 1st investigations to order

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
More investigations to consider

Treatment algorithm

INITIAL

suspected invasive aspergillosis

ACUTE

confirmed invasive aspergillosis

aspergilloma

ONGOING

prior invasive aspergillosis: prophylactic therapy

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.

  • Aspergillosis images
  • Differentials

    • Mucormycosis and other zygomycoses (e.g., phycomycosis, basidiobolomycosis)
    • Fusariosis
    • Scedosporiosis
    More Differentials
  • Guidelines

    • Microbiological laboratory testing in the diagnosis of fungal infections in pulmonary and critical care practice
    • Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline
    More Guidelines
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