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Aspergillosis

Last reviewed: 9 Nov 2024
Last updated: 17 Apr 2024

Summary

Definition

History and exam

Key diagnostic factors

  • pleuritic chest pain
  • pleural rub
  • nasal ulcer
  • skin rash
Full details

Other diagnostic factors

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

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
  • prior or current lung disease
  • advanced chronic lung disease
  • influenza infection
  • COVID-19 infection
  • primary immunodeficiency
  • HIV infection
  • diabetes mellitus
  • cystic fibrosis
  • severe burns
  • malnutrition
  • multiple myeloma
  • immunocompetent patients
  • age >55 years
  • smoking
Full details

Diagnostic tests

1st tests 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
Full details

Tests 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 Aspergillus IgG
  • tissue biopsy
  • tissue fungal culture
  • tissue fungal stain
Full details

Treatment algorithm

INITIAL

suspected invasive aspergillosis

ACUTE

confirmed invasive aspergillosis

aspergilloma with life-threatening hemoptysis

ONGOING

chronic pulmonary aspergillosis

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

Daniel Friedman, MD

Assistant Professor of Medicine

Section of Infectious Diseases and Global Health

University of Chicago

Chicago

IL

Disclosures

DM declares that he has no competing interests.

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

    • Revision and update of the consensus definitions of invasive fungal disease
    • Microbiological laboratory testing in the diagnosis of fungal infections in pulmonary and critical care practice
    More Guidelines
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