Aspergillosis

Aspergillosis is caused by filamentous fungi of the Aspergillus species, which are found ubiquitously in soil. Aerosolized conidia (spores) are inhaled, which may result in infection.

Invasive aspergillosis (IA) mostly affects immunocompromised patients (e.g., stem cell transplant recipients, prolonged severe neutropenia, immunosuppressive therapy). It is rare in immunocompetent individuals.

Chronic pulmonary aspergillosis (CPA) generally affects people who are not immunocompromised, but have an underlying lung condition. Aspergilloma (fungal ball) may form in cavities.

Clinical findings of IA 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 of IA.

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

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

Treatment of CPA depends on the type.

Filamentous fungi of the Aspergillus species are ubiquitously found as soil inhabitants. Inhalation of aerosolized conidia (spores) causes the infection. The clinical spectrum varies from colonization, allergy (e.g., allergic bronchopulmonary aspergillosis), chronic infection, or aspergilloma (fungal ball) to invasive disease, depending on the individual’s immune status. Neutropenia and compromised T-lymphocyte/macrophage function are key immune deficiencies predisposing to tissue invasion. 

This topic covers invasive aspergillosis and chronic pulmonary aspergillosis. For information on allergic aspergillosis, see Allergic bronchopulmonary aspergillosis.