Last reviewed: 8 Feb 2021
Last updated: 11 Nov 2020
Summary
Definition
History and exam
Key diagnostic factors
- pleuritic chest pain
- pleural rub
- nasal ulcer
- skin rash
Other diagnostic factors
- cough
- headache
- fever
- congestion or sinus tenderness
- hemoptysis
- dyspnea
- 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 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
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
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
Treatment algorithm
Contributors
Authors

Senior Consultant
Division of Infectious Diseases
Henry Ford Hospital
Detroit
MI
Disclosures
MR declares that he has no competing interests.

Professor
Division of Infectious Diseases
Wayne State University
Detroit
MI
Disclosures
PC is an author of references cited in this topic.
Peer reviewers
Professor of Medical Microbiology
Department of Medical Microbiology
Radboud University
Nijmegen
The Netherlands
Disclosures
Not disclosed.
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.
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