Last reviewed: 1 Sep 2023
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

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

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