Resumen
Definição
História e exame físico
Principais fatores diagnósticos
- presencia de factores de riesgo
- dolor torácico pleurítico
- roce pleural
- úlcera nasal
- erupción cutánea
Outros fatores diagnósticos
- tos
- cefalea
- fiebre
- congestión o sensibilidad sinusal
- hemoptisis
- disnea
- dolor facial
- convulsión
- alteración del estado mental
- parálisis de pares craneales
- malestar general
- pérdida de peso
Fatores de risco
- trasplante alogénico de células madre
- neutropenia grave prolongada (>10 días)
- uso de tratamiento inmunosupresor
- enfermedad granulomatosa crónica (EGC)
- trasplante de órgano sólido (TOS)
- leucemia aguda
- anemia aplásica
- enfermedad pulmonar anterior o actual
- enfermedad pulmonar crónica avanzada
- infección gripal.
- Infección por COVID-19
- inmunodeficiencia primaria
- Infección por VIH
- diabetes mellitus
- fibrosis quística
- quemaduras graves
- desnutrición
- mieloma múltiple
- pacientes inmunocompetentes
- edad >55 años
- tabaquismo
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- radiografía del tórax (RT)
- exploración por tomografía computarizada (TC) de tórax de alta resolución
- exploración de senos por tomografía computarizada (TC) de alta resolución
- exploración por tomografía computarizada (TC) cerebral de alta resolución
- imagen por resonancia magnética (IRM) de los senos
- imagen por resonancia magnética (IRM) cerebral
- antígeno galactomanano (GM) de Aspergillus sérico por enzimoinmunoanálisis (EIA)
- cultivo de esputo
- frotis de esputo
Investigações a serem consideradas
- antígeno galactomanano (GM) de Aspergillus en LBA
- broncoscopía con lavado broncoalveolar (LBA) tinción para aislamiento de hongos
- broncoscopía con cultivo fúngico de lavado broncoalveolar (LBA)
- reacción en cadena de la polimerasa
- beta-D-glucano sérico (1-3)
- IgG de Aspergillus en suero
- biopsia de tejido
- cultivo fúngico tisular
- tinción tisular para aislamiento de hongos
Algoritmo de tratamento
sospecha de aspergilosis invasiva
aspergilosis invasiva confirmada
aspergiloma con hemoptisis potencialmente mortal
aspergilosis pulmonar crónica
Colaboradores
Autores
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
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Barnes PD, Marr KA. Aspergillosis: spectrum of disease, diagnosis, and treatment. Infect Dis Clin North Am. 2006 Sep;20(3):545-61, Abstract
Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Aug 15;63(4):e1-e60.Full text Abstract
Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J. 2016 Jan;47(1):45-68.Full text Abstract
Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax. 2015 Mar;70(3):270-7.Full text Abstract
Ullmann AJ, Aguado JM, Arikan-Akdagli S, et al. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect. 2018 May;24 Suppl 1:e1-e38.Full text Abstract
Hope WW, Walsh TJ, Denning DW. Laboratory diagnosis of invasive aspergillosis. Lancet Infect Dis. 2005 Oct;5(10):609-22. Abstract
Maghrabi F, Denning DW. The management of chronic pulmonary aspergillosis: the UK National Aspergillosis Centre approach. Curr Fungal Infect Rep. 2017;11(4):242-51.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
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