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Aspergilose

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
最后审阅： 24 Sep 2025
最后更新： 17 Apr 2024

小结

定义

病史和体格检查

关键诊断因素

  • presença de fatores de risco
  • dor torácica pleurítica
  • atrito pleural
  • úlcera nasal
  • erupção cutânea
完整详情

其他诊断因素

  • tosse
  • cefaleia
  • febre
  • congestão ou sensibilidade dos seios nasais
  • hemoptise
  • dispneia
  • dor facial
  • convulsão
  • estado mental alterado
  • paralisia do nervo craniano
  • mal-estar
  • perda de peso
完整详情

危险因素

  • transplante alogênico de células-tronco
  • neutropenia grave prolongada (>10 dias)
  • terapia imunossupressora (TI)
  • doença granulomatosa crônica
  • transplante de órgão sólido (TOS)
  • leucemia aguda
  • anemia aplásica
  • doença pulmonar anterior ou atual
  • doença pulmonar crônica avançada
  • infecção por influenza
  • Infecção por COVID-19
  • imunodeficiência primária
  • Infecção pelo vírus da imunodeficiência humana (HIV)
  • diabetes mellitus
  • fibrose cística
  • queimaduras graves
  • desnutrição
  • mieloma múltiplo
  • pacientes imunocompetentes
  • idade >55 anos
  • tabagismo
完整详情

诊断性检查

首要检查

  • radiografia torácica
  • tomografia computadorizada (TC) de alta resolução do tórax
  • TC de alta resolução dos seios nasais
  • TC cranioencefálica de alta resolução
  • ressonância nuclear magnética (RNM) dos seios nasais
  • ressonância nuclear magnética (RNM) cranioencefálica
  • antígeno galactomanana (GM) sérico de Aspergillus por ensaio imunoenzimático (EIE)
  • cultura de escarro
  • baciloscopia do escarro
完整详情

需考虑的检查

  • Antígeno galactomanana (GM) de Aspergillus por LBA
  • broncoscopia com coloração fúngica de lavagem broncoalveolar (LBA)
  • broncoscopia com cultura fúngica de LBA
  • reação em cadeia da polimerase
  • (1,3)-beta-D-glicano sérico
  • IgG sérica contra Aspergillus
  • biópsia tecidual
  • cultura fúngica tecidual
  • coloração fúngica do tecido
完整详情

治疗流程

初步治疗

aspergilose invasiva suspeita

急症处理

aspergilose invasiva confirmada

aspergiloma com hemoptise com risco de vida

持续性治疗

aspergilose pulmonar crônica

撰稿人

作者

Mayur Ramesh, MD
Mayur Ramesh

Senior Consultant

Division of Infectious Diseases

Henry Ford Hospital

Detroit

MI

利益声明

MR declares that he has no competing interests.

Pranatharthi Chandrasekar, MD
Pranatharthi Chandrasekar

Professor

Division of Infectious Diseases

Wayne State University

Detroit

MI

利益声明

PC is an author of references cited in this topic.

同行评议者

Daniel Friedman, MD

Assistant Professor of Medicine

Section of Infectious Diseases and Global Health

University of Chicago

Chicago

IL

利益声明

DM declares that he has no competing interests.

Paul Verweij, MD

Professor of Medical Microbiology

Department of Medical Microbiology

Radboud University

Nijmegen

The Netherlands

利益声明

Not disclosed.

Changa Kurukularatne, MD

Attending Physician/Consultant

Ochsner Medical Center

Department of Infectious Diseases

New Orleans

LO

利益声明

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.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Barnes PD, Marr KA. Aspergillosis: spectrum of disease, diagnosis, and treatment. Infect Dis Clin North Am. 2006 Sep;20(3):545-61, 摘要

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.全文  摘要

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.全文  摘要

Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax. 2015 Mar;70(3):270-7.全文  摘要

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.全文  摘要

Hope WW, Walsh TJ, Denning DW. Laboratory diagnosis of invasive aspergillosis. Lancet Infect Dis. 2005 Oct;5(10):609-22. 摘要

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.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Aspergilose images

  • 鉴别诊断

    • Mucormicose e outras zigomicoses (por exemplo, ficomicose, basidiobolomicose)
    • Fusariose
    • Infecção por Scedosporium
    更多 鉴别诊断

  • 指南

    • 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
    更多 指南
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