Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- dor torácica pleurítica
- atrito pleural
- úlcera nasal
- erupção cutânea
Other diagnostic factors
- 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
Risk factors
- 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
Diagnostic investigations
1st investigations to order
- 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
Investigations to consider
- 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
Treatment algorithm
aspergilose invasiva suspeita
aspergilose invasiva confirmada
aspergiloma com hemoptise com risco de vida
aspergilose pulmonar crônica
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
Раскрытие информации
PC is an author of references cited in this topic.
Рецензенты
Daniel Friedman, MD
Assistant Professor of Medicine
Section of Infectious Diseases and Global Health
University of Chicago
Chicago
IL
Раскрытие информации
DM declares that he has no competing interests.
Paul Verweij, MD
Professor of Medical Microbiology
Department of Medical Microbiology
Radboud University
Nijmegen
The Netherlands
Раскрытие информации
Not disclosed.
Changa Kurukularatne, MD
Attending Physician/Consultant
Ochsner Medical Center
Department of Infectious Diseases
New Orleans
LO
Раскрытие информации
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.
Список литературы
Основные статьи
Barnes PD, Marr KA. Aspergillosis: spectrum of disease, diagnosis, and treatment. Infect Dis Clin North Am. 2006 Sep;20(3):545-61, Аннотация
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.Полный текст Аннотация
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.Полный текст Аннотация
Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax. 2015 Mar;70(3):270-7.Полный текст Аннотация
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.Полный текст Аннотация
Hope WW, Walsh TJ, Denning DW. Laboratory diagnosis of invasive aspergillosis. Lancet Infect Dis. 2005 Oct;5(10):609-22. Аннотация
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.Полный текст Аннотация
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Mucormicose e outras zigomicoses (por exemplo, ficomicose, basidiobolomicose)
- Fusariose
- Infecção por Scedosporium
Больше ОтличияРекомендации
- 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
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