Skip to Main Content

Key Features

Essentials of Diagnosis

  • Most common cause of noncandidal invasive fungal infection in transplant recipients and in patients with hematologic malignancies

  • Predisposing factors: leukemia, bone marrow or organ transplant, late HIV infection

  • Lungs, sinuses, and CNS are most common disease sites

  • Serologic detection in serum or other body fluids

    • Useful for early diagnosis and treatment

    • However, multiple determinations should be done and usefulness is decreased in patients receiving anti-mold prophylaxis (ie, voriconazole or posaconazole)

General Considerations

  • Aspergillus fumigatus is the usual cause of aspergillosis, although many species of Aspergillus can cause disease

  • Clinical illness results from abnormal immune response or tissue invasion

  • Allergic bronchopulmonary aspergillosis (ABPA) occurs in persons with asthma or cystic fibrosis

  • Invasive aspergillosis

    • Usually occurs in profound immunodeficiency, particularly in patients

      • Who have undergone hematopoietic stem cell transplantation

      • With prolonged severe neutropenia

    • Can occur among critically ill immunocompetent patients

Clinical Findings

  • Allergic forms of aspergillosis

    • ABPA causes worsening bronchospasm in patients with asthma or cystic fibrosis

    • Allergic aspergillus sinusitis produces a chronic sinus inflammation characterized by eosinophilic mucous and noninvasive hyphal elements

  • Chronic aspergillosis

    • Cough

    • Shortness of breath

    • Weight loss

    • Malaise

  • Invasive aspergillosis

    • Pulmonary disease most common

    • Invasive sinus disease

Diagnosis

  • ABPA

    • Eosinophilia

    • High levels of total IgE, and IgE and IgG specific for Aspergillus in the blood

  • Chronic aspergillosis

    • Disease manifestations range from aspergillomas that develop in a lung cavity to chronic fibrosing pulmonary aspergillosis in which the majority of lung tissue is replaced with fibrosis

  • Invasive aspergillosis

    • Patchy infiltration leading to a severe necrotizing pneumonia

    • Tissue infarction (development of pleuritic chest pain and elevation of serum lactate dehydrogenase [LD])

    • Hematogenous dissemination to the CNS, skin, and other organs

    • Blood cultures have very low yield

    • Detection of galactomannan by enzyme-linked immunosorbent assay (ELISA) or Aspergillus DNA by polymerase chain reaction (PCR); multiple determinations should be done

    • Definitive diagnosis requires demonstration of Aspergillus in tissue or culture from a sterile site

    • Chest CT scan may show indicative characteristics (eg, "halo sign")

Treatment

  • ABPA

    • For acute exacerbations, prednisone, 0.5 mg/kg/day orally tapered slowly over several months

    • Itraconazole, 200 mg orally once daily for 16 weeks, appears to improve pulmonary function and decrease corticosteroid requirements, although voriconazole is increasingly being used

  • Allergic aspergillus sinusitis

    • Topical corticosteroids cornerstone of therapy

    • Itraconazole is best studied agent

  • Chronic aspergillosis

    • Surgical resection remains most effective therapy for symptomatic aspergilloma

    • Other forms of chronic aspergillosis are generally treated with at least 4–6 months of oral triazole therapy

      • Itraconazole, 200 mg twice daily

      • Voriconazole, 200 mg twice daily

      • Posaconazole, 300 mg daily

  • Invasive aspergillosis

    • Reversal of any correctable immunosuppression

    • Rapid institution of voriconazole (6 mg/kg intravenously twice on day 1 and then 4 mg/kg every 12 hours thereafter) is considered optimal therapy

    • Combination therapy of anidulofungin (200 mg on day 1 and then 100 mg ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.