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For further information, see CMDT Part 36-07: Aspergillosis
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Essentials of Diagnosis
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Most common cause of noncandidal invasive fungal infection in transplant recipients and in patients with hematologic malignancies
Predisposing factors for invasive disease: leukemia, bone marrow or organ transplantation, corticosteroid use, advanced AIDS
Lungs, sinuses, and CNS are most common disease sites
Detection of galactomannan in serum or other body fluids is useful for early diagnosis in at-risk patients
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General Considerations
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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
Can occur among critically ill immunocompetent patients
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ABPA
Chronic aspergillosis
Invasive aspergillosis
Definitive diagnosis requires demonstration of Aspergillus in tissue or culture from a sterile site
Indirect diagnostic assays include detection of galactomannan in bronchoalveolar lavage fluid or serum, or serum assays for (1, 3)-beta-D-glucan (though the latter is not specific for Aspergillus); the diagnostic utility of Aspergillus DNA by PCR is debated
To improve the reliability of galactomannan testing, multiple determinations should be done, though sensitivity is decreased in patients receiving anti-mold prophylaxis (ie, voriconazole or posaconazole)
Galactomannan levels and Aspergillus DNA PCR can be tested in serum or in bronchoalveolar lavage fluid, which may be more sensitive than serum
Isolation of Aspergillus from pulmonary secretions does not necessarily imply invasive disease, although its positive predictive value increases with more advanced immunosuppression
CT scanning of the chest may aid in early detection and help direct additional diagnostic procedures
Common radiologic findings include
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