Skip to Main Content

For further information, see CMDT Part 38-07: Aspergillosis

KEY FEATURES

Essentials of Diagnosis

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

  • Risk factors for invasive disease

    • Leukemia

    • Hematopoietic stem cell or solid-organ transplantation

    • Corticosteroid use

    • AIDS

    • COVID-19 coinfection

  • Pulmonary, sinuses, and central nervous system (CNS) are most common disease sites

  • Detection of galactomannan in serum or other body fluids is useful for early diagnosis in at-risk patients

General Considerations

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

  • Clinical illness results from abnormal immune response or tissue invasion; lungs, sinuses, and brain are the organs most often involved

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

  • Chronic pulmonary aspergillosis

    • Usually occurs when there is preexisting lung damage without significant immunocompromise

    • Manifestations range from aspergillomas in a lung cavity to chronic fibrosing pulmonary aspergillosis where the majority of lung tissue is replaced with fibrosis

  • Invasive aspergillosis

    • Usually occurs in patients who are profoundly immunodeficiency, particularly those

      • Who have undergone hematopoietic stem cell transplantation

      • With prolonged severe neutropenia

    • Can occur among critically ill immunocompetent patients

    • Tracheobronchitis and pulmonary aspergillosis can occur with severe COVID-19 infection (termed COVID-19–associated pulmonary aspergillosis)

CLINICAL FINDINGS

  • Allergic forms of aspergillosis

    • Occurs in patients with preexisting asthma or cystic fibrosis

    • Worsening bronchospasm

    • Fleeting pulmonary infiltrates

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

  • Chronic aspergillosis

    • Long-standing symptoms (> 3 months)

    • Cough

    • Shortness of breath

    • Weight loss

    • Malaise

  • Invasive aspergillosis

    • Pulmonary disease most common; patchy infiltration leading to a severe necrotizing pneumonia

    • Invasive sinus disease

    • At any time, there may be hematogenous dissemination to the CNS, skin, and other organs

DIAGNOSIS

Laboratory Tests

  • ABPA

    • Eosinophilia

    • High levels of IgE and IgG Aspergillus precipitins in the blood

  • Chronic aspergillosis

    • Symptoms or signs for at least 3 months with identification of lung cavitation or nodules

    • Microbiologic evidence of Aspergillus (such as culture or tissue identification from biopsy or serology)

    • Exclusion of alternative diagnoses (eg, mycobacterial infection)

  • Invasive aspergillosis

    • Elevation of serum lactate dehydrogenase [LD]) from tissue infarction

    • Blood cultures have very low yield

    • Galactomannan (component of the Aspergillus cell wall)

      • May be recovered in serum or bronchoalveolar lavage

      • Serial determinations of serum galactomannan improve the test reliability

    • Serum assays for (1,3)-beta-D-glucan (a fungal cell wall component that is not specific for Aspergillus)

    • Utility of the galactomannan and (1,3)-beta-D-glucan assays in patients who are neutropenic is debated

    • Aspergillus DNA in serum or bronchoalveolar lavage may be useful, particularly when used with other biomarkers

    • Plasma cell-free DNA assays may prove promising for early detection

    • Definitive diagnosis

      • Requires demonstration of Aspergillus in tissue or culture from a sterile site

      • Isolation of ...

Pop-up div Successfully Displayed

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

  • Create a Free Profile