Aspergillosis

Introduction 

Aspergillosis is a spectrum of diseases caused by Aspergillus species, most commonly by Aspergillus fumigatus 

-it is the most common invasive fungal infection in transplant recipients and in patients with hematologic cancer 

-it produces small conidia which are inhaled; following inhalation conidia germinate to produce hyphae that invade the lungs and other tissues 

Symptoms & Signs 

 The lungs, sinuses, brain and skin are the organs most often involved.

Allergic bronchopulmonary aspergillosis (ABPA): 

-ABPA is a hypersensitivity reaction to the presence of Aspergillus in the bronchi

-Dyspnea, wheezing, cough, malaise, fever, hemoptysis, bronchiectasis

-Characteristic radiographic finds: “Tramline shadows” (parallel linear shadows); “finger in glove” opacity (due to mucoid impaction in dilated bronchi); “toothpaste shadows” (due to mucoid impaction of the bronchi); “ring shadows” (due to dilated bronchi) 

-The screening test for ABPA is a skin prick test with Aspergillus antigens

Severe Asthma with Fungal Sensitivity 

Pneumonia 

-The most common syndrome associated with aspergillosis is pneumonia

-Fever, chest pain, cough, hemoptysis 

-Aspergilli have remarkable ability to grow in lung cavities created by tuberculosis; within the cavities, they produce radiopaque aspergillomas (fungus balls) 

Sinuses 

-Aspergillus is the most common cause of fungal sinusitis

-Fever, headache, sinus discharge, epistaxis, tissue destruction, necrotic lesions in the nose or palate

Brain 

-Disseminated aspergillosis can spread to the brain

-headache, fever, neck rigidity, mental status changes 

Skin  

-Erythematous plaques progressing to necrotic ulcers with black eschars 

Diagnosis 

Biopsy: Septate, branching hyphae with radiating chains of conidia in V or Y shaped branches 

Serology: Detection of Aspergillus antigens, Galactomannan and 1,3-β-D-glucan

Treatment 

Antifungal drugs: Voriconazole, posaconazole, itraconazole, isavuconazole, micafungin, caspofungin, and amphotericin B 

ABPA: Systemic corticosteroids, antifungals 

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