Aspergillosis Signs and Symptoms

• Encompasses a variety of clinical syndromes depending on the host immunity factor

Invasive Aspergillosis (IA)

• A rapidly progressive and frequently fatal disease that occurs in highly immunocompromised individuals
• Most common cause of infectious pneumonic mortality in patients undergoing hematopoietic stem cell transplantation (HSCT) and is an important cause of opportunistic respiratory and disseminated infection in other immunocompromised patients
• Inhalation of etiologic agent is extremely common but disease is rare
• Any organ may be involved in the immunocompromised host, but sinopulmonary disease is the most frequent

Allergic Bronchopulmonary Aspergillosis (ABPA)

• A hypersensitivity reaction to Aspergillus antigens often due to A fumigatus and typically occurs in patients with long-standing asthma or cystic fibrosis
• It is believed that the pathogenesis involves Aspergillus-specific, IgE-mediated type I hypersensitivity reaction and specific IgG-mediated type III hypersensitivity reactions

Allergic Aspergillus Sinusitis (AAS)

• A hypersensitivity response to the presence of Aspergillus within the paranasal sinuses and is characterized by mucoid impaction similar to that of ABPA

Aspergilloma

• Conglomeration of intertwined Aspergillus hyphae, fibrin, mucus and cellular debris within a pulmonary cavity or an ectatic bronchus
• Most common pulmonary involvement due to Aspergillus
• Pre-existing lung cavity formed secondary to tuberculosis, sarcoidosis, bronchiectasis, bronchial cysts and bullae, ankylosing spondylitis, neoplasm or pulmonary infarction is the most common predisposing factor

Chronic Pulmonary Aspergillosis (CPA)

• Subtypes include chronic cavitary pulmonary aspergillosis (CCPA), chronic fibrosing pulmonary aspergillosis (CFPA), Aspergillus nodule, single (simple) aspergilloma, and subacute invasive pulmonary aspergillosis (previously known as chronic necrotizing pulmonary aspergillosis)
  • CCPA is the most common manifestation of CPA, which may progress to CFPA when left untreated
• A pulmonary aspergillosis that commonly causes a slowly progressive inflammatory destruction of lung tissue in patients with underlying lung diseases and low-grade immunosuppression usually due to invasion by A fumigatus
• No vascular involvement or dissemination to other organs

Cutaneous Aspergillosis

• Primary cutaneous aspergillosis is usually resulting from a skin disruption site (eg intravenous devices, adhesive dressing, surgical wound, burn) creating access for the infection, or traumatic inoculation
• Secondary cutaneous aspergillosis results from hematogenous seeding from a primary source in immunocompromised patients

Otic Aspergillosis

• Otomycosis: A condition of superficial colonization typically due to A niger and A fumigatus
• Usually occurs in patients with hypogammaglobulinemia, diabetes mellitus (DM), chronic eczema or human immunodeficiency virus (HIV) infection and those taking corticosteroids

• Caused by Aspergillus, an ubiquitous, soil-dwelling, filamentous fungus that grows on soil, food, dead leaves, household dust, etc
  • Grows best at 37°C, and the small spores are easily inhaled and deposited deep in the lungs
• The most common pathogens are Aspergillus fumigatus, A flavus, A niger and A terreus
• Other species can also cause disease, including A nidulans and A clavatus
• In immunocompetent persons, aspergillosis can occur in previously damaged tissue or induce allergic responses

Invasive Aspergillosis (IA)

• Patient may present with:
  • Fever refractory to empirical broad-spectrum antibacterials
  • Cough
  • Pleural pain
  • Paranasal sinus findings
  • Hemoptysis

Allergic Bronchopulmonary Aspergillosis (ABPA)

• Patient usually presents with expectoration of brown mucus plugs, wheezing, fever and pleuritic chest pain

Allergic Aspergillus Sinusitis (AAS)

• Patient usually presents with nasal obstruction, rhinorrhea, headache and epistaxis
• May occasionally manifest as proptosis due to extension of fungal sinusitis into the orbit

Aspergilloma

• Aspergilloma may exist for many years without causing symptoms
• Hemoptysis that can be severe and life-threatening
• Chronic cough and dyspnea that are more likely due to underlying disease
• Rarely fever

Chronic Pulmonary Aspergillosis (CPA) 

• Chronic pulmonary symptoms (fever, cough with or without hemoptysis, dyspnea, fatigue, chest pain, sputum production, weight loss) of at least 3 months’ duration

Cutaneous Aspergillosis

• Erythematous indurated papules that progresses into ulcerative necrotic lesions

Otic Aspergillosis

• Patient may usually present with ear pain, pruritus, hypoacusis and otic discharge

Invasive Aspergillosis (IA) 

• Major risk factors include:
  • Prolonged neutropenia (neutrophil count <100/microL for >10 days)
  • Intensive cytotoxic chemotherapy
  • Hematopoietic stem cell transplantation (HSCT) or solid-organ transplantation
  • Acquired immune deficiency syndrome (AIDS)
  • Chronic granulomatous disease (CGD)
  • Critical illness without documented immunodeficiency
  • Hematologic malignancies
  • Severe aplastic anemia
  • Primary immunodeficiencies
  • Prolonged corticosteroid use
  • Cytomegalovirus disease