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Aspergillosis
Allen Heeger, DO
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Mycetoma, aspergilloma: Most mycetomas are aspergillomas; terms often used interchangeably
              • Definitions

                • Aspergillosis: Fungal infection caused by organisms of genus Aspergillus (> 100 species)
                • Saprophytic aspergillosis (aspergilloma): Fungus ball that develops in preexisting cavity
                • Semi-invasive aspergillosis: Chronic necrotizing pulmonary aspergillosis
                  • Subacute disease in patient with mildly depressed immune function or chronic underlying lung disease
                • Invasive aspergillosis: Fungal infection that affects severely immunocompromised patients
                  • Airway invasive aspergillosis: Central invasive airway infection
                  • Angioinvasive aspergillosis: Rapidly progressive angioinvasive infection

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Diagnostic Options

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            • Reporting Tips

                                              Selected References

                                              1. Borman AM et al: COVID-19-associated invasive aspergillosis: data from the UK National Mycology Reference Laboratory. J Clin Microbiol. 59(1), 2020
                                              2. Koehler P et al: Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis. 21(6):e149-62, 2020
                                              3. van Arkel ALE et al: COVID-19-associated pulmonary aspergillosis. Am J Respir Crit Care Med. 202(1):132-5, 2020
                                              4. Benedict K et al: Estimation of direct healthcare costs of fungal diseases in the United States. Clin Infect Dis. 68(11):1791-7, 2019
                                              5. Brauer VS et al: Antifungal agents in agriculture: friends and foes of public health. Biomolecules. 9(10), 2019
                                              6. Schauwvlieghe AFAD et al: Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med. 6(10):782-92, 2018
                                              7. Ullmann AJ et al: Diagnosis and management of aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect. 24 Suppl 1:e1-38, 2018
                                              8. Webb BJ et al: Epidemiology and clinical features of invasive fungal infection in a US health care network. Open Forum Infect Dis. 5(8):ofy187, 2018
                                              9. Kosmidis C et al: The clinical spectrum of pulmonary aspergillosis. Thorax. 70(3):270-7, 2014
                                              10. Tunnicliffe G et al: Airway and parenchymal manifestations of pulmonary aspergillosis. Respir Med. 107(8):1113-23, 2013
                                              11. Brown GD et al: Hidden killers: human fungal infections. Sci Transl Med. 4(165):165rv13, 2012
                                              12. Kousha M et al: Pulmonary aspergillosis: a clinical review. Eur Respir Rev. 20(121):156-74, 2011
                                              13. Segal BH: Aspergillosis. N Engl J Med. 360(18):1870-84, 2009
                                              14. Weber DJ et al: Preventing healthcare-associated Aspergillus infections: review of recent CDC/HICPAC recommendations. Med Mycol. 47 Suppl 1:S199-209, 2009
                                              15. Vonberg RP et al: Nosocomial aspergillosis in outbreak settings. J Hosp Infect. 63(3):246-54, 2006
                                              16. Rementeria A et al: Genes and molecules involved in Aspergillus fumigatus virulence. Rev Iberoam Micol. 22(1):1-23, 2005
                                              17. Pinto PS: The CT halo sign. Radiology. 230(1):109-10, 2004
                                              18. Kartsonis NA et al: Caspofungin: the first in a new class of antifungal agents. Drug Resist Updat. 6(4):197-218, 2003
                                              19. Abramson S: The air crescent sign. Radiology. 218(1):230-2, 2001
                                              20. Franquet T et al: Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics. 21(4):825-37, 2001
                                              21. Kim SY et al: Semiinvasive pulmonary aspergillosis: CT and pathologic findings in six patients. AJR Am J Roentgenol. 174(3):795-8, 2000
                                              22. Gefter WB: The spectrum of pulmonary aspergillosis. J Thorac Imaging. 7(4):56-74, 1992
                                              23. Libshitz HI et al: Pleural thickening as a manifestation of aspergillus superinfection. Am J Roentgenol Radium Ther Nucl Med. 120(4):883-6, 1974
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Mycetoma, aspergilloma: Most mycetomas are aspergillomas; terms often used interchangeably
                                                          • Definitions

                                                            • Aspergillosis: Fungal infection caused by organisms of genus Aspergillus (> 100 species)
                                                            • Saprophytic aspergillosis (aspergilloma): Fungus ball that develops in preexisting cavity
                                                            • Semi-invasive aspergillosis: Chronic necrotizing pulmonary aspergillosis
                                                              • Subacute disease in patient with mildly depressed immune function or chronic underlying lung disease
                                                            • Invasive aspergillosis: Fungal infection that affects severely immunocompromised patients
                                                              • Airway invasive aspergillosis: Central invasive airway infection
                                                              • Angioinvasive aspergillosis: Rapidly progressive angioinvasive infection

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • CT Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Diagnostic Options

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      • Image Interpretation Pearls

                                                                                        • Reporting Tips

                                                                                          Selected References

                                                                                          1. Borman AM et al: COVID-19-associated invasive aspergillosis: data from the UK National Mycology Reference Laboratory. J Clin Microbiol. 59(1), 2020
                                                                                          2. Koehler P et al: Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis. 21(6):e149-62, 2020
                                                                                          3. van Arkel ALE et al: COVID-19-associated pulmonary aspergillosis. Am J Respir Crit Care Med. 202(1):132-5, 2020
                                                                                          4. Benedict K et al: Estimation of direct healthcare costs of fungal diseases in the United States. Clin Infect Dis. 68(11):1791-7, 2019
                                                                                          5. Brauer VS et al: Antifungal agents in agriculture: friends and foes of public health. Biomolecules. 9(10), 2019
                                                                                          6. Schauwvlieghe AFAD et al: Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med. 6(10):782-92, 2018
                                                                                          7. Ullmann AJ et al: Diagnosis and management of aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect. 24 Suppl 1:e1-38, 2018
                                                                                          8. Webb BJ et al: Epidemiology and clinical features of invasive fungal infection in a US health care network. Open Forum Infect Dis. 5(8):ofy187, 2018
                                                                                          9. Kosmidis C et al: The clinical spectrum of pulmonary aspergillosis. Thorax. 70(3):270-7, 2014
                                                                                          10. Tunnicliffe G et al: Airway and parenchymal manifestations of pulmonary aspergillosis. Respir Med. 107(8):1113-23, 2013
                                                                                          11. Brown GD et al: Hidden killers: human fungal infections. Sci Transl Med. 4(165):165rv13, 2012
                                                                                          12. Kousha M et al: Pulmonary aspergillosis: a clinical review. Eur Respir Rev. 20(121):156-74, 2011
                                                                                          13. Segal BH: Aspergillosis. N Engl J Med. 360(18):1870-84, 2009
                                                                                          14. Weber DJ et al: Preventing healthcare-associated Aspergillus infections: review of recent CDC/HICPAC recommendations. Med Mycol. 47 Suppl 1:S199-209, 2009
                                                                                          15. Vonberg RP et al: Nosocomial aspergillosis in outbreak settings. J Hosp Infect. 63(3):246-54, 2006
                                                                                          16. Rementeria A et al: Genes and molecules involved in Aspergillus fumigatus virulence. Rev Iberoam Micol. 22(1):1-23, 2005
                                                                                          17. Pinto PS: The CT halo sign. Radiology. 230(1):109-10, 2004
                                                                                          18. Kartsonis NA et al: Caspofungin: the first in a new class of antifungal agents. Drug Resist Updat. 6(4):197-218, 2003
                                                                                          19. Abramson S: The air crescent sign. Radiology. 218(1):230-2, 2001
                                                                                          20. Franquet T et al: Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics. 21(4):825-37, 2001
                                                                                          21. Kim SY et al: Semiinvasive pulmonary aspergillosis: CT and pathologic findings in six patients. AJR Am J Roentgenol. 174(3):795-8, 2000
                                                                                          22. Gefter WB: The spectrum of pulmonary aspergillosis. J Thorac Imaging. 7(4):56-74, 1992
                                                                                          23. Libshitz HI et al: Pleural thickening as a manifestation of aspergillus superinfection. Am J Roentgenol Radium Ther Nucl Med. 120(4):883-6, 1974