Although Aspergillus is ubiquitous in the environment, immunocompetent people do not usually develop aspergillosis unless very sick. Risk factors for the disease are neutropenia, immunosuppression (either by disease or by pharmacological intervention), cytotoxic chemotherapy, allogeneic hematopoietic stem cell transplantation, and solid organ (such as lung) transplantation [1]. Neoplasms are also risk factors, mainly those of hematopoietic or lymphoreticular origin [2].

Invasive infection can spread to the systemic circulation and be carried to various organs. The portal of entry is often the lung and less commonly the skin, and the gastrointestinal tract [3] [4] [5]. Other, less usual entry sites have been reported, for example, a peritoneal dialysis [6]. As Aspergillus reaches the circulatory system, it can cause hemorrhage and infarction [7] and invade other organs: the brain, heart, kidneys, liver, spleen and gastrointestinal tract [4]. The brain is a frequently affected end organ; most cases of brain aspergillosis originate from lung infection [7].

Many patients have respiratory problems, such as fever, cough, hemoptysis, tracheobronchitis [8], and pleural friction rub, which may indicate hemorrhagic infarction of the lung [4]. Central nervous system aspergillosis manifests as nonspecific neurological symptoms, which are often dramatic [4], presenting as seizures, cerebral infarctions, intracranial hemorrhage, meningitis and others [8].

Other tissues affected by hematogenous dispersion of the organism are the eye, the heart (although cardiac surgery remains the leading cause of aspergillosis in the heart), the skin, the gastrointestinal tract where perforation, bleeding or ischemia may follow; the kidneys, and ribs where infections mainly in children with chronic granulomatous disease may occur [4].

• Fever

  Clinical and pathologic findings in a 65-year old woman with fever of unknown origin are described in this report. Generalized aspergillosis with endocarditis was demonstrated at autopsy. [ncbi.nlm.nih.gov]

  Symptoms may include unilateral (one-sided) facial swelling, headaches, nasal or sinus congestion or pain, serosanguinous (bloody) nasal discharge, and fever. [cdc.gov]

• Goiter

  An ultrasound revealed moderate goiter of left lobe prevalence with parenchymal hypoechogenicity and heterogeneous structure, changes in the left lobe: solid-cystic heterogeneous nodular lesion 27 x 16 x 23mm, thick peripheral hypoechoic halo without [revistanefrologia.com]

• Amyloidosis

  We describe a case of fatal disseminated aspergillosis immediately following autologous peripheral stem cell reconstitution in a patient who had undergone orthotopic heart transplantation for systemic amyloidosis. [ncbi.nlm.nih.gov]

• Low Back Pain

  An immunocompromised patient presented with chronic low back pain as the initial symptom and a subcutaneous abscess as the initial sign of disseminated aspergillosis. [ncbi.nlm.nih.gov]

  back pain as the initial symptom and a subcutaneous abscess as the initial sign of disseminated aspergillosis. [mdedge.com]

Many authors remark that diagnosis of invasive and disseminated aspergillosis is difficult [1] [8] [9], yet because of the high mortality, diagnosis must be prompt to allow quick and aggressive treatment [10]. Ambiguity in the description of the disease, such as distinguishing ‘proven’ aspergillosis from ‘probable’ and ‘possible’ disease, is one reason for the difficulty [10] [3]. Colonization and invasion by Aspergillus are also not easily distinguished [11]. The standard methods of culturing the fungus and identifying its characteristic hyphae in the microscope from sputum or bronchoalveolar lavage (BAL) are not sensitive enough [1] [3]. Invasive procedures such as thoracoscopic biopsy may be needed for conclusive diagnosis.

Chest computed tomography (CT) frequently shows nodules and a characteristic “halo sign”, which can be used as an indication of invasive aspergillosis in neutropenic patients [1].

Laboratory tests for the early detection of aspergillosis have been developed; an assay detects galactomannan (GM) [9], which is released from the hyphae of Aspergillus. GM can be detected in the serum or BAL, days before radiological signs are seen; however, the sensitivity of the test may not be consistent between different laboratories [1]. Another cell wall component beta-d-glucan is tested for the levels in serum samples [12] in an assay that is regarded as very sensitive for detecting early fungal infections [1]. Another promising technique is the polymerase chain reaction (PCR), performed on BAL and blood samples [11] [13].

Characteristics of imaging patterns for cerebral aspergillosis have been described [14]: these include decreased CT attenuation and ring-enhancing lesions in multiple areas. The most typically affected brain areas are the basal nuclei and thalami [7]. This reflects the spreading of the disease through the lenticulostriate and thalamoperforator arteries. The radiologic appearance of disseminated aspergillosis in the brain is characterized by the appearance of early infarcts and hemorrhages followed by the later spreading into surrounding tissue and is different from metastases [7]. Any of the above findings, or an increase in the size or number of the lesions in immunocompromised patients, should be a strong enough indication for starting antifungal therapy [7].

• Mural Thrombus

  A thoracic CT revealed mycotic aneurysm of the ascending thoracic aorta, including mural thrombus. [elsevier.es]

• Bowel Distention

  CT findings were a diffuse, small-bowel distention with a thickened, distal, ileum wall. Emergency surgery was performed with resection and immediate anastomosis of the distal ileum. [ncbi.nlm.nih.gov]

• Thrombocytosis

  A patient with idiopathic thrombocytosis developed sudden loss of vision in his left eye secondary to endophthalmitis caused by Aspergillus flavus. [ncbi.nlm.nih.gov]

• Toxoplasma Gondii

  Vitreous was also sent to the NMC and Toxoplasma gondii PCR was performed with a negative result. [elsevier.es]

• Hepatic Necrosis

  Disseminated aspergillosis is not generally known as a complication of hepatic failure. Three patients with subacute hepatic necrosis died of clinically unrecognized disseminated aspergillosis. [ncbi.nlm.nih.gov]

Skin lesions healed without any surgical treatment. The infant was discharged in good health. Long-term follow-up at three years of age revealed normality of all neurodevelopmental and cognitive parameters. [ncbi.nlm.nih.gov]

[…] a serum obtained after 22 days of treatment. [elsevier.es]

Disseminated aspergillosis is very rare in immunocompetent hosts and is typically associated with a poor prognosis. [ncbi.nlm.nih.gov]

Prognosis is generally poor, although early diagnosis and treatment may result in recovery 3-4. [radiopaedia.org]

Prognosis CNPA has a significant mortality of up to 40%, even if promptly recognised and treated. It is easy to miss and, in such cases, carries a worse prognosis. [patient.info]

Taek Soo Kim Kyoung-Ho Song Se Joon Woo Eu Suk Kim Kyoung Un Park Hong Bin Kim Article First Online: 29 May 2015 292 Downloads 7 Citations Abstract Disseminated aspergillosis is very rare in immunocompetent hosts and is typically associated with a poor prognosis [link.springer.com]

Despite aggressive treatment, the visual prognosis is poor because of frequent macular involvement. Final visual acuity is usually less than 20/200. Hariprasad SM, Mieler WF, Holtz ER, et al. [aao.org]

The latter etiologic mechanism was suggested once before. Neither of these patients showed other underlying disease. [neurology.org]

Initial cutaneous lesions may appear in the form of either macules, papules, nodules, or plaques. [4] Although rare, cases of primary cutaneous infection with Aspergillus have been described in immunocompetent patients. [5, 6] Etiology Aspergillosis is [emedicine.medscape.com]

The Etiology of Ring Lesions on Diffusion-Weighted Imaging. Neuroradiol J, 2014; 27(3):280–7. pmid:24976194 View Article PubMed/NCBI Google Scholar 32. Osborn AG. Diagnostic Cerebral Angiography. Lippincott Williams & Wilkins; 1999. 491 p. 33. [journals.plos.org]

With studies suggesting that the incidence of this disease is increasing, and with relatively few epidemiological data available in this population, we evaluated cases of disseminated aspergillosis identified at autopsy over a one-year period on a 31- [ncbi.nlm.nih.gov]

This book summarizes the current knowledge about Aspergillosis, covering: Epidemiology Pathogenesis Clinical manifestations Diagnosis Treatment Prevention Written by internationally respected authors, the information presented in this book adds for a [books.google.de]

Aspergilloma Epidemiology Aspergilloma has a variable prevalence depending on the amount of cavitating lung disease affecting a population. [patient.info]

Trends in the postmortem epidemiology of invasive fungal infections at a university hospital. J Infect. 2010;61:259–65. CrossRef PubMed Google Scholar 5. Cook DJ, Achong MR, King DE. Disseminated aspergillosis in an apparently healthy patient. [link.springer.com]

Epidemiology and risk factors for infection The at-risk population for aspergillosis includes patients with prolonged neutropenia, allogeneic hematopoietic stem cell transplant (HSCT), solid organ transplant (SOT), inherited/acquired immunodeficiencies [clinicaladvisor.com]

While Aspergillus also disseminates to the CNS hematogenously, most commonly but not exclusively from the lung (1), the pathophysiology is often different. [ajnr.org]

The pathophysiology of tsunami lung is thought to involve not only chemical or mechanically induced inflammation, but also bacterial infection, the chief pathogens of which include Aeromonas species, Burkholderia pseudomallei, Chromobacterium violaceum [rc.rcjournal.com]

Pathophysiology Cutaneous aspergillosis is caused by infection with ubiquitous soil- and water-dwelling saprophytes of the Aspergillus genus. [emedicine.medscape.com]

Pathophysiology In a healthy, immunocompetent individual, macrophages and neutrophils normally defend against the inhaled fungus. [patient.info]

Special attention is given to the prevention and treatment of these diseases found in developing countries as well as the latest findings about new antimicrobial agents, gram-negative infections and their management, and recommendations for immunization [books.google.de]

Centers for Disease Control and Prevention (June 12, 2015 updated.) Candidiasis. Available online at http://www.cdc.gov/fungal/diseases/candidiasis/index.html. Accessed August 27, 2016. [labtestsonline.it]

Centers for Disease Control and Prevention Aspergillosis (Medical Encyclopedia) Aspergillosis precipitin (Medical Encyclopedia) Pulmonary aspergilloma (Medical Encyclopedia) [ Read More ] [icdlist.com]

H&O Are there ways to prevent infection with invasive Aspergillus ? BM It is challenging to prevent infection. Many of these patients already have colonization of their bodies with the Aspergillus spores before diagnosis of AML. [hematologyandoncology.net]

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13. Buchheidt D, Baust C, Skladny H, et al. Detection of Aspergillus species in blood and bronchoalveolar lavage samples from immunocompromised patients by means of 2-step polymerase chain reaction: clinical results. Clin Infect Dis. 2001 Aug 15;33(4):428-435.
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