Fact-sheet: Invasive pulmonary aspergillosis
Updated on 02/17/2022 at 3:53 PM
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Definition
Severe form of aspergillosis (infection caused by Aspergillus fumigatus: a ubiquitous filamentous fungus)
Setting: severe generalized immunosuppression (neutrophils < 500)
2 forms:
- Angioinvasive
- Bronchoinvasive (15 to 30% of invasive forms)
NB: chronic necrotizing form = former semi-invasive form --> more moderate generalized immunosuppression, chronic disease (e.g., diabetic on corticosteroid therapy)
Clinical features
Hematologic malignancies (acute leukemia on chemotherapy, bone marrow allograft)
Transplant recipients, particularly lung transplant recipients
Radiography
Nonspecific, poorly sensitive
Opacities that may cavitate in the angioinvasive form
CT
- Angioinvasive form: nodules followed by alveolar consolidations with rapid cavitation due to necrosis (2 weeks to 1 month) --> formation of a primary mycetoma
The air crescent sign may be seen, as in aspergilloma: intracavitary consolidation with a peripheral air crescent, resulting from rapidly progressive cavitation of the initial consolidation
Halo sign: peripheral ground-glass opacity (perilesional alveolar hemorrhage)
- Bronchoinvasive form: nonspecific bronchopneumonia pattern (alveolar consolidations, centrilobular micronodules = tree-in-bud pattern --> as in bronchiolitis)
- Chronic necrotizing form: resembles the angioinvasive form.
Predominantly upper lobe alveolar consolidations that progressively cavitate (over several months), unlike the angioinvasive form --> comparison with prior studies is important
Vascular intervention
Embolization in case of hemoptysis
Management
Antifungal therapy tailored after sampling
(antigenemia in immunocompromised patients, sputum, BAL)
Classification
Denning criteria for the chronic necrotizing form (2003):
- compatible pulmonary or systemic symptoms for at least 3 months
- pulmonary cavitary lesion
- Aspergillus species on sampling
- biological inflammatory syndrome
- no other identified pathogen that would produce a similar picture
- moderate immunosuppression
--> all criteria are required
Differential diagnosis
All pulmonary mycoses
