ABSTRACT
CONTENTS 21.1 Clinical Presentation ............................................................................................................... 360
21.1.1 Epidemiology and Risk Factors ................................................................................. 360 21.1.1.1 Pulmonary Aspergillosis ........................................................................... 361 21.1.1.2 Invasive Aspergillus Sinusitis .................................................................... 361 21.1.1.3 Cerebral Aspergillosis ............................................................................... 362 21.1.1.4 Cutaneous Aspergillosis ............................................................................ 362 21.1.1.5 Chronic Aspergillosis ................................................................................ 362 21.1.1.6 Aspergilloma .............................................................................................. 363 21.1.1.7 Allergic Bronchopulmonary Aspergillosis ................................................ 363
21.2 Diagnosis ................................................................................................................................. 363 21.2.1 Cultures ..................................................................................................................... 364 21.2.2 Radiology .................................................................................................................. 364
21.2.2.1 Bronchoalveolar Lavage ............................................................................ 365 21.2.2.2 Galactomannan Antigen ........................................................................... 365 21.2.2.3 (1,3)-β-D-Glucan ....................................................................................... 366 21.2.2.4 Polymerase Chain Reaction (PCR) ........................................................... 366
21.3 Treatment ................................................................................................................................ 367 21.3.1 Immunomodulatory Therapy .................................................................................... 368
21.4 Prognosis ................................................................................................................................. 369 References .......................................................................................................................................... 370
Aspergillosis refers to infection with any of the approximately 185 recognized species of the genus Aspergillus, of which only 20 are known to cause human disease. Most human disease is primarily caused by Aspergillus fumigatus, Aspergillus fl avus, Aspergillus niger, Aspergillus terreus, and Aspergillus nidulans [1]. Aspergillus fumigatus causes approximately 90% of cases of invasive aspergillosis [2], and most pulmonary disease is caused by A. fumigatus, while most isolated sinus disease is caused by A. niger and A. fl avus [3]. A review of Aspergillus cultures found that amphotericin B-resistant A. terreus was seen in only 3% of isolates in cases of invasive aspergillosis and found exclusively in cases of invasive disease, and not in patients with colonization [3].
