Aspergillosis (Aspergillus Infection)

Clinical Features

In immunosuppressed hosts: invasive pulmonary infection, usually with fever, cough, and chest pain. May disseminate to other organs, including brain, skin and bone. In immunocompetent hosts: localized pulmonary infection in persons with underlying lung disease. Also causes allergic sinusitis and allergic bronchopulmonary disease.

Aetiologic Agent

Aspergillus fumigatus, A. flavus. Less commonly A. terreus, A. nidulans, A. niger.

Reservoir

Ubiquitous in the environment. Found in soil, decomposing plant matter, household dust, building materials, ornamental plants, items of food, and water.

Incidence

Not reportable. Population-based data available for San Francisco suggest a rate of 1-2 per 100,000 per year.

Sequelae

If severe granulocytopaenia persists, mortality rate can be very high (up to 100% in patients with cerebral abscesses). Patient outcome depends on resolution of granulocytopaenia and early institution of effective antifungal drug therapy.

Transmission

Inhalation of airborne conidia (spores). Nosocomial infection may be associated with dust exposure during building renovation or construction. Occasional outbreaks of cutaneous infection traced to contaminated biomedical devices.

Risk Groups

Persons with severe, prolonged granulocytopaenia (e.g., haematologic malignancy, haematopoietic stem cell and solid organ transplant recipients, and patients on high-dose corticosteroids). Rarely, persons with HIV infection.

Surveillance

No national surveillance exists. Active surveillance is being conducted among haematopoietic stem cell and solid organ transplant recipients in selected U.S. hospitals.

Challenges

Identifying modifiable risk factors for disease in immunocompromised persons. Improving understanding of sources and routes of transmission from the environment. Developing sensitive and specific methods for earlier diagnosis.

Opportunities

Development of rapid antigenemia and antigenuria tests and molecular probes may facilitate earlier clinical diagnosis. Availability of improved molecular typing methods may assist in epidemiologic studies.

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