Aspergillosis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Haytham Allaham, M.D. [2]; Serge Korjian M.D.

Overview

Apergillosis may be classified according to the clinical syndrome it causes into allergic bronchopulmonary aspergillosis, allergic Aspergillus sinusitis, aspergilloma, chronic pulmonary aspergillosis, invasive aspergillosis, or cutaneous aspergillosis.

Classification

Apergillosis may be classified according to the clinical syndrome it causes into the following:

• Allergic bronchopulmonary aspergillosis
• Allergic Aspergillus sinusitis
• Aspergilloma
• Chronic pulmonary aspergillosis
• Invasive aspergillosis
• Cutaneous aspergillosis

The table below distinguishes between the different types of aspergillosis:

Clinical Syndrome	Characteristics
Allergic Bronchopulmonary Aspergillosis (ABPA)	Immune-modulated pulmonary disease due to hypersensitivity to A. fumigatus (not an infection) Clinical features include persistent cough, wheezing, symptoms of asthma exacerbation or bronchiectasis Common among patients with asthma Recurrent pulmonary infiltrates on chest imaging May result in development of bronchiectasis, chronic pulmonary aspergillosis, or aspergilloma Treatment with antifungal agents, steroids, and asthma control
Allergic Aspergillus Sinusitis / Rhinosinusitis	Immune-modulated sinus disease (not an infection) Clinical features of recurrent or resistant sinusitis, such as increased sinus drainage, stuffiness, headache, facial tenderness, and eosinophilic secretions Non-invasive Common in healthy young adults Diagnosed using Bent and Kuhn diagnostic criteria (see criteria here) Unilateral, asymmetric involvement of sinues with bone erosions on imaging Treamtent includes de-obstruction, nasal drainage, oral steroids, immunotherapy against allergens, and allergy control
Aspergilloma (Fungus Ball)	An Aspergillus mass colonizes locally in either the lungs or the sinuses May occur with chronic pulmonary aspergillosis Clinical features vary from an asymptomatic course to fatal hemoptysis Common among individuals with prior history of lung diseases, including tuberculosis Chest CT in prone position shows movable fungus ball Treatment includes surgical resection
Chronic Pulmonary Aspergillosis	Invasion of Aspergillus in the lungs for > 3 months May occur with aspergillomas (single or multiple) Clinical features include weight loss, chronic productive cough, dyspnea, and hemoptysis On Imaging, 1 of 3 patterns is characteristic: 1) multiple cavities (chronic cavitary pulmonary aspergillosis - CCPA, in immunocompetent patients, chronic course), 2) fibrosis (chronic fibrosing pulmonary aspergillosis - CFPA, in immunocompetent patient, chronic course, follows CCPA), or 3) subacutely enlarging single cavity (chronic necrotizing pulmonary aspergillosis - CNPA, subacute within weeks i.e. not chronic, in immunocompromised patients) Treatment includes systemic antifungal therapy with or without intracavitary antifungal agents
Invasive Aspergillosis	Severe infection among immunocompromised individuals (e.g. transplant recipients or neutropenic patients) Associated with high mortality rate May progress to involve other non-pulmonary organs Non-specific clinical features make diagnosis difficult, may mimic asthma or bronchitis Classical triad of fever, pleuritic chest pain, and hemoptysis Focal nodules and infiltration common on imaging Treatment includes antifungal agents
Cutaneous Aspergillosis	Infection of the skin Invasion may be either primary through a skin lesion (e.g. surgical or burn wound or at catheter site) or secondary to a distant organ with subsequent dissemination to the skin Common among immunocompromised individuals and neonates Clinical features usually include fever, change in lesion morphology. Lesions are commonly macules, papules, nodules, or plaques. Other lesions may also occur. Diagnosis is by biopsy of the lesion, evaluation of other primary sources (e.g. CT scan for pulmonary lesions) is necessary Treatment includes antifungal agents with or without surgery