Aspergillosis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]; Yazan Daaboul, M.D.; Serge Korjian M.D.
Overview
Symptoms of aspergillosis are dependent on the clinical syndrome and extent of disease invasion.[1][2] Patients with allergic bronchopulmonary aspergillosis or sinusitis have symptoms typical of asthma and sinusitis, respectively. Symptoms of invasive pulmonary aspergillosis include spiking fever, pleuritic chest pain, productive cough, dyspnea, and hemoptysis. Symptoms of chronic pulmonary aspergillosis include chronic fever, weight loss, productive cough, and hemoptysis.
History
- When evaluating a patient for aspergillosis, you should take a detailed history of the presenting symptom (duration, onset, progression), other associated symptoms, and a thorough occupational history. Other specific areas of focus when obtaining the history are outlined below:[1][2]
- Review past medical history for any previous immunodeficient states such as AIDS, hematological cancers, and cystic fibrosis
- Review past medical history for any previous cavitary pulmonary disease such as tuberculosis or sarcoidosis, which may predispose to aspergilloma formation
- Review surgical history for any organ transplant procedures
- Patients medications review for any immune-suppressive drugs such as chemotherapy and long term corticosteroid use
- The following algorithm demonstrates common clinical syndromes that develop Aspergillus inhalation among different patient groups:
| Inhalation of Aspergillus spores | |||||||||||||||||||||||||||||||||||||||||
| Healthy host | Cavitary lung disease | Chronic lung disease or mildly immunocompromised host | Immunocompromised host | Either asthma, cystic fibrosis, or atopy | |||||||||||||||||||||||||||||||||||||
| No sequelae | Aspergilloma | Chronic necrotizing aspergillosis | Invasive pulmonary aspergillosis | Allergic bronchopulmonary aspergillosis (ABPA) | |||||||||||||||||||||||||||||||||||||
Adapted from Kousha M, Tadi R, and Soubani AO. Pulmonary aspergillosis: a clinical review. Euro Respir Rev. 2011;20(121):156-74[2] / Soubani AO, Chandrasekar PH. The clinical spectrum of pulmonary aspergillosis. Chest. 2002;121(6):1988-99.[3]
Symptoms
- The specific clinical presentation of aspergillosis is determined by the exact clinical subtype of the disease such as:[1][2]
Allergic Bronchopulmonary Aspergillosis (ABPA)
Allergic Aspergillus Sinusitis / Rhinosinusitis
- Increased sinus drainage
- Nasal stuffiness
- Headache
- Facial tenderness
- Eosinophilic secretions
Aspergilloma
- Most patients with aspergilloma are asymptomatic
- Mild haemoptysis (most common symptom)
- Cough
- Dyspnea
- Fever (related to bacterial super-infection)
Chronic Pulmonary Aspergillosis
- Chronic fever (1-6 months)
- Malaise
- Fatigue
- Weight loss
- Chronic productive cough
- Dyspnea
- Hemoptysis (may be severe)
Invasive Pulmonary Aspergillosis
- Spiking fever (refractory to antibiotic therapy)
- Pleuritic chest pain
- Cough
- Dyspnea
- Haemoptysis
- Headache
- Seizures
Cutaneous Aspergillosis
References
- ↑ 1.0 1.1 1.2 Aspergillosis. MAYO CLINIC (2015) http://www.mayoclinic.org/diseases-conditions/aspergillosis/basics/risk-factors/con-20030330 Accessed on February, 8 2016
- ↑ 2.0 2.1 2.2 2.3 Kousha M, Tadi R, Soubani AO (2011). "Pulmonary aspergillosis: a clinical review". Eur Respir Rev. 20 (121): 156–74. doi:10.1183/09059180.00001011. PMID 21881144.
- ↑ Soubani AO, Chandrasekar PH (2002). "The clinical spectrum of pulmonary aspergillosis". Chest. 121 (6): 1988–99. PMID 12065367.