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Diagnosis of invasive aspergillosis

Author
Kieren A Marr, MD
Section Editor
Carol A Kauffman, MD
Deputy Editor
Anna R Thorner, MD

INTRODUCTION

The term "aspergillosis" refers to illness due to allergy, airway or lung invasion, cutaneous infection, or extrapulmonary dissemination caused by species of Aspergillus, most commonly A. fumigatus, A. flavus, and A. terreus. Aspergillus species are ubiquitous in nature, and inhalation of infectious conidia is a common event. However, tissue invasion is uncommon and occurs most frequently in the setting of immunosuppression associated with receipt of therapy for hematologic malignancies or hematopoietic cell or solid organ transplantation.

The diagnosis of invasive aspergillosis will be reviewed here. The epidemiology, clinical manifestations, and treatment of invasive aspergillosis are discussed separately; the diagnosis of invasive aspergillosis in HIV-infected patients as well as the diagnosis of other syndromes caused by Aspergillus spp are also presented elsewhere. (See "Epidemiology and clinical manifestations of invasive aspergillosis" and "Treatment and prevention of invasive aspergillosis" and "Clinical manifestations and diagnosis of allergic bronchopulmonary aspergillosis" and "Clinical manifestations and diagnosis of chronic pulmonary aspergillosis" and "Diagnosis and treatment of invasive pulmonary aspergillosis in HIV-infected patients".)

APPROACH TO DIAGNOSIS

Culture of Aspergillus spp in combination with the histopathologic demonstration of tissue invasion by hyphae provides definitive evidence of invasive aspergillosis. However, biopsy is frequently not feasible due to the risks of complications (eg, bleeding risk in patients with thrombocytopenia). A rational first step to establishing the diagnosis of invasive aspergillosis involves the use of noninvasive modalities, such as serum biomarkers (galactomannan and beta-D-glucan assays), and obtaining sputum and/or bronchoalveolar lavage (BAL) specimens for fungal staining and culture. When BAL is performed, a sample should be sent for galactomannan antigen testing.

A positive sputum fungal stain and/or culture should prompt therapy of hosts who are at risk for invasive aspergillosis. The galactomannan assay is relatively specific for invasive aspergillosis, and, in the right clinical context, provides adequate evidence of invasive pulmonary disease. In contrast, a positive beta-D-glucan assay can occur in the setting of various invasive fungal infections, including candidiasis.

Patients with clinical and radiographic findings that are suggestive of an invasive fungal infection but in whom both the serum galactomannan assay and fungal stain and culture of the sputum are negative (or are not able to be obtained) should ideally undergo bronchoscopy with BAL. Lung biopsy should be performed if feasible. Studies have demonstrated that bronchoscopy is safe and frequently yields important diagnostic information, especially when performed early in the evaluation and/or treatment of patients with pulmonary infiltrates [1,2].

                     

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Literature review current through: Nov 2016. | This topic last updated: Mon Dec 28 00:00:00 GMT 2015.
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