Internal Medicine

P1: SBT

0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8

166 Ascites Aspergillosis

■25% 1-y survival once ascites becomes refractory

■20% 1-y survival after first episode of spontaneous ascitic fluid infec-

tion

ASPERGILLOSIS

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Aspergillus species ubiquitous molds found in every country

■Found in soil and decomposing vegetable matter

■Aspergillus fumigatus cause about 90% of invasive disease

■Nosocomial infection via airborne transmission has been suggested

after case clusters in transplantation wards have been reported

■Airborne conidia or spores can enter the alveoli, nose, paranasal

sinuses, ear or skin if traumatized (IV sites, occlusive dressings,

etc)

Signs & Symptoms

■Continuum of colonization to invasive disease

■Three main spectra of disease: allergic bronchopulmonary asper-

gillosis (ABPA), pulmonary aspergilloma and invasive aspergillois

(lungs, sinuses, central nervous system, ears, eyes, skin, other sites)

■Allergic bronchopulmonary aspergillosis (ABPA):

➣Hypersensitivity pulmonary disease

➣Usually caused by A fumigatus

➣Suspect in corticosteroid-dependent asthmatic with wheezing,

pulmonary infiltrates, fevers, eosinophilia in sputum and blood

and sputum with brown flecks or plugs

■Pulmonary aspergilloma:

➣Comprised of matted tangle of Aspergillus hyphae, mucus, fib-

rin and cellular debris in a pulmonary cavity (eg, as in bullous

emphysema or cavitary tuberculosis)

➣Hemoptysis is common; cause of mortality in 25% patients with

aspergilloma

■Invasive aspergillosis:

➣Think of risk factors for invasive disease: neutropenia, long-term

corticosteroid therapy, bone marrow or solid transplantation

patients