P1: SBT
0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8
Aspergillosis 167➣Extremely high mortality (up to 100%) despite prompt surgical
and medical therapy
➣High mortality may reflect rapid growth and angio-invasiveness
of organism
■Manifestations depend on site of infection:
➣Lung:
Most common site of primary invasive disease
Neutropenic patients may have a fulminant course with high
fevers and dense infiltrates on chest x-ray
Cavitation can occur during bone marrow recovery as seen on
CT
Hemoptysis, pneumothorax and dissemination may occur
➣Sinus:
Indolent or fulminant based on host factors
Can present as headaches, sinus tenderness, proptosis or
monocular blindness
Neutropenic patients may progress rapidly with spread to con-
tiguous structures, vascular invasion and necrosis
➣Central nervous system:
May be seen as brain or epidural abscesses, meningitis (more
unusual) or subarachnoid hemorrhage
Strokes may occur with cerebral vessel invasion and infarction
➣Skin:
Usually via hematogenous spread; primary infection is less
common
Present as erythematous papules that progress to pustules;
eventually an ulcer covered by a black eschar forms
Primary skin infections associated with burn wounds and con-
taminated adhesive dressings
tests
Laboratory
■Blood cultures and CSF rarely positive
➣Isolation in urine, sputum, stool or wound interpreted in context
of the host (eg, sputum culture in a neutropenic patient with an
infiltrate may suggest invasive disease)
➣Basic studies: histopathology
Acute angle, septated, branching and non-pigmented hyphae
Best seen with Gomori methenamine silver and Periodic acid-
Schiff stains