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:[1]

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[2]
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[3]
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[4]
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[5]
Invasive Aspergillosis
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[7]

References

  1. Definition of Aspergillosis - Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/fungal/diseases/aspergillosis/definition.html Accessed on Feb 8 2016
  2. Agarwal R, Chakrabarti A, Shah A, Gupta D, Meis JF, Guleria R; et al. (2013). "Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria". Clin Exp Allergy. 43 (8): 850–73. doi:10.1111/cea.12141. PMID 23889240.
  3. Glass D, Amedee RG (2011). "Allergic fungal rhinosinusitis: a review". Ochsner J. 11 (3): 271–5. PMC 3179194. PMID 21960761.
  4. Lee SH, Lee BJ, Jung DY, Kim JH, Sohn DS, Shin JW; et al. (2004). "Clinical manifestations and treatment outcomes of pulmonary aspergilloma". Korean J Intern Med. 19 (1): 38–42. PMC 4531547. PMID 15053042.
  5. Denning DW, Riniotis K, Dobrashian R, Sambatakou H (2003). "Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review". Clin Infect Dis. 37 Suppl 3: S265–80. doi:10.1086/376526. PMID 12975754.
  6. Naaraayan A, Kavian R, Lederman J, Basak P, Jesmajian S (2015). "Invasive pulmonary aspergillosis - case report and review of literature". J Community Hosp Intern Med Perspect. 5 (1): 26322. doi:10.3402/jchimp.v5.26322. PMC 4318821. PMID 25656673. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW; et al. (2002). "Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis". N Engl J Med. 347 (6): 408–15. doi:10.1056/NEJMoa020191. PMID 12167683.
  7. van Burik JA, Colven R, Spach DH (1998). "Cutaneous aspergillosis". J Clin Microbiol. 36 (11): 3115–21. PMC 105285. PMID 9774549.

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