Chest
Volume 121, Issue 6, June 2002, Pages 1988-1999
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The Clinical Spectrum of Pulmonary Aspergillosis

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Aspergillus is a ubiquitous fungus that causes a variety of clinical syndromes in the lung, ranging from aspergilloma in patients with lung cavities, to chronic necrotizing aspergillosis in those who are mildly immunocompromised or have chronic lung disease. Invasive pulmonary aspergillosis (IPA) is a severe and commonly fatal disease that is seen in immunocompromised patients, while allergic bronchopulmonary aspergillosis is a hypersensitivity reaction to Aspergillus antigens that mainly affects patients with asthma. In light of the increasing risk factors leading to IPA, such as organ transplantation and immunosuppressive therapy, and recent advances in the diagnosis and treatment of Aspergillus-related lung diseases, it is essential for clinicians to be familiar with the clinical presentation, diagnostic methods, and approach to management of the spectrum of pulmonary aspergillosis.

Section snippets

Aspergilloma

This is the most common and best-recognized form of pulmonary involvement due to Aspergillus. The aspergilloma (fungal ball) consists of masses of fungal mycelia, inflammatory cells, fibrin, mucus, and tissue debris, usually developing in a preformed lung cavity. Although other fungi may cause the formation of a fungal ball (for example, Zygomycetes and Fusarium), Aspergillus spp (specifically, A fumigatus) are by far the most common etiologic agents.

The true incidence of aspergilloma is not

Chronic Necrotizing Aspergillosis

Also called semi-invasive aspergillosis, this entity was first described in two reports in 1981 and 1982.40,41 Chronic necrotizing aspergillosis (CNA) is an indolent, destructive process of the lung due to invasion by Aspergillus species (usually A fumigatus). This entity is different from aspergilloma in that there is local invasion of the lung tissue, and a preexisting cavity is not needed, although a cavity with a fungal ball may develop in the lung as a secondary phenomenon due to

IPA

The incidence of IPA has been on the rise since it was first described in 1953.45 Groll et al46 documented a rise in the rate of invasive mycoses from 0.4 to 3.1% of all autopsies performed between 1978 and 1992. In addition, invasive aspergillosis increased from 17% of all mycoses found on autopsy at the beginning of the study to 60% at the end of the 14-year study period.

The vast majority of IPA cases are seen in immunocompromised patients. The risk factors are summarized in Table 1.47,48,49,

Allergic Bronchopulmonary Aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus antigens, mostly due to A fumigatus. It is typically seen in patients with long-standing asthma or cystic fibrosis, and it is estimated that 7 to 14% of corticosteroid-dependent asthma patients and 6% of patients with cystic fibrosis meet the diagnostic criteria for ABPA.116,117 The factors leading to ABPA are not clearly understood. It is believed that Aspergillus-specific, IgE-mediated type I

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