Invasive Aspergillosis Symptoms and Diagnosis

Clinical Presentation

The primary symptoms of invasive aspergillosis include fever, cough, dyspnea, chest pain, hemoptysis, and hypoxemia, with radiographic evidence of diffuse, focal, or cavitary infiltrates, according to the Centers for Disease Control and Prevention (CDC) 1, 2
Invasive aspergillosis most commonly presents as a respiratory illness with two main forms: necrotizing pneumonia and tracheobronchitis, characterized by fever, cough, dyspnea, pleuritic chest pain, hemoptysis, and hypoxemia 1
Tracheobronchitis is characterized by fever, cough, dyspnea, stridor, and wheezing 1

Chest radiographs may show diffuse, focal, or cavitary infiltrates 1
CT scan findings include the "halo sign" and "air-crescent sign", which are less common in children than adults 1

Symptoms should be evaluated with higher suspicion in patients with advanced HIV infection (CD4+ counts <100 cells/μL) 1
Patients with a history of other AIDS-defining opportunistic infections should be evaluated with higher suspicion 1
Patients not receiving antiretroviral therapy should be evaluated with higher suspicion 1
Prolonged corticosteroid use is a risk factor for invasive aspergillosis 1
Exposure to broad-spectrum antibiotics is a risk factor for invasive aspergillosis 1
Previous pneumonia or underlying lung disease is a risk factor for invasive aspergillosis 1

Bronchoscopic examination in tracheobronchitis cases shows multiple ulcerative or plaque-like lesions on the tracheal wall, as recommended by the CDC 1
Galactomannan testing of serum or bronchoalveolar lavage fluid can aid diagnosis, according to the CDC 1
Definitive diagnosis requires histological evidence of tissue invasion by hyphae with positive culture, as recommended by the CDC 1