Aspergillosis history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]; Yazan Daaboul, M.D.; Serge Korjian M.D.

Symptoms of aspergillosis are dependent on the clinical syndrome and extent of disease invasion.^[1][2] Patients with allergic bronchopulmonary aspergillosis or sinusitis have symptoms typical of asthma and sinusitis, respectively. Symptoms of invasive pulmonary aspergillosis include spiking fever, pleuritic chest pain, productive cough, dyspnea, and hemoptysis. Symptoms of chronic pulmonary aspergillosis include chronic fever, weight loss, productive cough, and hemoptysis.

• When evaluating a patient for aspergillosis, a detailed history of the presenting symptom (duration, onset, progression), other associated symptoms, and occupational history should be performed. Other specific areas of focus when obtaining the history are outlined below:^[1][2]

• Review past medical history for any previous immunodeficient states such as AIDS, hematological cancers, and cystic fibrosis
• Review past medical history for any previous cavitary pulmonary disease such as tuberculosis or sarcoidosis, which may predispose to aspergilloma formation
• Review surgical history for any organ transplant procedures
• Patients medications review for any immune-suppressive drugs such as chemotherapy and long term corticosteroid use

• The following algorithm demonstrates common clinical syndromes that develop following Aspergillus inhalation among different patient groups:
  
  

^{Adapted from Kousha M, Tadi R, and Soubani AO. Pulmonary aspergillosis: a clinical review. Euro Respir Rev. 2011;20(121):156-74[2] / Soubani AO, Chandrasekar PH. The clinical spectrum of pulmonary aspergillosis. Chest. 2002;121(6):1988-99.[3]}

• The specific clinical presentation of aspergillosis is determined by the exact clinical subtype of the disease:^[1][2]

• Wheezing
• Cough
• Fever (in rare cases)

• Increased sinus drainage
• Nasal stuffiness
• Headache
• Facial tenderness
• Eosinophilic secretions

• Most patients with aspergilloma are asymptomatic
• Mild haemoptysis (most common symptom)
• Cough
• Dyspnea
• Fever (related to bacterial super-infection)

• Chronic fever (1-6 months)
• Malaise
• Fatigue
• Weight loss
• Chronic productive cough
• Dyspnea
• Hemoptysis (may be severe)

• Spiking fever (refractory to antibiotic therapy)
• Pleuritic chest pain
• Cough
• Dyspnea
• Haemoptysis
• Headache
• Seizures

• Fever
• Cutaneous lesions (macules, papules, nodules, or plaques)
• Central ulceration or eshcar formation