Aspergillosis natural history, complications and prognosis

Following transmission, the majority of patients do not develop any clinical manifestations. The incubation of Aspergillosis is highly dependent on the host immune factors. The incubation period may range from a few days to years, during which the host is asymptomatic. Among immunocompetent hosts, Aspergillosis may result in a localized pulmonary infection, allergic bronchopulmonary aspergillosis, or allergic Aspergillus sinusitis. Among immunocompromised hosts, Aspergillosis progresses faster and has a more invasive course. If left untreated, aspergillosis in immunocompromised patients often progresses, and patients report worsening fever, chest pain, and hemoptysis. Invasive aspergillosis eventually disseminates to non-pulmonary organs and results in life-threatening complications.

• Following transmission, the majority of patients do not develop any clinical manifestations.
• The incubation of Aspergillosis is highly dependent on the host immune factors. The incubation period may range from a few days to years, during which the host is asymptomatic.

• Among immunocompetent hosts, Aspergillosis may result in a localized pulmonary infection, allergic bronchopulmonary aspergillosis, or allergic Aspergillus sinusitis.
• Clinical manifestations may vary depending on the clinical syndrome. In allergic aspergillosis, patients often develop mild symptoms of asthma or sinusitis with productive cough, wheezing, and stuffiness.
• Patients with chronic aspergillosis, however, may develop chronic fever, constitutional symptoms (such as weight loss), dyspnea, and occasionally hemoptysis. If left untreated, patients who develop chronic cavitary aspergillosis may then progress to develop chronic fibrosing aspergillosis and respiratory failure.

• Among immunocompromised hosts, Aspergillosis progresses faster and has a more invasive course.
• Immunocompromised patients are at higher risk of developing invasive aspergillosis, aspergilloma, chronic necrotizing aspergillosis, and cutaneous aspergillosis secondary to lung aspergillosis.
• If left untreated, aspergillosis in immunocompromised patients often progresses, and patients report worsening fever, chest pain, and hemoptysis.
• Invasive aspergillosis eventually disseminates to non-pulmonary organs and results in life-threatening complications.

Complications of aspergillosis includes the following:

• Aortitis
• Acute kidney injury
• Hepatic injury
• Bronchiectasis
• Hemorrhage
• Respiratory failure
• Acute respiratory distress syndrome
• Encephalitis
• Asthma exacerbation
• Atelectasis
• Progressive pulmonary fibrosis
• Osteomyelitis
• Cardiothoracic aspergillosis
• Cardiac aspergillosis
• Valvular fungus ball
• Endocarditis
• Lacrimal canaliculitis

• The prognosis of aspergillosis varies according to the clinical syndrome.
• Allergic bronchopulmonary aspergillosis and allergic Aspergillus sinusitis generally have a good prognosis and rarely result in mortality.
• In contrast, the prognosis for either invasive aspergillosis or chronic necrotizing pulmonary aspergillosis is generally poor. The mortality rate may be as high as 40% to 90%.^[1]
• Poor prognostic factors include:

• Diagnosis of invasive aspergillosis
• Age extremes
• Severe immunosuppression
• Extensive degree of invasion at diagnosis