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Invasive Aspergillosis: Diagnosis and Treatment

Life-threatening mold infection in immunocompromised patients requiring rapid diagnosis and antifungal therapy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Internal Medicine department. Book Appointment →

What is Invasive Aspergillosis: Diagnosis and Treatment?

Invasive aspergillosis (IA) is a severe opportunistic infection caused predominantly by Aspergillus fumigatus and other species (A. flavus, A. terreus, A. niger). It primarily affects immunocompromised hosts including those with prolonged neutropenia, allogeneic stem cell transplant, solid organ transplant, advanced HIV/AIDS, prolonged corticosteroid therapy, ICU patients with severe influenza or COVID-19. Mortality remains 30-50% even with optimal therapy.

Pulmonary disease is most common (90%), but extrapulmonary sites include sinuses, central nervous system, skin, and disseminated infection. Diagnosis combines clinical features (fever, hemoptysis, pleuritic pain), CT imaging (halo sign, air crescent sign, dense consolidations, cavities), serum and BAL galactomannan, beta-D-glucan, PCR, and definitive culture or histopathology of tissue.

EORTC/MSGERC criteria classify cases as proven, probable, or possible based on host factors, clinical features, and mycological evidence. First-line antifungals are voriconazole or isavuconazole; lipid amphotericin B for refractory or intolerant cases. Combination therapy with echinocandin is considered in severe disease. Therapeutic drug monitoring of azoles, source control, and reducing immunosuppression when feasible are essential.

Symptoms

Persistent fever despite broad-spectrum antibiotics
Cough, often productive
Pleuritic chest pain
Hemoptysis (sometimes massive)
Dyspnea and hypoxemia
Sinusitis (facial pain, nasal congestion, black eschar)
Headache, focal neurologic deficits (CNS involvement)
Skin lesions (necrotic, ecthyma-like)
Endophthalmitis
Disseminated disease with multi-organ involvement
Fungus ball in pre-existing cavity (chronic forms)
Bronchospasm in ABPA-related disease
Bone or vertebral osteomyelitis

Risk Factors

Prolonged severe neutropenia (more than 10 days)
Allogeneic hematopoietic stem cell transplant
Solid organ transplant (lung, heart-lung)
Advanced HIV/AIDS with low CD4
Long-term corticosteroid use (more than 0.3 mg/kg prednisolone)
Ibrutinib and other BTK inhibitor therapy
Severe COVID-19 (CAPA)
Severe influenza (IAPA)
Decompensated cirrhosis
Critical illness in ICU
Construction or environmental Aspergillus exposure
Prior chronic pulmonary disease (COPD, bronchiectasis, sarcoidosis)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent fever in immunocompromised patient
  • New respiratory symptoms with imaging abnormalities
  • Hemoptysis
  • Sinus pain or facial swelling with eschar
  • New neurologic deficits in immunocompromised patient
  • Skin lesions of concern
  • Failure to respond to antibacterial therapy

Treatment Methods

01
Comprehensive risk assessment for host factors
02
High-resolution CT chest at first suspicion
03
Serum galactomannan and beta-D-glucan; repeat to monitor
04
Bronchoalveolar lavage with galactomannan, fungal culture, PCR
05
Tissue biopsy with culture and histopathology when feasible
06
Brain MRI for neurologic symptoms
07
Sinus endoscopy with biopsy for sinonasal disease
08
Initiate empiric therapy promptly when probable disease
09
First-line: voriconazole 6 mg/kg loading then 4 mg/kg twice daily IV/PO with TDM target trough 1-5.5 mg/L
10
Alternative first-line: isavuconazole 200 mg three times daily x 6 doses then 200 mg daily
11
Lipid amphotericin B (3-5 mg/kg/day) for refractory disease, intolerance, or CNS
12
Combination voriconazole plus echinocandin for severe disease (selected cases)
13
Posaconazole for prophylaxis and step-down therapy
14
Source control: surgical resection of single isolated cavity with persistent disease, drainage of empyema, debridement of sinus disease
15
Reduce immunosuppression where possible (taper steroids, hold mycophenolate, restore immune function)
16
G-CSF and granulocyte transfusions in select neutropenic patients
17
Therapeutic drug monitoring for azoles every 5-7 days early then weekly
18
Manage drug interactions, especially with calcineurin inhibitors and chemotherapy
19
Treat at least 6-12 weeks; longer for CNS or persistent immunosuppression
20
Secondary prophylaxis if ongoing immunosuppression
21
Multidisciplinary care: infectious diseases, transplant team, pulmonology, surgery, pharmacy

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.