Invasive Pulmonary Aspergillosis
This chapter provides a review of the spectrum of invasive pulmonary aspergillosis (IPA), including its epidemiology, clinical and radiographic presentation, outcomes, and unique situations related to IPA. Over 200 species of Aspergillus are known, although only a few have been reported as pathogenic to humans. The more commonly reported human pathogens include A. fumigatus, A. flavus, A. niger, and A. terreus. Of these, A. fumigatus is the most common species to cause invasive disease. Persons at highest risk of development of disease include those with hematologic malignancies, recipients of hematopoietic stem cell transplantation (HSCT; more so with allogeneic than autologous), and recipients of solid organ transplants (SOT). Pleuritic chest pain and hemoptysis may be present, as can altered mental status and respiratory failure. The availability of molecular markers of aspergillosis (galactomannan) allowed investigators to follow a group of 19 patients with IA during the time of neutrophil recovery. The majority of patients survived without any changes in antifungal therapy, and in the three deaths, autopsy revealed no evidence of IPA. Important issues that remain to be addressed include elucidation of the optimal monitoring strategy (diagnostic test of choice, frequency, specimen tested), the role of combination antifungal therapy in the treatment of the disease, and the role of novel adjunctive therapies in disease management. Risk groups are expanding beyond the traditional groups of hematologic malignancy patients and HSCT recipients to include rheumatologic patients on chronic corticosteroid therapy and patients with a prolonged intensive care unit admission.
