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Aspergillosis
In immunosuppressed hosts: invasive pulmonary infection, usually with fever, cough, and chest pain.
| Clinical Features |
May disseminate to other organs, including brain, skin and bone. In immunocompetent hosts: localized pulmonary infection in persons with underlying lung disease. Also causes allergic sinusitis and allergic bronchopulmonary disease. |
| Etiologic Agent |
Aspergillus fumigatus, A. flavus. Less commonly A. terreus, A. nidulans, A. niger. |
| Reservoir |
Ubiquitous in the environment. Found in soil, decomposing plant matter, household dust, building materials, ornamental plants, items of food, and water. |
| Incidence |
Not reportable. Population-based data available for San Francisco suggest a rate of 1-2 per 100,000 per year. |
| Sequelae |
If severe granulocytopenia persists, mortality rate can be very high (up to 100% in patients with cerebral abscesses). Patient outcome depends on resolution of granulocytopenia and early institution of effective antifungal drug therapy. |
| Transmission |
Inhalation of airborne conidia (spores). Nosocomial infection may be associated with dust exposure during building renovation or construction. Occasional outbreaks of cutaneous infection traced to contaminated biomedical devices. |
| Risk Groups |
Persons with severe, prolonged granulocytopenia (e.g., hematologic malignancy, hematopoietic stem cell and solid organ transplant recipients, and patients on high-dose corticosteroids). Rarely, persons with HIV infection. |
| Surveillance |
No national surveillance exists. Active surveillance is being conducted among hematopoietic stem cell and solid organ transplant recipients in selected U.S. hospitals. |
| Challenges |
Identifying modifiable risk factors for disease in immunocompromised persons. Improving understanding of sources and routes of transmission from the environment. Developing sensitive and specific methods for earlier diagnosis. |
| Opportunities |
Development of rapid antigenemia and antigenuria tests and molecular probes may facilitate earlier clinical diagnosis. Availability of improved molecular typing methods may assist in epidemiologic studies. |
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