29th July 2023

Invasive aspergillosis

The most severe form of the disease will typically only infect immunocompromised patients. Infection typically begins with pulmonary manifestations and may disseminate to various organ systems, such as the kidneys, heart, skin and CNS, where it can cause a meningitic illness. It is also a cause of endocarditis, and haematogenous spread is associated with endophthalmitis of the eye (inflammation of the intraocular fluids).

Regardless of the site affected, the patient will present with a systemic illness of fever, malaise, and sometimes rigors. Life-threatening complications such as sepsis, mass haemoptysis, kidney and liver failure, and airway obstruction may occur.

Diagnosis is confirmed with serological testing for Aspergillus.

Management is with high dose IV antifungals, such as voriconazole. Second line options include caspofungin and amphotericin B for cases which do not respond to initial treatment. Evidence increasingly suggests better outcomes with a combination of voriconazole and caspofungin, which is now generally first line management.

Pulmonary artery embolisation – and even surgery – may be required to manage severe or persistent haemoptysis.