Synopsis
Differentiate allergic, chronic, fungal-ball and invasive Aspergillus syndromes, combine imaging with organism-specific biomarkers and tissue diagnosis, and deliver early phenotype-appropriate antifungal and procedural care.
- Aspergillus causes distinct syndromes: allergic bronchopulmonary aspergillosis, aspergilloma, chronic pulmonary aspergillosis and invasive disease; a positive respiratory culture must be interpreted within that phenotype.
- Invasive pulmonary aspergillosis is especially associated with prolonged neutropenia, acute leukaemia, allogeneic transplantation, solid-organ transplantation, corticosteroids, chronic granulomatous disease and severe influenza or COVID-19 critical illness.
- First-line imaging for suspected invasive pulmonary disease is urgent thin-section CT chest; nodules, surrounding ground-glass halo, wedge infarcts or cavitation support but do not independently prove infection.
Key red flags
Massive or recurrent haemoptysis with an aspergilloma or chronic cavitary disease requires emergency airway, interventional-radiology and thoracic-surgical assessment.
Persistent fever, dry cough, pleuritic chest pain, dyspnoea or haemoptysis occurs in an immunocompromised host, sometimes with few auscultatory findings.
Investigation priorities
Detect early nodules, infarct-shaped lesions, halo sign, consolidation, cavitation, air-crescent change and chronic structural progression.
Management branches
A high-risk host develops persistent fever, focal chest symptoms, hypoxaemia, nodules or extrapulmonary signs.
- Obtain urgent thin-section CT chest and targeted sinus or brain imaging, then send serum galactomannan, beta-D-glucan and Aspergillus PCR according to local diagnostic policy.
- Collect sputum or BAL for microscopy, fungal culture, galactomannan and PCR before treatment when safe; pursue tissue from a peripheral lesion or involved site if feasible.
Invasive disease is proven, probable or strongly suspected and no overriding contraindication changes drug choice.