Aspergillis fumigatus

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Key Points

  • Aspergillus fumigatus
    • Includes A. flavus, A. fumigatus, and A. parasiticus
    • Characteristics
      • Fungi that exists in mold form only
        • Narrow septate hyphae
        • Branches at (acute) 45º angle
          • V-shaped branches
          • Contrast vs. Mucor/Rhizopus (broad non-septate hyphae branching at right angles)
    • Transmission
      • Grows on decaying vegetation
        • E.g. leaves, vegetables, corn, soybeans, peanuts, compost
      • Opportunistic fungal infection
    • Presentation and Treatment
      • Invasive aspergillosis
        • Usually affects immunocompromised patients
        • Formation of lung granulomas
        • Fever, pleuritic chest pain, hemoptysis
        • Can spread hematogenously, causing disseminated disease
        • Treat with voriconazole (or isavuconazole)
          • Amphotericin B or caspofungin is used second-line
      • Aspergillomas
        • Fungus balls in pre-existing lung cavities (especially after TB infection)
        • Treat with surgical removal
      • Allergic bronchopulmonary aspergillosis (ABPA)
        • Asthma-like hypersensitivity response
          • Presents with wheezing
          • Eosinophilia with elevated IgE and IgG vs. Aspergillus
          • Associated with asthma and cystic fibrosis
        • Treat with corticosteroids
    • Complications
      • May produce aflatoxins
        • Produced as a byproduct of corn/soybean metabolism
        • Associated with hepatocellular carcinoma