| Clinical
Features |
In immunosuppressed hosts: invasive
pulmonary infection, usually with fever, cough, and chest
pain. 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. |
|
December 2003
|
