What are the symptoms of invasive aspergillosis?

Symptoms of Invasive Aspergillosis

The primary symptoms of invasive aspergillosis include fever, cough, dyspnea, chest pain, hemoptysis, and hypoxemia, with radiographic evidence of diffuse, focal, or cavitary infiltrates. 1

Pulmonary Manifestations (Most Common)

Invasive aspergillosis most commonly presents as a respiratory illness with two main forms:

• Necrotizing pneumonia characterized by:

  • Fever unresponsive to broad-spectrum antibiotics 2
  • Cough 1
  • Dyspnea (shortness of breath) 1
  • Pleuritic chest pain 1, 2
  • Hemoptysis (typically occurs late, often after neutrophil recovery) 1, 2, 3
  • Hypoxemia 1

• Tracheobronchitis characterized by:

  • Fever 1
  • Cough 1
  • Dyspnea 1
  • Stridor 1
  • Wheezing 1

Radiological Findings

• Chest radiographs may show diffuse, focal, or cavitary infiltrates 1
• CT scan findings include:
  • "Halo sign" (a zone of low attenuation surrounding a pulmonary nodule) - less common in children than adults 1, 4
  • "Air-crescent sign" - less common in children than adults 1, 4
  • Nodules (most common radiologic finding in pediatric patients) 4
  • Cavitation in approximately 25% of cases 4

Extrapulmonary Manifestations

Invasive aspergillosis can affect multiple organ systems:

• Sinonasal/Upper Respiratory Tract:

  • Nasal obstruction 2
  • Epistaxis (nosebleed) 2
  • Facial pain 2
  • Periorbital swelling 2
  • Palate destruction (in severe cases) 2

• Central Nervous System:

  • Focal neurological deficits 2
  • Meningism (signs of meningeal irritation) 2
  • Decreased level of consciousness 5
  • Intracranial hemorrhage (severe cases) 5

• Cardiovascular System:

  • Atrial fibrillation (in disseminated disease) 5
  • Myocardial abscess formation (rare) 5

• Cutaneous:

  • Non-purulent ulcerations (especially associated with intravenous devices) 2

High-Risk Populations

Symptoms should be evaluated with higher suspicion in patients with:

• Advanced HIV infection (CD4+ counts <100 cells/μL) 1
• Neutropenia (PN < 500 per mm³) 3
• History of other AIDS-defining opportunistic infections 1
• Not receiving antiretroviral therapy 1
• Prolonged corticosteroid use 1, 5
• Exposure to broad-spectrum antibiotics 1
• Previous pneumonia or underlying lung disease 1
• Hematologic malignancies 3, 4
• Allogeneic stem cell transplant recipients 4

Clinical Course and Progression

• Initial presentation is often non-specific and may resemble bacterial pneumonia 3
• Without treatment, rapid progression to life-threatening disease can occur 3
• Massive hemoptysis is a serious complication that can develop, particularly as neutrophil counts recover 3
• In immunocompromised patients, symptoms may be subtle initially with rapid deterioration 5

Important Diagnostic Considerations

• Fever unresponsive to broad-spectrum antibiotics is often the earliest sign 2
• Bronchoscopic examination in tracheobronchitis cases shows multiple ulcerative or plaque-like lesions on the tracheal wall 1
• Galactomannan testing of serum or bronchoalveolar lavage fluid can aid diagnosis 1, 5
• Definitive diagnosis requires histological evidence of tissue invasion by hyphae with positive culture 1

Early recognition of these symptoms in high-risk patients is crucial, as prompt diagnosis and treatment significantly impact mortality and morbidity outcomes 2, 5.