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Pulmonary Aspergillosis: Different Diseases for the Same Pathogen

Dimopoulos, George MD, PhD, FCCP*; Karampela, Irene MD†

Clinical Pulmonary Medicine: March 2009 - Volume 16 - Issue 2 - pp 68-73
doi: 10.1097/CPM.0b013e31819b14b8
Review

Aspergillus, a ubiquitous fungus, may cause a variety of clinical syndromes in the lung, depending on immune status of the host as well as the presence of underlying lung disease. The clinical spectrum of pulmonary aspergillosis ranges from aspergilloma in patients with cavitary lung disease and allergic bronchopulmonary aspergillosis in patients with hypersensitivity to Aspergillus antigens to invasive pulmonary aspergillosis in immunocompromised patients and chronic necrotizing aspergillosis in patients with chronic lung disease or mild immunosuppression. Organ transplantation, immunosuppressive therapy, chronic lung disease, and critical illness are considered risk factors for pulmonary aspergillosis. During the last years, major advances have taken place in the diagnosis and management of these diseases with the development of newer noninvasive diagnostic techniques and antifungal agents, such as derivatives of azoles and echinocandins.

The present review article summarizes the clinical spectrum of Aspergillus spp. infections, the diagnostic approach, the available laboratory methods used for the diagnosis, and the therapeutic measurements for the successful treatment of the disease. Although the pathophysiology and the mechanisms allowing to infection appearance are well known, there are major difficulties regarding the confirmation of the definite diagnosis because of the lack of a diagnostic tool able to discriminate colonization from infection.

From the *Department of Intensive Care, University Hospital “Attikon,” Medical School, University of Athens, Greece; and †Department of Intensive Care Medicine, “Konstantopoulion” General Hospital, Athens, Greece.

Address correspondence to: George Dimopoulos, MD, PhD, FCCP, 7 Kiprou str. 14569, Anixi, Athens, Greece. E-mail: dimop@vodafone.net.gr.

© 2009 Lippincott Williams & Wilkins, Inc.