eMedicine Specialties > Dermatology > Fungal Infections

Aspergillosis: Differential Diagnoses & Workup

Author: Annie Chiu, MD, Staff Physician, Department of Dermatology, Cedars-Sinai Medical Group
Coauthor(s): Alexa F Boer Kimball, MD, MPH, Associate Professor of Dermatology, Harvard University School of Medicine; Vice Chair, Department of Dermatology, Massachusetts General Hospital; Director of Clinical Unit for Research Trials in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital and Brigham and Women's Hospital
Contributor Information and Disclosures

Updated: Nov 12, 2008

Differential Diagnoses

Cellulitis
Ecthyma
Ecthyma Gangrenosum

Other Problems to Be Considered

Fusarium infection
Mucormycosis
Cryptococcosis
Phaeohyphomycosis

Workup

Laboratory Studies

Findings from skin biopsy with special staining for fungus, such as with periodic acid-Schiff or methenamine silver stain, can be supportive or suggestive of Aspergillus infection, but other fungi may appear nearly identical in histopathologic sections.

Tissue, sputum, or blood culturing is usually performed, but the results may be negative or unreliable because Aspergillus is a common laboratory contaminant. If truly present in tissue, Aspergillus is a rapidly growing fungus that can be isolated in culture within 1-3 days, but longer incubation times may be required if the inoculum is very small.

In disseminated disease, the serum galactomannan assay can be used in conjunction with cultures and/or histologic examination. Galactomannan, an Aspergillus cell wall constituent, can be detected by enzyme-linked immunosorbent assay with an approximate sensitivity of 81% and specificity of 89%.2

Imaging Studies

Chest radiography can help in diagnosing a primary pulmonary infection, or it can confirm the presence of a fungal ball. CT scanning or MRI may help reveal fungal abscesses in the brain.

Histologic Findings

In tissue sections, narrow septate hyphae with delicate chitinous walls, bubbly blue cytoplasm, and acute-angle branching can be demonstrated, especially with special staining. Keep in mind that on sectioning, other fungi may appear to have acute-angle branching and Aspergillus species may appear to have more of a right-angle branching. Primary cutaneous infection often involves a granulomatous reaction in the dermis and the formation of multinucleated giant cells. Hematogenous disease is usually characterized by numerous branching hyphae surrounding and, occasionally, eroding into blood vessel lumens.

More on Aspergillosis

Overview: Aspergillosis
Differential Diagnoses & Workup: Aspergillosis
Treatment & Medication: Aspergillosis
Follow-up: Aspergillosis
Multimedia: Aspergillosis
References
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References

  1. Zhang QQ, Li L, Zhu M, Zhang CY, Wang JJ. Primary cutaneous aspergillosis due to Aspergillus flavus: a case report. Chin Med J (Engl). Feb 5 2005;118(3):255-7. [Medline].

  2. Wheat LJ. Rapid diagnosis of invasive aspergillosis by antigen detection. Transpl Infect Dis. Dec 2003;5(4):158-66. [Medline].

  3. Cooke FJ, Terpos E, Boyle J, Rahemtulla A, Rogers TR. Disseminated Aspergillus terreus infection arising from cutaneous inoculation treated with caspofungin. Clin Microbiol Infect. Dec 2003;9(12):1238-41. [Medline].

  4. Koss T, Bagheri B, Zeana C, Romagnoli MF, Grossman ME. Amphotericin B-resistant Aspergillus flavus infection successfully treated with caspofungin, a novel antifungal agent. J Am Acad Dermatol. Jun 2002;46(6):945-7. [Medline].

  5. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. Aug 8 2002;347(6):408-15. [Medline].

  6. Walsh TJ, Raad I, Patterson TF, Chandrasekar P, Donowitz GR, Graybill R, et al. Treatment of invasive aspergillosis with posaconazole in patients who are refractory to or intolerant of conventional therapy: an externally controlled trial. Clin Infect Dis. Jan 1 2007;44(1):2-12. [Medline].

  7. Chakrabarti A, Gupta V, Biswas G, Kumar B, Sakhuja VK. Primary cutaneous aspergillosis: our experience in 10 years. J Infect. Jul 1998;37(1):24-7. [Medline].

  8. Elder D, Elenitsas R, Jaworsky C, eds. Lever's Histopathology of the Skin. Philadelphia, Pa: Lippincott-Raven; 1997:525-6.

  9. Freedberg I, Eisen AZ, Wolff K, et al, eds. Fitzpatrick's Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999:1436-7.

  10. Klein KC, Blackwood RA. Topical voriconazole solution for cutaneous aspergillosis in a pediatric patient after bone marrow transplant. Pediatrics. Aug 2006;118(2):e506-8. [Medline].

  11. Larkin JA, Greene JN, Sandin RL, Houston SH. Primary cutaneous aspergillosis: case report and review of the literature. Infect Control Hosp Epidemiol. Jun 1996;17(6):365-6. [Medline].

  12. Naidu J, Singh SM. Aspergillus chevalieri (Mangin) Thom and Church: a new opportunistic pathogen of human cutaneous aspergillosis. Mycoses. Jul-Aug 1994;37(7-8):271-4. [Medline].

  13. Odom RB, James WD, Berger TG, eds. Andrews' Diseases of the Skin. Philadelphia, Pa: WB Saunders; 2000:415.

  14. Richardson MD, Warnock DW, eds. Fungal Infection. In: Diagnosis and Management. 2nd ed. Blackwell Science: Oxford, England; 1997:113-30.

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Further Reading

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Keywords

cutaneous aspergillosis, fungal infection, Aspergillus fumigatus, A fumigatus, Aspergillus flavus, A flavus, Aspergillus terreus, A terreus, Aspergillus chevalieri, A chevalieri, Aspergillus niger, A niger, Aspergillus ustus, A ustus

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Contributor Information and Disclosures

Author

Annie Chiu, MD, Staff Physician, Department of Dermatology, Cedars-Sinai Medical Group
Annie Chiu, MD is a member of the following medical societies: American Academy of Dermatology and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Alexa F Boer Kimball, MD, MPH, Associate Professor of Dermatology, Harvard University School of Medicine; Vice Chair, Department of Dermatology, Massachusetts General Hospital; Director of Clinical Unit for Research Trials in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital and Brigham and Women's Hospital
Alexa F Boer Kimball, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Peter Fritsch, MD, Chair, Department of Dermatology and Venereology, University of Innsbruck, Austria
Peter Fritsch, MD is a member of the following medical societies: American Dermatological Association, International Society of Pediatric Dermatology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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