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Dermatologic Manifestations of Aspergillosis Workup

  • Author: Annie Chiu, MD; Chief Editor: William D James, MD  more...
 
Updated: Mar 13, 2014
 

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%.[8]

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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.

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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.

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Contributor Information and Disclosures
Author

Annie Chiu, MD Cosmetic and General Dermatologist

Annie Chiu, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, Women's Dermatologic Society

Disclosure: Received consulting fee from Temptu for consulting; Received honoraria from Galderma for consulting; Received honoraria from SkinMedica for consulting.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

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

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.

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.

References
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