Dermatologic Manifestations of Aspergillosis Workup
- Author: Annie Chiu, MD; Chief Editor: William D James, MD more...
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%.
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.
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.
Ozer B, Kalaci A, Duran N, Dogramaci Y, Yanat AN. Cutaneous infection caused by Aspergillus terreus. J Med Microbiol. 2009 Jul. 58:968-70. [Medline].
Zhang QQ, Li L, Zhu M, Zhang CY, Wang JJ. Primary cutaneous aspergillosis due to Aspergillus flavus: a case report. Chin Med J (Engl). 2005 Feb 5. 118(3):255-7. [Medline].
Mohapatra S, Xess I, Swetha JV, et al. Primary cutaneous aspergillosis due to Aspergillus niger in an immunocompetent patient. Indian J Med Microbiol. 2009 Oct-Dec. 27(4):367-70. [Medline].
Larkin JA, Greene JN, Sandin RL, Houston SH. Primary cutaneous aspergillosis: case report and review of the literature. Infect Control Hosp Epidemiol. 1996 Jun. 17(6):365-6. [Medline].
Robinson A, Fien S, Grassi MA. Nonhealing scalp wound infected with Aspergillus niger in an elderly patient. Cutis. 2011 Apr. 87(4):197-200. [Medline].
Naidu J, Singh SM. Aspergillus chevalieri (Mangin) Thom and Church: a new opportunistic pathogen of human cutaneous aspergillosis. Mycoses. 1994 Jul-Aug. 37(7-8):271-4. [Medline].
Kim CW, Seo JS, Kim MK, Jun EJ, Choi JC, Choi BW. Secondary cutaneous aspergillosis disseminated from the lungs of a patient with asthma on 1 month steroid treatment. Diagn Microbiol Infect Dis. 2010 Jan. 66(1):104-7. [Medline].
Wheat LJ. Rapid diagnosis of invasive aspergillosis by antigen detection. Transpl Infect Dis. 2003 Dec. 5(4):158-66. [Medline].
Krishnan-Natesan S, Chandrasekar PH, Manavathu EK, Revankar SG. Successful treatment of primary cutaneous Aspergillus ustus infection with surgical debridement and a combination of voriconazole and terbinafine. Diagn Microbiol Infect Dis. 2008 Dec. 62(4):443-6. [Medline].
Cooke FJ, Terpos E, Boyle J, Rahemtulla A, Rogers TR. Disseminated Aspergillus terreus infection arising from cutaneous inoculation treated with caspofungin. Clin Microbiol Infect. 2003 Dec. 9(12):1238-41. [Medline].
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. 2002 Jun. 46(6):945-7. [Medline].
Klein KC, Blackwood RA. Topical voriconazole solution for cutaneous aspergillosis in a pediatric patient after bone marrow transplant. Pediatrics. 2006 Aug. 118(2):e506-8. [Medline].
Cabral C, Francisco V, Cavaleiro C, et al. Essential Oil of Juniperus communis subsp. alpina (Suter) Celak Needles: Chemical Composition, Antifungal Activity and Cytotoxicity. Phytother Res. 2012 Feb 1. [Medline].
[Guideline] Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008 Feb 1. 46(3):327-60. [Medline].
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. 2002 Aug 8. 347(6):408-15. [Medline].
Walsh TJ, Raad I, Patterson TF, 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. 2007 Jan 1. 44(1):2-12. [Medline].
Elder D, Elenitsas R, Jaworsky C, eds. Lever's Histopathology of the Skin. Philadelphia, Pa: Lippincott-Raven; 1997. 525-6.
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.
Odom RB, James WD, Berger TG, eds. Andrews' Diseases of the Skin. Philadelphia, Pa: WB Saunders; 2000. 415.
Richardson MD, Warnock DW, eds. Fungal Infection. Diagnosis and Management. 2nd ed. Blackwell Science: Oxford, England; 1997. 113-30.