Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Aspergillosis Workup

  • Author: Eloise M Harman, MD; Chief Editor: Ryland P Byrd, Jr, MD  more...
 
Updated: Apr 01, 2015
 

Laboratory Studies

Because Aspergillus infection may cause colonization, allergy, or invasive infection, its manifestations are quite variable and are best considered based on the disease process.

Allergic bronchopulmonary aspergillosis (ABPA) is defined by several abnormalities, including the following:

  • Asthma
  • Eosinophilia
  • Positive skin test result for A fumigatus
  • Marked elevation of the serum immunoglobulin E (IgE) level to greater than 1000 IU/dL
  • Fleeting pulmonary infiltrates
  • Central bronchiectasis
  • Mucoid impaction
  • Positive test results for Aspergillus precipitins (primarily immunoglobulin G [IgG], but also immunoglobulin A [IgA] and immunoglobulin M [IgM])

Minor criteria for diagnosis include positive Aspergillus radioallergosorbent assay test results and culture findings for Aspergillus in sputum.

Diagnostic criteria for ABPA in persons with cystic fibrosis (CF) were revised by the Cystic Fibrosis Foundation. ABPA is considered a definite diagnosis requiring treatment if the following are noted[19] :

  • Clinical deterioration, including cough, wheeze, increased sputum production, diminished exercise tolerance, or diminished pulmonary function
  • Total serum IgE level greater than 1000 IU/mL or a greater than twofold rise from baseline
  • Positive serology results for Aspergillus ( Aspergillus precipitins or Aspergillus -specific IgG or IgE)
  • New infiltrates on chest radiographs or computed tomography (CT) scans

Treatment for ABPA is also recommended in patients with CF who have new radiographic findings and symptoms and a change in baseline IgE level to greater than 500 IU/mL.[19]

Definitive diagnosis of invasive aspergillosis or chronic necrotizing Aspergillus pneumonia depends on the demonstration of the organism in tissue.

In the appropriate clinical setting of pulmonary infiltrates in a patient who is neutropenic or immunosuppressed, visualization of the characteristic fungi using Gomori methenamine silver stain or Calcofluor or a positive culture result from sputum, needle biopsy, or bronchoalveolar lavage (BAL) fluid should result in the prompt institution of therapy.

This is especially important after bone marrow transplantation because a positive Aspergillus culture result from sputum has a 95% positive predictive value for invasive disease. However, a negative fungus result from culture of sputum or BAL fluid does not exclude pulmonary aspergillosis because Aspergillus is cultured from sputum in 8-34% of patients and from BAL fluid in 45-62% of patients eventually found by biopsy or autopsy to have invasive disease.

An assay to detect galactomannan, a major component of the Aspergillus cell wall, is available.[4] Patients who are at high risk, such as those who have received stem cell transplants or who have prolonged neutropenia, may be screened for the development of invasive Aspergillus infection by monitoring serum galactomannan levels weekly.[5]

One study of serum galactomannan index (GMI) found that charting early GMI trends during the first two weeks of antifungal therapy can be helpful in predicting clinical outcomes. A reduction in GMI between baseline and week 1 predicted a good clinical response.[20]

The presence of an elevated galactomannan level in BAL fluid may also be helpful in the diagnosis of pulmonary aspergillosis in patients in whom compatible radiographic changes are present and BAL testing is performed in the suspicious area.[21] A meta-analysis and systematic review determined that the measurement of BAL-galactomannan levels may help in diagnosing invasive aspergillosis early.[22]

A study by Luong et al of 150 BAL samples from lung transplant recipients concluded that real-time polymerase chain reaction (PCR) assays could be useful in diagnosis of invasive aspergillosis in high-risk populations. Pan-Aspergillus PCR combined with BAL galactomannan testing was 97% specific and 93% sensitive for invasive pulmonary aspergillosis. Species-specific real-time PCR assays for A fumigatus and for A terreus could be used to rule out or identify the common A fumigatus and the amphotericin B-resistant A terreus.[23]

Aspergilloma does not cause many characteristic laboratory abnormalities. Aspergillus precipitin antibody test results (ie, for IgG) are usually positive.

Next

Imaging Studies

ABPA may cause variable manifestations on chest radiographs, from fleeting pulmonary infiltrates to mucoid impaction to central bronchiectasis. Mucoid impaction of bronchiectatic areas may cause a lobulated infiltrate, which has been likened to a cluster of grapes or a hand in a mitten. CT is helpful for better defining bronchiectasis, and scans may show that apparent lobulated masses are mucus-filled dilated bronchi. Areas of atelectasis related to bronchial obstruction from mucoid impaction may be present.

In aspergilloma, chest radiography reveals a mass in a preexisting cavity, usually in an upper lobe, manifested by a crescent of air partially outlining a solid mass. As the patient is moved onto his or her side or from supine to prone, the mass is typically observed to move within the cavity. CT images provide better definition of the mass within a cavity and may demonstrate multiple aspergillomas in areas of extensive cavitary disease. The scanning may be performed with the patient in the supine and prone positions to demonstrate movement of the mass within the cavity.

In invasive aspergillosis, chest radiographic features are variable, with solitary or multiple nodules, cavitary lesions, or alveolar infiltrates that are localized or bilateral and more diffuse as disease progresses. CT images may be very helpful in the early diagnosis of aspergillosis because they may demonstrate a characteristic halo sign (ie, an area of ground-glass infiltrate surrounding nodular densities).[6] Later disease may show a crescent of air surrounding nodules, indicative of cavitation. Because Aspergillus is angioinvasive, infiltrates may be wedge-shaped, pleural-based, and cavitary, which is consistent with pulmonary infarction.

Previous
Next

Other Tests

With ABPA, prick or intradermal skin testing with Aspergillus antigen results in a positive reaction manifested by wheal and flare.

Previous
Next

Procedures

In ABPA, mucoid impaction of dilated bronchi can cause a masslike appearance, and patients with ABPA sometimes undergo transthoracic needle aspiration in an effort to obtain diagnostic information.

ABPA may be observed in association with chronic eosinophilic pneumonia or cryptogenic organizing pneumonia (COP), and patients may require transbronchial or open biopsy for diagnosis of unresolving pulmonary infiltrates with or without mucoid impaction. In the proper context, prick or intradermal skin testing to confirm immediate hypersensitivity to Aspergillus should be performed first because a negative skin test result excludes the diagnosis of ABPA.[24]

Procedures that may be helpful for the diagnosis of invasive aspergillosis include the following:

  • Bronchoscopy
  • Needle biopsy
  • Open lung biopsy

At bronchoscopy, BAL in areas of pneumonia may provide evidence for the diagnosis. Transbronchial biopsy may be helpful, but it may not be possible, because patients are often thrombocytopenic because of bone marrow suppression. Peripheral lesions may be amenable to transthoracic needle aspiration and biopsy. Open lung biopsy through a small thoracotomy or by video-assisted thoracoscopy may be the only way to obtain tissue samples large enough to confirm the presence of Aspergillus organisms in tissue.[21, 25]

Previous
Next

Histologic Findings

Histopathology and silver staining for persons with invasive aspergillosis demonstrate the characteristic septate hyphae, branching at acute angles, and acute inflammatory infiltrate and tissue necrosis with occasional granulomata and blood vessel invasion. The airways of patients with ABPA contain mucus filled with degenerating eosinophils and typical fungal hyphae. ABPA may occur against a background of chronic eosinophilic pneumonia and bronchiolitis, granulomatous bronchitis, bronchocentric granulomatosis, and, occasionally, COP.

Previous
Next

Staging

No staging protocol is used for invasive aspergillosis or aspergilloma. ABPA may be progressive, and the following five stages have been described[26] :

  • Acute disease
  • Remission
  • Exacerbation or recurrence
  • Corticosteroid-dependent asthma
  • End-stage fibrosis
Previous
 
 
Contributor Information and Disclosures
Author

Eloise M Harman, MD Staff Physician and MICU Director, Pulmonary Division, Gainesville Veterans Affairs Medical Center

Eloise M Harman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American Medical Womens Association, American Thoracic Society, Phi Beta Kappa, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Ryland P Byrd, Jr, MD Professor of Medicine, Division of Pulmonary Disease and Critical Care Medicine, James H Quillen College of Medicine, East Tennessee State University

Ryland P Byrd, Jr, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Acknowledgements

Oleh Wasyl Hnatiuk, MD Program Director, National Capital Consortium, Pulmonary and Critical Care, Walter Reed Army Medical Center; Associate Professor, Department of Medicine, Uniformed Services University of Health Sciences

Oleh Wasyl Hnatiuk, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

References
  1. Brooks M. FDA Clears IV Formulation of Antifungal Posaconazole. Medscape Medical News. Available at http://www.medscape.com/viewarticle/822125. Accessed: March 25, 2014.

  2. Samarakoon P, Soubani AO. Invasive pulmonary aspergillosis in patients with COPD: a report of five cases and systematic review of the literature. Chron Respir Dis. 2008. 5(1):19-27. [Medline].

  3. Ader F, Bienvenu AL, Rammaert B, Nseir S. Management of invasive aspergillosis in patients with COPD: rational use of voriconazole. Int J Chron Obstruct Pulmon Dis. 2009. 4(2):279-87. [Medline]. [Full Text].

  4. Maertens J, Verhaegen J, Lagrou K, Van Eldere J, Boogaerts M. Screening for circulating galactomannan as a noninvasive diagnostic tool for invasive aspergillosis in prolonged neutropenic patients and stem cell transplantation recipients: a prospective validation. Blood. 2001 Mar 15. 97(6):1604-10. [Medline].

  5. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis. 2006 May 15. 42(10):1417-27. [Medline].

  6. Kuhlman JE, Fishman EK, Siegelman SS. Invasive pulmonary aspergillosis in acute leukemia: characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis. Radiology. 1985 Dec. 157(3):611-4. [Medline].

  7. Salez F, Brichet A, Desurmont S, Grosbois JM, Wallaert B, Tonnel AB. Effects of itraconazole therapy in allergic bronchopulmonary aspergillosis. Chest. 1999 Dec. 116(6):1665-8. [Medline].

  8. Stevens DA, Schwartz HJ, Lee JY, Moskovitz BL, Jerome DC, Catanzaro A, et al. A randomized trial of itraconazole in allergic bronchopulmonary aspergillosis. N Engl J Med. 2000 Mar 16. 342(11):756-62. [Medline].

  9. Wark PA, Gibson PG, Wilson AJ. Azoles for allergic bronchopulmonary aspergillosis associated with asthma. Cochrane Database Syst Rev. 2003. (3):CD001108. [Medline].

  10. Wark PA, Hensley MJ, Saltos N, Boyle MJ, Toneguzzi RC, Epid GD, et al. Anti-inflammatory effect of itraconazole in stable allergic bronchopulmonary aspergillosis: a randomized controlled trial. J Allergy Clin Immunol. 2003 May. 111(5):952-7. [Medline].

  11. Giron JM, Poey CG, Fajadet PP, Balagner GB, Assoun JA, Richardi GR, et al. Inoperable pulmonary aspergilloma: percutaneous CT-guided injection with glycerin and amphotericin B paste in 15 cases. Radiology. 1993 Sep. 188(3):825-7. [Medline].

  12. Mal H, Rullon I, Mellot F, Brugiere O, Sleiman C, Menu Y, et al. Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis. Chest. 1999 Apr. 115(4):996-1001. [Medline].

  13. 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].

  14. Maertens J, Raad I, Petrikkos G, Boogaerts M, Selleslag D, Petersen FB, et al. Efficacy and safety of caspofungin for treatment of invasive aspergillosis in patients refractory to or intolerant of conventional antifungal therapy. Clin Infect Dis. 2004 Dec 1. 39(11):1563-71. [Medline].

  15. Addrizzo-Harris DJ, Harkin TJ, McGuinness G, Naidich DP, Rom WN. Pulmonary aspergilloma and AIDS. A comparison of HIV-infected and HIV-negative individuals. Chest. 1997 Mar. 111(3):612-8. [Medline].

  16. Virnig C, Bush RK. Allergic bronchopulmonary aspergillosis: a US perspective. Curr Opin Pulm Med. 2007 Jan. 13(1):67-71. [Medline].

  17. Meersseman W, Vandecasteele SJ, Wilmer A, Verbeken E, Peetermans WE, Van Wijngaerden E. Invasive aspergillosis in critically ill patients without malignancy. Am J Respir Crit Care Med. 2004 Sep 15. 170(6):621-5. [Medline].

  18. Smith NL, Denning DW. Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J. 2011 Apr. 37(4):865-72. [Medline].

  19. Stevens DA, Moss RB, Kurup VP, Knutsen AP, Greenberger P, Judson MA, et al. Allergic bronchopulmonary aspergillosis in cystic fibrosis--state of the art: Cystic Fibrosis Foundation Consensus Conference. Clin Infect Dis. 2003 Oct 1. 37 Suppl 3:S225-64. [Medline].

  20. Chai LY, Kullberg BJ, Johnson EM, Teerenstra S, Khin LW, Vonk AG, et al. Early Serum Galactomannan Trend as a Predictor of Outcome in Invasive Aspergillosis. J Clin Microbiol. 2012 May 2. [Medline].

  21. Becker MJ, Lugtenburg EJ, Cornelissen JJ, Van Der Schee C, Hoogsteden HC, De Marie S. Galactomannan detection in computerized tomography-based broncho-alveolar lavage fluid and serum in haematological patients at risk for invasive pulmonary aspergillosis. Br J Haematol. 2003 May. 121(3):448-57. [Medline].

  22. Guo YL, Chen YQ, Wang K, Qin SM, Wu C, Kong JL. Accuracy of BAL galactomannan in diagnosing invasive aspergillosis: a bivariate metaanalysis and systematic review. Chest. 2010 Oct. 138(4):817-24. [Medline].

  23. Luong ML, Clancy CJ, Vadnerkar A, et al. Comparison of an Aspergillus real-time polymerase chain reaction assay with galactomannan testing of bronchoalvelolar lavage fluid for the diagnosis of invasive pulmonary aspergillosis in lung transplant recipients. Clin Infect Dis. 2011 May. 52(10):1218-26. [Medline].

  24. Agarwal R. Allergic bronchopulmonary aspergillosis. Chest. 2009 Mar. 135(3):805-26. [Medline].

  25. Gruson D, Hilbert G, Valentino R, Vargas F, Chene G, Bebear C, et al. Utility of fiberoptic bronchoscopy in neutropenic patients admitted to the intensive care unit with pulmonary infiltrates. Crit Care Med. 2000 Jul. 28(7):2224-30. [Medline].

  26. Patterson R, Greenberger PA, Radin RC, Roberts M. Allergic bronchopulmonary aspergillosis: staging as an aid to management. Ann Intern Med. 1982 Mar. 96(3):286-91. [Medline].

  27. van der Ent CK, Hoekstra H, Rijkers GT. Successful treatment of allergic bronchopulmonary aspergillosis with recombinant anti-IgE antibody. Thorax. 2007 Mar. 62(3):276-7. [Medline].

  28. Krishnan-Natesan S, Chandrasekar PH. Current and future therapeutic options in the management of invasive aspergillosis. Drugs. 2008. 68(3):265-82. [Medline].

  29. Magill SS, Chiller TM, Warnock DW. Evolving strategies in the management of aspergillosis. Expert Opin Pharmacother. 2008 Feb. 9(2):193-209. [Medline].

  30. Kontoyiannis DP, Hachem R, Lewis RE, Rivero GA, Torres HA, Thornby J, et al. Efficacy and toxicity of caspofungin in combination with liposomal amphotericin B as primary or salvage treatment of invasive aspergillosis in patients with hematologic malignancies. Cancer. 2003 Jul 15. 98(2):292-9. [Medline].

  31. Brooks M. FDA Okays Antifungal Delayed-Release Tablets. Available at http://www.medscape.com/viewarticle/815030. Accessed: December 3, 2013.

  32. National Institutes of Health. Isavuconazole (BAL8557) for primary treatment of invasive Aspergillosis.NLM identfier: NCT00412893. ClinicalTrials.gov. Available at http://clinicaltrials.gov/ct2/show/NCT00412893. Accessed: April 2, 2015.

  33. Pidhorecky I, Urschel J, Anderson T. Resection of invasive pulmonary aspergillosis in immunocompromised patients. Ann Surg Oncol. 2000 May. 7(4):312-7. [Medline].

  34. Schubert MS, Goetz DW. Evaluation and treatment of allergic fungal sinusitis. I. Demographics and diagnosis. J Allergy Clin Immunol. 1998 Sep. 102(3):387-94. [Medline].

  35. Boyle BM, McCann SR. The use of itraconazole as prophylaxis against invasive fungal infection in blood and marrow transplant recipients. Transpl Infect Dis. 2000 Jun. 2(2):72-9. [Medline].

  36. Cordonnier C, Maury S, Pautas C, Bastie JN, Chehata S, Castaigne S, et al. Secondary antifungal prophylaxis with voriconazole to adhere to scheduled treatment in leukemic patients and stem cell transplant recipients. Bone Marrow Transplant. 2004 May. 33(9):943-8. [Medline].

  37. Kontoyiannis DP, Lionakis MS, Lewis RE, Chamilos G, Healy M, Perego C. Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: a case-control observational study of 27 recent cases. J Infect Dis. 2005 Apr 15. 191(8):1350-60. [Medline].

  38. Wirk B, Wingard JR. Current approaches in antifungal prophylaxis in high risk hematologic malignancy and hematopoietic stem cell transplant patients. Mycopathologia. 2009 Dec. 168(6):299-311. [Medline].

  39. Mohammad RA, Klein KC. Inhaled amphotericin B for prophylaxis against invasive Aspergillus infections. Ann Pharmacother. 2006 Dec. 40(12):2148-54. [Medline].

  40. Avery RK. Aspergillosis in hematopoietic stem cell transplant recipients: risk factors, prophylaxis, and treatment. Curr Infect Dis Rep. 2009 May. 11(3):223-8. [Medline].

  41. Denning DW, Park S, Lass-Florl C, et al. High-frequency triazole resistance found In nonculturable Aspergillus fumigatus from lungs of patients with chronic fungal disease. Clin Infect Dis. 2011 May. 52(9):1123-9. [Medline]. [Full Text].

  42. Bartlett JG. Aspergillosis update. Medicine (Baltimore). 2000 Jul. 79(4):281-2. [Medline].

  43. Caillot D, Casasnovas O, Bernard A, Couaillier JF, Durand C, Cuisenier B, et al. Improved management of invasive pulmonary aspergillosis in neutropenic patients using early thoracic computed tomographic scan and surgery. J Clin Oncol. 1997 Jan. 15(1):139-47. [Medline].

  44. Clancy CJ, Nguyen MH. Invasive sinus aspergillosis in apparently immunocompetent hosts. J Infect. 1998 Nov. 37(3):229-40. [Medline].

  45. Cockrill BA, Hales CA. Allergic bronchopulmonary aspergillosis. Annu Rev Med. 1999. 50:303-16. [Medline].

  46. Collin BA, Ramphal R. Pneumonia in the compromised host including cancer patients and transplant patients. Infect Dis Clin North Am. 1998 Sep. 12(3):781-805, xi. [Medline].

  47. Denning DW. Invasive aspergillosis. Clin Infect Dis. 1998 Apr. 26(4):781-803; quiz 804-5. [Medline].

  48. Graybill JR. Itraconazole: managing mycotic complications in immunocompromised patients. Semin Oncol. 1998 Jun. 25(3 Suppl 7):58-63. [Medline].

  49. Jean-Baptiste E. Clinical assessment and management of massive hemoptysis. Crit Care Med. 2000 May. 28(5):1642-7. [Medline].

  50. Klastersky J. Antifungal therapy in patients with fever and neutropenia--more rational and less empirical?. N Engl J Med. 2004 Sep 30. 351(14):1445-7. [Medline].

  51. Klein NC, Cunha BA. New antifungal drugs for pulmonary mycoses. Chest. 1996 Aug. 110(2):525-32. [Medline].

  52. Marr KA, Boeckh M, Carter RA, Kim HW, Corey L. Combination antifungal therapy for invasive aspergillosis. Clin Infect Dis. 2004 Sep 15. 39(6):797-802. [Medline].

  53. Massachusetts General Hospital. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 24-2001. A 46-year-old woman with chronic sinsusitis, pulmonary nodules, and hemoptysis. N Engl J Med. 2001 Aug 9. 345(6):443-9. [Medline].

  54. Mehrad B, Paciocco G, Martinez FJ, Ojo TC, Iannettoni MD, Lynch JP 3rd. Spectrum of Aspergillus infection in lung transplant recipients: case series and review of the literature. Chest. 2001 Jan. 119(1):169-75. [Medline].

  55. Mylonakis E, Barlam TF, Flanigan T, Rich JD. Pulmonary aspergillosis and invasive disease in AIDS: review of 342 cases. Chest. 1998 Jul. 114(1):251-62. [Medline].

  56. Nagappan V, Deresinski S. Reviews of anti-infective agents: posaconazole: a broad-spectrum triazole antifungal agent. Clin Infect Dis. 2007 Dec 15. 45(12):1610-7. [Medline].

  57. Nepomuceno IB, Esrig S, Moss RB. Allergic bronchopulmonary aspergillosis in cystic fibrosis: role of atopy and response to itraconazole. Chest. 1999 Feb. 115(2):364-70. [Medline].

  58. Novey HS. Epidemiology of allergic bronchopulmonary aspergillosis. Immunol All Clin North Am. 1998. 18:641-53.

  59. Paterson DL, Singh N. Invasive aspergillosis in transplant recipients. Medicine (Baltimore). 1999 Mar. 78(2):123-38. [Medline].

  60. Patterson TF, Kirkpatrick WR, White M, Hiemenz JW, Wingard JR, Dupont B, et al. Invasive aspergillosis. Disease spectrum, treatment practices, and outcomes. I3 Aspergillus Study Group. Medicine (Baltimore). 2000 Jul. 79(4):250-60. [Medline].

  61. Sambatakou H, Dupont B, Lode H, Denning DW. Voriconazole treatment for subacute invasive and chronic pulmonary aspergillosis. Am J Med. 2006 Jun. 119(6):527.e17-24. [Medline].

  62. Saraceno JL, Phelps DT, Ferro TJ, Futerfas R, Schwartz DB. Chronic necrotizing pulmonary aspergillosis: approach to management. Chest. 1997 Aug. 112(2):541-8. [Medline].

  63. Serody JS, Shea TC. Prevention of infections in bone marrow transplant recipients. Infect Dis Clin North Am. 1997 Jun. 11(2):459-77. [Medline].

  64. Singh N, Limaye AP, Forrest G, Safdar N, Munoz P, Pursell K, et al. Combination of voriconazole and caspofungin as primary therapy for invasive aspergillosis in solid organ transplant recipients: a prospective, multicenter, observational study. Transplantation. 2006 Feb 15. 81(3):320-6. [Medline].

  65. Smith J, Safdar N, Knasinski V, Simmons W, Bhavnani SM, Ambrose PG, et al. Voriconazole therapeutic drug monitoring. Antimicrob Agents Chemother. 2006 Apr. 50(4):1570-2. [Medline].

  66. Stevens DA, Kan VL, Judson MA, Morrison VA, Dummer S, Denning DW, et al. Practice guidelines for diseases caused by Aspergillus. Infectious Diseases Society of America. Clin Infect Dis. 2000 Apr. 30(4):696-709. [Medline].

  67. Tillie-Leblond I, Tonnel AB. Allergic bronchopulmonary aspergillosis. Allergy. 2005 Aug. 60(8):1004-13. [Medline].

  68. Ullmann AJ, Lipton JH, Vesole DH, Chandrasekar P, Langston A, Tarantolo SR, et al. Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease. N Engl J Med. 2007 Jan 25. 356(4):335-47. [Medline].

  69. Viscoli C, Machetti M, Cappellano P, Bucci B, Bruzzi P, Van Lint MT, et al. False-positive galactomannan platelia Aspergillus test results for patients receiving piperacillin-tazobactam. Clin Infect Dis. 2004 Mar 15. 38(6):913-6. [Medline].

  70. [Guideline] Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, 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].

  71. Walsh TJ, Hiemenz JW, Anaissie E. Recent progress and current problems in treatment of invasive fungal infections in neutropenic patients. Infect Dis Clin North Am. 1996 Jun. 10(2):365-400. [Medline].

  72. Walsh TJ, Teppler H, Donowitz GR, Maertens JA, Baden LR, Dmoszynska A, et al. Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. N Engl J Med. 2004 Sep 30. 351(14):1391-402. [Medline].

  73. Ward S, Heyneman L, Lee MJ, Leung AN, Hansell DM, Muller NL. Accuracy of CT in the diagnosis of allergic bronchopulmonary aspergillosis in asthmatic patients. AJR Am J Roentgenol. 1999 Oct. 173(4):937-42. [Medline].

  74. Yao Z, Liao W. Fungal respiratory disease. Curr Opin Pulm Med. 2006 May. 12(3):222-7. [Medline].

  75. Zmeili OS, Soubani AO. Pulmonary aspergillosis: a clinical update. QJM. 2007 Jun. 100(6):317-34. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.