More than 80% of invasive disease cases involve the lungs; in pts who are significantly immunocompromised, virtually any organ can be affected.

• Invasive pulmonary aspergillosis: Pts can be asymptomatic or can present with fever, cough, chest discomfort, hemoptysis, and shortness of breath.
  • - Acute and subacute forms have courses of ≤1 month and 1-3 months, respectively.
  • - Early diagnosis requires a high index of suspicion, screening for circulating antigen (in leukemia), and urgent CT of the chest.
• Invasive sinusitis: Pts have fever, nasal or facial discomfort, and nasal discharge. The sinuses are involved in 5-10% of cases of invasive aspergillosis; sinus involvement is especially likely in leukemic pts and hematopoietic stem cell transplant recipients.
• Disseminated aspergillosis:Aspergillus disseminates from lung to brain, skin, thyroid, bone, and other organs, after which pts develop skin lesions and deteriorate clinically over 1-3 days, with fever and signs of mild sepsis. Blood cultures are usually negative.
  • - Cerebral aspergillosis: Single or multiple lesions, hemorrhagic infarction, and cerebral abscess are common. The presentation can be acute or subacute, with mood changes, focal signs, seizures, and a decline in mental status. MRI is the most useful investigation.
  • - Cutaneous aspergillosis: Dissemination of Aspergillus occasionally results in cutaneous features, usually an erythematous or purplish nontender area that develops into a necrotic eschar.
• Chronic pulmonary aspergillosis: Pts develop one or more cavities that expand over months or years, with pulmonary symptoms, fatigue, and weight loss. Pericavitary infiltrates and multiple cavities are typical. Without treatment, pulmonary fibrosis can develop.
• Aspergilloma: A fungal ball occurs in up to 20% of residual chest cavities ≥2.5 cm in diameter. Life-threatening hemoptysis may occur.
• Chronic sinusitis: Pts develop one of three presentations: a fungal ball in the maxillary sinus; chronic invasive sinusitis that is slowly destructive; or chronic granulomatous sinusitis, which is most common in the Middle East and India and is often caused by A. flavus.
• Allergic bronchopulmonary aspergillosis(ABPA): A hypersensitivity reaction leads to bronchial plugging, coughing fits, and dyspnea, primarily affecting asthmatics and pts with cystic fibrosis. Total IgE levels are usually >1000 IU/mL.