Culture, molecular testing, antigen detection, and histopathology usually confirm the diagnosis; ~40% of cases of invasive aspergillosis are diagnosed only at autopsy.
- Culture may be falsely positive (e.g., in pts with airway colonization) or falsely negative; only 10-30% of pts with invasive Aspergillus have a positive culture at any time.
- Galactomannan antigen testing of serum from high-risk pts is best done prospectively, as positive results precede clinical disease; false-positive results can occur (in association, for example, with certain β-lactam/β-lactamase inhibitor antibiotic combinations).
- A halo sign on high-resolution thoracic CT scan (a localized ground-glass appearance representing hemorrhagic infarction surrounding a nodule) suggests the diagnosis.
Treatment: Aspergillosis - See Table 106-1 for recommended treatments and doses.
- - The duration of treatment for pts with invasive aspergillosis varies from ~3 months to years, depending on the host and the response.
- - Chronic cavitary pulmonary aspergillosis probably requires treatment for life.
- Surgical treatment is important for some forms of aspergillosis (e.g., maxillary sinus fungal ball; single aspergilloma; invasive disease of bone, heart valve, brain, or sinuses).
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