The clinical spectrum of pulmonary aspergillosis.

[allergic bronchopulmonary aspergillosis]

The clinical presentation of Aspergillus lung disease is determined by the interaction between fungus and host . Invasive aspergillosis develops in severely immunocompromised patients , including those with neutropenia , and increasingly in the non-neutropenic host , including lung transplant recipients , the critically ill patients and patients on steroids . A high index of suspicion is required in patients without the classical risk factors as early presentation is usually silent and non-specific , pyrexia uncommon and timely treatment is crucial for survival . Invasive aspergillosis has also been diagnosed in normal hosts after massive exposure to fungal spores . Chronic pulmonary aspergillosis affects patients without obvious immune compromise , but with an underlying lung condition such as COPD or sarcoidosis , prior or concurrent TB or non-tuberculous mycobacterial disease . Aspergillus bronchitis may be responsible for persistent respiratory symptoms in patients with Aspergillus detected repeatedly in sputum without evidence of parenchymal Aspergillus disease , especially in patients with bronchiectasis and cystic fibrosis . Allergic bronchopulmonary aspergillosis affects patients with asthma and cystic fibrosis , and is important to recognise as permanent lung or airways damage may accrue if untreated . Changes in the classification of Aspergillus allergic lung disease have been proposed recently . Cases of extrinsic allergic alveolitis and chronic pulmonary aspergillosis have been observed after Aspergillus exposure . Asymptomatic colonisation of the respiratory tract needs close monitoring as it can lead to clinical disease especially with ongoing immunosuppression . The various syndromes should be viewed as a semicontinuous spectrum of disease and one form may evolve into another depending on the degree of ongoing immunosuppression .