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Clinical Features

Immunosuppressed hosts: Invasive pulmonary infection, usually with fever, cough, and chest pain. Infection may disseminate to other organs, including brain, skin and bone.

Immunocompetent hosts: Localized pulmonary infection in people with underlying lung disease, allergic bronchopulmonary disease, and allergic sinusitis.

Etiologic Agent: Aspergillus fumigatus, A. flavus, and less commonly A. terreus, A. nidulans, and A. niger.

Reservoir: Aspergillus is ubiquitous in the environment; it can be found in soil, decomposing plant matter, household dust, building materials, ornamental plants, food, and water.

Incidence: Incidence is difficult to determine, as aspergillosis is not a reportable disease. Population-based data available for San Francisco suggest a rate of 1-2 cases per 100,000 people per year.

Sequelae: If severe granulocytopenia persists, mortality rate can be very high (up to 100% in patients with cerebral abscesses). Patient outcome depends on resolution of granulocytopenia and early institution of effective antifungal drug therapy.

Transmission: Transmission occurs through inhalation of airborne conidia. Nosocomial infections may be associated with dust exposure during building renovation or construction. Occasional outbreaks of cutaneous infection have been traced to contaminated biomedical devices.

Risk Groups: Risk groups include people with severe/prolonged granulocytopenia, hematologic malignancies, and rarely HIV/AIDS.  Other risk factors include receipt of hematopoietic stem cell or solid organ transplants and taking high-dose corticosteroids or other immunosuppressive therapies. 

Surveillance: No national surveillance exists. Active surveillance is being conducted among hematopoietic stem cell and solid organ transplant recipients in selected U.S. hospitals.


  • Identifying modifiable risk factors for disease in immunocompromised people
  • Improving understanding of sources and routes of transmission from the environment
  • Developing sensitive and specific methods for earlier diagnosis


  • Developing rapid antigenemia and antigenuria tests and molecular probes may facilitate earlier clinical diagnosis
  • Availability of improved molecular typing methods to assist in epidemiologic studies
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