Aspergillosis



Aspergillosis


Anthony Chang, MD





Key Facts


Etiology/Pathogenesis



  • A. fumigatus


  • A. flavus


  • A. niger


Clinical Issues



  • Treatment



    • Renal allograft nephrectomy


    • Nephrostomy drainage and systemic antifungal therapy


    • Voriconazole


  • Incidence



    • 0.1% in kidney transplant patients after 1 year


  • Presentation



    • Fever


    • Flank pain


    • Hematuria


  • Laboratory tests



    • Cultures


Macroscopic Features



  • Abscesses, cortical or perinephric


Microscopic Pathology



  • Microorganisms, fungus



    • Septate hyphae with 45° angle branching


    • Vascular invasion


  • Tubulointerstitial inflammation, neutrophil rich


Top Differential Diagnoses



  • Candidiasis


  • Mucormycosis


  • Pseudallescheriasis


  • Fusariosis


  • Bacterial pyelonephritis







Hematoxylin & eosin shows a necrotic area of renal cortex with prominent neutrophilic inflammation and many acute angle branching hyphae image that are characteristic of Aspergillus.






Hematoxylin & eosin shows septate hyphae image with 45° angle branching, which has entirely replaced a glomerulus in an autopsied kidney of a patient with disseminated aspergillosis.


TERMINOLOGY


Definitions



  • Aspergillus infection of kidney in immunosuppressed or immunocompromised patients


ETIOLOGY/PATHOGENESIS


Environmental Exposure



  • Ubiquitous fungus in environment


Infectious Agents



  • Aspergillus



    • A. fumigatus


    • A. flavus


    • A. niger


    • A. terreus


    • A. nidulans


CLINICAL ISSUES


Epidemiology



  • Incidence



    • 0.1% in kidney transplant patients after 1 year


  • Age



    • No age predilection


  • Gender



    • M:F = 4:1


  • Ethnicity



    • No ethnic predilection


Site



  • Lungs



    • Most common site of involvement


  • Kidneys



    • 30-40% involvement in disseminated aspergillosis


    • Isolated involvement in some deceased donor kidney allografts



      • Probable transmission from deceased donor or during organ procurement


      • Fungi account for up to 2.5% of isolates cultured from perfusion solutions used for kidney preservation


Presentation



  • Fever


  • Flank pain


  • Hematuria


Laboratory Tests



  • Serologic tests



    • Enzyme-linked immunoassay



      • Detection of galactomannan antigen of Aspergillus


    • Immunodiffusion


    • Complement fixation


  • Cultures


  • Direct microscopy

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Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Aspergillosis

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