The impact of culture isolation of Aspergillus species: A hospital-based survey of aspergillosis

The term "aspergillosis" comprises several categories of infection: invasiv e aspergillosis; chronic necrotizing aspergillosis; aspergilloma, or fungus ball; and allergic bronchopulmonary aspergillosis. In 24 medical centers, we examined the impact of a culture positive for Aspergillus species on the diagnosis, risk factors, management, and outcome associated with these dis eases. Most Aspergillus culture isolates from nonsterile body sites do not represent disease. However, for high-risk patients, such as allogeneic bone marrow transplant recipients (60%), persons with hematologic cancer (50%), and those with signs of neutropenia (60%) or malnutrition (30%), a positiv e culture result is associated with invasive disease. When such risk factor s as human immunodeficiency virus infection (20%), solid-organ transplantat ion (20%), corticosteroid use (20%), or an underlying pulmonary disease (10 %) are associated with a positive culture result, clinical judgment and bet ter diagnostic tests are necessary. The management of invasive aspergillosi s remains suboptimal: only 38% of patients are alive 3 months after diagnos is. Chronic necrotizing aspergillosis, aspergilloma, and allergic bronchopu lmonary aspergillosis have variable management strategies and better short- term outcomes.