Airway invasive aspergillosis

Last revised by Yuranga Weerakkody on 27 Sep 2023

Airway invasive aspergillosis, also known as Aspergillus bronchopneumonia or bronchopneumonic aspergillosis, refers to a form of invasive aspergillosis that affects the airways as the major or only feature.

It usually occurs in immunocompromised neutropenic patients, particularly HIV/AIDS patients. Aspergillosis affecting the airways as the major or only feature of the invasive disease is uncommon and is thought to occur in only around 7% of cases of intrathoracic aspergillosis 3.

Clinical manifestations can vary and range from an acute tracheobronchitis, to bronchiolitis to bronchopneumonia.

It is histologically characterized by the presence of Aspergillus organisms deep to the airway basement membrane 1.  

Two morphological forms of invasive aspergillosis of the trachea and bronchi have been described 3:

  • intraluminal: circumferential and superficial “pseudomembrane” of necrotic tissue, fibrin and hyphae, which may result in airway occlusion

  • multiple nodular plaques: invades adjacent tissues and may lead to broncho-esophageal and fatal hemorrhage from bronchoarterial fistulation

  • some studies have shown galactomannan (GM) detection in bronchoalveolar lavage fluid (BALF) of

    • greater than 0.77 in nonneutropenic patients or

    • GM index of > 1 in patients with AML or myelodysplasia undergoing intensive chemotherapy and patients receiving an allogeneic stem cell transplantation who are in the early engraftment phase, as being suggestive airway invasive aspergillosis.

The imaging spectrum is variable, depending on whether is it an obstructive tracheobronchitis, bronchiolitis or bronchopneumonia:

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Cases and figures

  • Case 1
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  • Case 2: Aspergillus bronchopneumonia
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