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ABPA with disseminated invasive aspergillosis Chest x ray of patient 4 days prior to admission
ABPA with disseminated invasive aspergillosis Chest x ray of patient 4 days prior to admission

The chest X rays showed a rapid progression of lung disease- with bilateral upper zone and midzone consolidation and bilateral pleural effusion. Both lower lobes showed bronchiectasis in a central distribution along with centrilobular nodules and tree-in-bud pattern.

Case details kindly provided by Professor Arunaloke Chakrabarti Division of Mycology, Postgraduate Institute of Medical Education, Chandigarh, India

Voriconazole rash. Side effects of anti-fungal drugs - drug rashes. Patient RW: Voriconazole rash. Facial erythema
April 04 Back to where he was April 04 Back to where he was in terms of symptoms when he stopped itraconzole. CRP,
April 04 Back to where he was April 04 Back to where he was in terms of symptoms when he stopped itraconzole. CRP,

A. December 1991 Close up view of right upper-lobe of the lung in a 45 year old man who smoked cigarettes showing an ill-defined shadow behind the clavicle and additional abnormalities inferior to this in the right upper-lobe. The lesions were considered to be possibly malignant and surgically resected. Histological examination showed granulomata containing hyphae consistent with Aspergillus. Fungal cultures were not done. 

B. June 1992 Recurrence of disease.Chest radiograph demonstrating cavitary invasive aspergillosis. Despite resection of part of the right upper-lobe, invasive aspergillosis recurred six months later. Sputum cultures grew A.fumigatus and Aspergillus antibodies were detected in serum. He responded to itraconazole but subsequently progressed. 

CSeptember 1992 Chest radiograph demonstrating further progression of pulmonary aspergillosis with multiple cavities in the right upper-lobe. Although the appearance suggests the formation of aspergillomas, the contemporaneous CT scan did not confirm this.

D.September 2002 Well, although had a respiratory infection. CRP and ESR normal in August 02, aspergillus precipitins positive at a titre of 1:2.

E.January 03 Much worse with lethargy, anorexia, weight loss and radiological deterioration on Chest Xray (link). Aspergillus precipitins rose to a titre of 1:32 , and CRP to 30, and ESR to 49. He was restarted on itraconazole.

F. April 03 No better on itraconazole despite high concentrations of itraconazole in blood.

G. October 03 Stable and reasonable, with weight loss reversed, CRP <5, ESR 13 and Aspergillus precipitins at a titre of 1:16 . Further evolution of radiological features.

H. April 04 Back to where he was in terms of symptoms when he stopped itraconzole. CRP, <5, ESR 20, Aspergillus precipitins titre 1:8. Further radiological change.

I. June 08 Patient remained well no cough, no sputum despite radiological signs

J. Oct 09 X ray showed little change over last 16 months in reasonable health, continuing on itraconazole.

Fungal ball A fungal ball, or plug, coughed up by a patient.
Fungal ball A fungal ball, or plug, coughed up by a patient.

A fungal ball, or plug, coughed up by a patient.

Pt DL mucoid impaction G Sheets of eosinophils
Pt DL mucoid impaction G Sheets of eosinophils

The patient underwent a pneumonectomy because of the severity of her disease process, and uncertainty about the diagnosis, prior to serology results being obtained. Serology showed an IgE of 2600, with a strongly positive Aspergillus RAST test and weakly positive Aspergillus precipitins. Material removed at bronchoscopy showed eosinophilia. These features confirm a diagnosis of allergic bronchopulmonary aspergillosis (ABPA).

Allergic fungal sinusitis (or eosinophilic fungal rhinosinusitis) 1 Axial computed tomography (CT) scans of the frontal sinus. A: due to the long lasting pressure
Allergic fungal sinusitis (or eosinophilic fungal rhinosinusitis) 1 Axial computed tomography (CT) scans of the frontal sinus. A: due to the long lasting pressure
SA Balajee
SA Balajee

Dr. Balajee is a graduate of the University of Madras (India) and completed her post doctoral training in Dr. Kieren Marr’s laboratory at the Fred Hutchinson Cancer Research Center, Seattle, US. Currently she leads the Molecular Epidemiology Unit within the Mycotic Diseases Branch at the Centers for Disease Control and Prevention.

Dr. Balajee’s dynamic research program is focused on public health mycology that includes studies on the molecular epidemiology of medically important fungi, specifically the genus Aspergillus. Another area of interest is understanding the role of mycotoxins, specifically aflatoxin elaborated by Aspergillus in mediating adverse health effects in humans. Dr. Balajee has published over 25 peer-reviewed articles and several book chapters and is committed to creating a learning environment for budding public health mycologists in her laboratory.  Dr. Balajee is the convenor for an international working group on A. terreus to gather and disseminate scientific knowledge in this field and is a member of the working group on species concepts inAspergillus.

Key Contributions to recent literature:

Contact details:

Arun Balajee Ph.D.
Chief, Molecular Epidemiology Unit,
Mycotic Diseases Branch,
Centers for Disease Control and Prevention Mail stop - G 11 1600 Clifton Road, Atlanta, GA - 30333

Email [email protected]

Phone - 404 639 3337
Fax - 404 639 3546

Aspergillus keratitis - a case of fungal keratitis following amnoiotic membrane transplantation (AMT) for bullous keratopathy. Slit-lamp photograph of left eye showing ring shaped stromal infiltrate. Aspergillus keratitis - a case of fungal keratitis following amnoiotic membrane transplantation (
Aspergillus keratitis - a case of fungal keratitis following amnoiotic membrane transplantation (AMT) for bullous keratopathy. Slit-lamp photograph of left eye showing ring shaped stromal infiltrate. Aspergillus keratitis - a case of fungal keratitis following amnoiotic membrane transplantation (

Amniotic membrane transplantation (AMT) has been used effectively in the treatment of bullous keratopathy. It can be considered as an alternative to conjunctival flap in alleviating pain, promoting epithelialisation in patients with symptomatic bullous keratopathy and poor visual potential .This 55-year-old female underwent amniotic membrane transplantation (AMT) with epithelial debridement and anterior stromal puncture in the left eye for symptomatic bullous keratopathy. She developed fungal keratitis after 4 weeks. Aspergillus sp. was isolated from the corneal scraping. The patient was treated with systemic and topical antifungal medication. Although AMT is safe, there is a risk of microbial infection after the procedure especially in poor ocular surfaces.

Aspergillus versicolor causing onychomycosis Cultures were grown on malt extract agar. Image kindly provided by Niall Hamilton.
Aspergillus versicolor causing onychomycosis Cultures were grown on malt extract agar. Image kindly provided by Niall Hamilton.
Finger clubbing Chronic cavitary pulmonary aspergillosis. Pt CJ finger clubbing
Finger clubbing Chronic cavitary pulmonary aspergillosis. Pt CJ finger clubbing

Pt CJ finger clubbing, this patient had chronic cavitary pulmonary aspergillosis, with an aspergilloma since 1988, following an episode of haemoptysis. Currently patient still has symptomatic disease.

The molecular structure of Abafungin The molecular structure of Abafungin
The molecular structure of Abafungin The molecular structure of Abafungin
Cerebral aspergillosis Cerebral aspergillosis, Pt MN
Cerebral aspergillosis Cerebral aspergillosis, Pt MN

Contrast enhanced scan of the brain in a 5 year old child who had a convulsion several weeks after starting chemotherapy for acute lymphoblastic leukaemia. Multiple ring enhancing abscesses with substantial surrounding oedema was demonstrated. He had no focal neurological deficits. A needle aspiration confirmed the clinical impression of cerebral aspergillosis by culture and microscopy.

Airways (tracheobronchial) Bronchoscopic biopsy demonstrated septate hyphae with branching at 45o (methenamine silver stain ×
Airways (tracheobronchial) Bronchoscopic biopsy demonstrated septate hyphae with branching at 45o (methenamine silver stain ×

Featured as part of Airways (tracheobronchial) in the treatment section

The molecular structure of posaconazole (SCH56592)

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