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Aspergillus epiglottitis and laryngitis

Aspergillus epiglottitis and laryngitis Aspergillus may infect the epiglottis leading to upper airway obstruction (Bolivar, 1983, Sriskandabalan, 1996). Most cases have had a fatal outcome but protection of the airway and systemic antifungal therapy is the appropriate therapeutic approach.

Aspergillus may infect the larynx in both non-immunocompromised patients and immunocompromised patients (Rao, 1969, Ferlito, 1974, Kheir, 1983, Benson-Mitchell, 1994, Kingdom, 1996, Richardson, 1996). In the case of the former it tends to be an indolent presentation with nodules on the cords. Cautery with or without oral itraconazole would be the management of choice, once the diagnosis is established by biopsy. In immunocompromised patients, systemic antifungal therapy is always appropriate. In those with rapidly progressive disease, intravenous amphotericin B would be appropriate, but in those slightly less immunocompromised, such as patients with AIDS, oral itraconazole will likely be as efficacious.

David W. Denning FRCP FRCPath FIDSA FMedSci
Professor of Medicine and Medical Mycology
Director, National Aspergillosis Centre
Education and Research Centre
University Hospital of South Manchester (Wythenshawe Hospital)
Southmoor Road
Manchester M23 9LT UK

September 2000