Date: 7 May 2013
![Aspergillus_041[1]](https://www.aspergillus.org.uk/wp-content/uploads/2013/11/Aspergillus_0411.jpg "Aspergillus_041[1]")
Copyright: n/a
Notes:
Colonies on CYA 60-70 mm diam, plane, sparse to moderately dense, velutinous in marginal areas at least, often floccose centrally, sometimes deeply so; mycelium only conspicuous in floccose areas, white; conidial heads usually borne uniformly over the whole colony, but sparse or absent in areas of floccose growth or sclerotial production, characteristically Greyish Green to Olive Yellow (1-2B-E5-7), but sometimes pure Yellow (2-3A7-8), becoming greenish in age; sclerotia produced by about 50% of isolates, at first white, becoming deep reddish brown, density varying from inconspicuous to dominating colony appearance and almost entirely suppressing conidial production; exudate sometimes produced, clear, or reddish brown near sclerotia; reverse uncoloured or brown to reddish brown beneath sclerotia. Colonies on MEA 50-70 mm diam, similar to those on CYA although usually less dense. Colonies on G25N 25-40 mm diam, similar to those on CYA or more deeply floccose and with little conidial production, reverse pale to orange or salmon. No growth at 5°C. At 37°C, colonies usually 55-65 mm diam, similar to those on CYA at 25°C, but more velutinous, with olive conidia, and sometimes with more abundant sclerotia.
Sclerotia produced by some isolates, at first white, rapidly becoming hard and reddish brown to black, spherical, usually 400- 800 µm diam. Teleomorph not known. Conidiophores borne from subsurface or surface hyphae, stipes 400 µm to 1 mm or more long, colourless or pale brown, rough walled; vesicles spherical, 20-45 µm diam, fertile over three quarters of the surface, typically bearing both metulae and phialides, but in some isolates a proportion or even a majority of heads with phialides alone; metulae and phialides of similar size, 7-10 µm long; conidia spherical to subspheroidal, usually 3.5-5.0 µm diam, with relatively thin walls, finely roughened or, rarely, smooth.
Distinctive features
Aspergillus flavus is distinguished by rapid growth at both 25°C and 37°C, and a bright yellow green (or less commonly yellow) conidial colour. A. flavus produces conidia which are rather variable in shape and size, have relatively thin walls, and range from smooth to moderately rough, the majority being finely rough.
Images library
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25/04/90 After itraconazole treatment. Major improvement, defined as a complete response, after 10 weeks therapy with itraconazole.
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Image A. Chest x-ray shows a single nodule in the left mid lung field.
Image B. This emphasises how chest x-rays in this context underestimate the extent of disease. The most anterior nodule has ground glass surrrounding the nodule, a halo sign. This diagnostic feature is missed on plain chest X-rays.
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Chest X ray after 4 days, prior to treatment, showing massive increase in volume of lesion (Fig 2)
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Image A. This patient, aged 25 years developed a non productive cough and dyspnoea in the context of late-stage AIDS, CMV disease with ganciclovir-induced neutropenia and receiving corticosteroids. His chest radiograph shows fine bilateral reticular lower-lobe shadowing. He then developed gastro-intestinal bleeding with a gastric ulcer which showed hyphae on biopsy. He then developed blindness of one eye and the globe of his eye perforated. Hyphae were seen and Aspergillus cultured from the vitreous aspirate.
Image B. This radiograph, taken 25 days after the first and 3 days before death, shows of fine bilateral lower-lobe reticular shadows progressing to nodules in all lung zones.
This patient was reported as patient 3 in Denning DW, Follansbee S, Scolaro M, Norris S, Edelstein D, Stevens DA. Pulmonary aspergillosis in the acquired immunodeficiency syndrome. N Engl J Med 1991; 324: 654-662.
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Further details
Image A. Bronchoscopy revealed Aspergillus on culture.
Image B. The ability of Aspergillus to cause pulmonary infarction, probably through direct angioinvasion in this case, is characteristic.
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(Fig 1) Chest radiograph with ‘classical’ appearance of a pulmonary infarction – a wedge-shaped lesion peripherally set against the pleura.
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Large soft left upper-lobe shadow of focal invasive pulmonary aspergillosis in leukaemia, that was missed on earlier radiographs but apparent retrospectively. Variable density of the lesion suggests cavitation, which would be clearly visible on a CT scan of the thorax.
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Severe unilateral invasive aspergillosis of the left lung, with complete consolidation of the left lower-lobe and reticular shadowing extending up into the left upper lobe. The right lung appears normal.
