Asymptomatic Pulmonary Aspergillosis

  • Guan-Xun Cheng
  • Ling-Wei Wang


The type of pulmonary aspergillosis that occurs after inhalation of aspergillus spores via the respiratory tract depends on the immunity of the host. The more serious the immunity is compromised, the more likely the occurrence of pulmonary aspergillosis is and the more serious the symptoms are. In cases with hyperactive immune response, allergic bronchopulmonary aspergillosis occurs in patients with asthma and cystic fibrosis. In cases with competent immune response, only planting or temporary residence of aspergillus occurs. Therefore, asymptomatic or slightly symptomatic pulmonary aspergillosis commonly occurs in hosts with competent immunity or slightly suppressed immunity. And the most common type of pulmonary aspergillosis is simplex pulmonary aspergilloma, followed by subacute invasive pulmonary aspergillosis (also known as chronic necrotizing pulmonary aspergillosis). Radiology may demonstrate both with air crescent sign, which indicates the diagnosis. However, subacute invasive pulmonary aspergillosis is radiologically characterized by infiltration opacity around cavity as well as thick and irregular cavity wall. Pathologically, subacute invasive pulmonary aspergillosis is demonstrated as invasion of aspergillus hyphae into lung tissue, while pulmonary aspergilloma only grows in cavity or dilated bronchus and does not invade the lung tissue. The symptoms of simplex pulmonary aspergilloma are slight or absent. But if patients show hemoptysis, it indicates vascular invasion. Serum and bronchoalveolar lavage fluid (BALF) GM test shows a higher positive rate to subacute invasive pulmonary aspergillosis than to simplex pulmonary aspergilloma, which is related to their invasiveness.


  1. 1.
    Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J. 2016;47(1):45–68.CrossRefGoogle Scholar
  2. 2.
    Guo X, Song N, Liu Y, et al. Interpretations of the 2015 clinical guideline for chronic pulmonary aspergillosis. Clin Focus. 2016;31(3):325–31.Google Scholar
  3. 3.
    Dabó H, Marinho A, Gomes I. Pulmonary aspergillus nodule—still challenging? Arch Bronconeumol. 2015;51(11):603–4.CrossRefGoogle Scholar
  4. 4.
    Luo J, Peng M, Xiao Y. Clinical analysis of invasive pulmonary fungal infection. J Chin Acad Med Sci. 2010;32(02):141–6.Google Scholar
  5. 5.
    Cen Y, Li Y, Huang Y. Pulmonary cryptococcosis: clinical pathology of 25 cases. J Clin Exp Pathol. 2010;26(02):237–8.
  6. 6.
    Soubani AO, Chandraseker PH. The clinical spectrum of pulmonary aspergillosis. Chest. 2002;121:988–1999.CrossRefGoogle Scholar
  7. 7.
    Akbari JG, Varma PK, Neema PK, et al. Clinical profile and surgical outcome for pulmonary aspergilloma: a single center experience. Ann Thomc Surg. 2005;80:1067–72.CrossRefGoogle Scholar
  8. 8.
    Sharma S, Dubey SK, Kumar N, et al. Monod and air crescent sign in aspergilloma. BMJ Case Rep. 2013; Scholar
  9. 9.
    Trof RJ, Beishuizen A, Debets-Ossenkopp YJ, et al. Management of invasive pulmonary aspergillosis in non-neutropenic critically ill patients. Intensive Care Med. 2007;33(10):1694–703.CrossRefGoogle Scholar
  10. 10.
    Bochennek K, Abolmaali N, Wittekindt B, et al. Diagnostic approaches for immunocompromised paediatric patients with pulmonary infiltrates. Clin Microbiol Infect. 2006;12(3):199–201.CrossRefGoogle Scholar
  11. 11.
    Moodley L, Pillay J, Dheda K. Aspergilloma and the surgeon. J Thorac Dis. 2014;6:202–9.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(3):327–60.CrossRefGoogle Scholar
  13. 13.
    Leeflang MM, Debets-Ossenkopp YJ, Wang J, et al. Galactomannan detection for invasive aspergillosis in immunocompromised patients. Cochrane Database Syst Rev. 2015;(12):CD007394.Google Scholar
  14. 14.
    Park SY, Lee SO, Choi SH, et al. Serum and bronchoalveolar lavage fluid galactomannan assays in patients with pulmonary aspergilloma. Clin Infect Dis. 2011;52(7):e149–52.CrossRefGoogle Scholar
  15. 15.
    Ba PS, Ndiaye A, Diatta S, et al. Results of surgical treatment for pulmonary aspergilloma. Med Sante Trop. 2015;25(1):92–6.PubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. and Peoples Medical Publishing House, PR of China 2019

Authors and Affiliations

  • Guan-Xun Cheng
    • 1
  • Ling-Wei Wang
    • 2
  1. 1.Shenzhen Hospital of Beijing UniversityShenzhenChina
  2. 2.Second Clinical Medical College of Jinan UniversityShenzhenChina

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