Fungus Superficial Mycoses PDF

Fungus Super cial mycoses: colonize the keratinized outer layers of the skin, hair, and nails Fungi Transmission Morphology and Clinical manifestations...

Fungus Super cial mycoses: colonize the keratinized outer layers of the skin, hair, and nails Fungi Transmission Morphology and Clinical manifestations Risks Detection method Treatment Pathophysiology Pityriasis (tinea) Direct or indirect transfer Spherical, yeast-like Small, hypopigmented Found with tropical Microscopic examination Usually chronic and versicolor of infected keratinous cells mixed with or hyper pigmented environments Culture persistent material from person to infrequently branched macule Young adults Topical azoles Caused by Malassezia person hyphae Lesions are irregular, Selenium sul de furfur complex Interfere with production well-demarcated shampoo of melanin patches of discoloration Usually on upper trunk, arms, chest, shoulders, face, and neck Dark-skinned: hypopigmented lesions Light-skinned: pink to pale brown, more obvious with tanned skin Asymptomatic lesions Mild pruritis in severe cases Tinea nigra Traumatic inoculation of Dermatiaceous (brown/ Solitary, irregular brown/ Found with tropical Microscopic examination Whit eld ointment the fungus into black melanin black macule environments Azole creas Caused by Hortaea super cial layers of pigmented) branched, Usually on palms or Children Terbina ne werneckii epidermis septate hyphae soles of feet Young adults Not contagious No discomfort Females have higher Lesion sometimes incidence resembles malignant melanoma Black piedra Condition due to poor Pigmented brown- Dark nodules that Found with tropical Microscopic examination Haircut hygiene reddish/black mold surround hair shaft environments Proper and regular Caused by Piedraia Grow as spindle-shaped Usually on scalp Poor hygiene washings hortae ascospores within asci Asymptomatic Structures are produced within rock-hard hyphal mass that surrounds hair shaft Page 1 of 23 fi fi fi  fi fi   Cutaneous mycoses: infections caused by dermatophytic fungi (dermatophytosis) and nondermatophytic fungi (dermatomycosis) Fungi Transmission Morphology and Clinical manifestations Risks Detection method Treatment Pathophysiology Dermatophytoses Geophilic: live in the soil Pathophysiology A ected by species of School settings GMS and PAS stains Topical treatments like and spread to humans Keratinophilic and dermatophytes, Tinea capitis: found with Microscopic examination azoles, terbina ne, Complex of disease and animals keratinolytic: can inoculum size, site of prepubescent children Cultures haloprogin, and Whit eld caused by Trichophyton, Zoophilic: parasitize the breakdown keratin infection, and immune Tinea cruris and tinea ointment Epidermophyton, and hair and skin of animals surfaces of the hair, skin, status of host pedis: found with adult Oral antifungals like Microsporum and can be spread to and nails Various forms referred to males uconazole and humans Ectothrix: arthroconidia as “tineas” or ringworm griseofulvin Anthropophilic: infect are formed on the Pattern of a ring of humans and can be outside of the hair in ammatory scaling transmitted directly or Endothrix: arthroconidia with diminution of indirectly from person to are formed inside the in ammation toward the person hair center of the lesion Tineas of hair-bearing Favic: hyphae, areas: raised, circular, or arthroconidia, and ring-shaped patches of empty spaces alopecia wwith erythema resembling air bubbles and scaling, scattered (honeycomb pattern) are papules or pustules, or formed inside the hair kerions (severe in ammation involving Morphology the hair shaft) Appear as hyaline Tinea unguium: septate hyphae, chains onychomycosis; nail of arthroconidia, or plate is destroyed by dissociated chains of fungus arthroconidia that invade Tinea rubrum: rapid, the stratum corneum, progressive form of hair follicles, and hair oncyomycosis seen with Trichophyton: AIDS patients numerous, spherical, teardrop, or peg-shaped *Non-dermatopytic fungi microconidia can also cause Epidermophyton: onychomycosis* smooth-walled macroconidia in clusters of two to three Microsporum: large multicellular, thick/ rough-walled macroconidia Page 2 of 23 fl ff fl fl fl  fi  fi  Subcutaneous mycoses: involve the deeper layers of the skin, including the cornea, muscle, and connective tissue Fungi Transmission Morphology and Clinical manifestations Risks Detection method Treatment Pathophysiology Lymphocutaneous Traumatic inoculation of Wrinkled membranous Initial nodules Common in warmer Culture of infected Oral potassium iodide in sporotrichosis soil, vegetable, or surface that gradually Appears after local climates tissue/pus saturated solution organic matter becomes tan, brown, or trauma Forest work Splendore-Hoeppli Itraconazole or Caused by Sporothrix contained with fungus black Small nodule Mining surrounding the yeast uconazole schenckii Zoonotic transmission Narrow, hyaline, septate Sometimes ulcerates Gardening cells with armadillo hunters hyphae that produce Can sometimes be Serology and stray cat bites oval conidia “ xed” without lymphatic Rigmata formation on spread; can resemble conidiophores SCCa Yeast form: spheric, oval, or elongated yeast- Secondary lymphatic like cells with single or nodules (after 2 weeks) multiple buds Linear chain of painless, subcutaneous nodules Extend proximally along the course of lymphatic drainage of the primary nodules Can ulcerate and discharge pus Page 3 of 23 fl fi    Fungi Transmission Morphology and Clinical manifestations Risks Detection method Treatment Pathophysiology Chromoblastomycosis Contact with woody Diverse morphology Early lesions Common in the tropics Microscopic examination Antifungals are usually plants and infected soil seen with cultures due Usually don’t present Working in rural, infected Culture ine ective due to Caused by to multiple genera until the infection is well- soil advance stage of dermatiaceous fungi of In tissue, the fungi that established infection on presentation the genera Fonsecaea, cause the disease Small, warty papules Most e ective are Exophialia, characteristically form Enlarge slowly itraconazole and Cladosporium, medlar bodies (sclerotic Can range from terbina ne Cladophialophora, bodies) that are verrucous lesions to at Heat or cryotherapy Rhinocladiella, and muriform cells that are plaques prior to anti fungal is Phialophoria chestnut brown due to most successful melanin Established lesions Pigmented hyphae may Multiple, large, warty, be present “cauli ower-like” Most often contained growths within macrophages or Clustered in the same giant cells region Large lesions are hyperkeratotic Plaque-like lesion show central scarring as they enlarge Limbs are grossly distorted due to brosis and secondary lymphedema At risk for SCCa with long-standing lesions Page 4 of 23 ff fl ff fi  fi  fl  Fungi Transmission Morphology and Clinical manifestations Risks Detection method Treatment Pathophysiology Eumycotic mycetoma Traumatic percutaneous Septate fungal hyphae Mycetoma: localized, Common in the tropics Culture Commonly present implantation of etiologic that are either black chronic, granulomatous, Men are more a ected Microscopic examination symptoms with long- Caused by true fungi device into exposed grains or pale/white infectious process compared to women H&E stai standing infections parts of the body grains involving cutaneous and Di cult to treat Mycetomas are not Large, spheric, thick- subcutaneous tissue Ketoconazole, contagious walled chlamydoconidia that contain large amphotericin B, and are often present aggregates of fungal itraconazole treatments hyphae (granules or work poorly but slow grains) down course of disease Amputation is the only Early mycetoma de nitive treatment Small, painless subcutaneous nodular plaque Increases slowly but progressively in size Established mycetoma A ected area gradually enlarges Becomes dis gured Causes chronic in ammation and brosis Sinus tracts appear on skin surface and drain uid with granules Commonly breaches tissue planes Can destroy muscle and bone locally Page 5 of 23 fl fi ff fl ffi fi  fi ff   Fungi Transmission Morphology and Clinical manifestations Risks Detection method Treatment Pathophysiology Subcutaneous B. ranarum: Traumatic Hyphal elements are B. ranarum Common in tropical Biopsy is required for B. ranarum enthomophthoromycosis implantation of the sparse and appear as Disk-shaped, rubbery, environments diagnosis Surgical excision fungus into the hyphal fragments movable masses that Potassium iodide Caused by subcutaneous tissues of Surrounded by intensely can be large Prolonged azole Murcormycetes of the the thighs, buttocks, and eosinophilic Splendore- Localized to the treatment species C. coronatus trunk Hoeppli material shoulder, pelvis, hips, and B. ranarum C. coronatus: Inhalation Hyphal fragments ate and thighs C. coronatus of the fungal spores thin-walled Sporadic infections of Potassium iodide which invade the tissues the GI tract have been Facial reconstruction of the nasal cavity, the reported surgery may be paranasal sinuses, and necessary facial soft tissue C. coronatus Con ned to rhino facial area Does not come to medical attention until there is swelling of upper lip or face Swelling is rm and painless; may progress to the nasal bridge and upper/lower face Facial deformity is common and looks dramatic Subcutaneous Traumatic implantation Grow as black mold Present as solitary Working soil and plants Biopsy of cyst Surgical excision of the phaeohyphomycosis of the fungus Appear dark-walled, in ammatory cysts H&E stain cyst Found in soil and plant irregular, hyphal, and Usually occur with feet Plaquelike treatments Caused by pigmented debris yeast-like in tissue and legs; sometimes on requires itraconazole (dermmatiaceous) fungi; May be branched or hands and other body frequently Exophiala, septate sites Alternaria, Curvularia, Bizarre, thick-walled, Lesions grow slowly and Phaeoacremonium vesicular swellings may Firm or uctuant, usually species be present painless Identi ed in culture by Are sometimes mistaken their characteristic mode as a synovial cyst if near or sporulation a joint Cyst shows a brous Sometimes include capsule, granulomatous pigmented plaquelike reaction, and central lesions that are necrosis indurated but non- tender Page 6 of 23 fl fi fi fl  fi fi   Systemic mycoses (dimorphic fungi) Fungi Transmission Morphology and Clinical manifestations Risks Detection method Treatment Pathophysiology Blastomycosis Inhalation of aerosolized Non-encapsulated Severity is dependent on the Con ned to the Yeast form: H&E stain Disseminated disease extent of exposure and immune conidia produced by the yeastlike cells in tissue status of the individual Mississippi River, Great Mold form: GMS and requires anti-fungal Caused by dimorphic fungus in soil and leaf and in culture Lakes, and southeastern PAS stains therapy; amphotericin B pathogens of litter Mold form produces Pulmonary regions Culture Mild to moderate Can present as pulmonary disease Blastomyces Found in decaying round to oval or pear- or extra pulmonary disseminated Occupational or Skin scrapings disease can be treated organic matter shaped conidia on long disease recreational contact with with itraconazole or short terminal hyphal 2/3 of patients with extra soil Immunocompromised pulmonary disseminated disease branches exhibit involvement with skin, AIDS; rare but will patients may require Yeast form are bones, prostate, liver, spleen, involve the CNS with a long-term suppressive spherical, hyaline, kidney, and CNS poor prognosis therapy with itraconazole Mild case: asymptomatic or mild- multinucleate, and have ulike illness thick, double contoured Severe case: resembles bacteria pneumonia with acute onset; can walls cause adult respiratory distress Yeast cells reproduce by syndrome or respiratory failure the formation of buds Chronic cutaneous involvement (blastoconidia); usually Due to dissemination from the lung single and attached to without any evident pulmonary the parent cell by broad lesions or systemic symptoms Lesions are painless and can be bases papular, pustular, ulcerative-nodular with crusted surfaces and raised borders Localized to face, scalp, neck, and hands Can be mistaken for SCCa Untreated can lead to chronic course with remissions and exacerbations with gradual increase of the lesions Rare pulmonary disease from B. parvus Inhalation of aerosolized conidia released from the mycelial phase of the fungus in soil Conidia will dramatically enlarge in lungs to adiaspores Provoke a foreign body reaction that leads to granulomatous lung disease Mild case: subclinical pneumonia Severe case: di use pulmonary disease with hypoxic respiratory failure; death Page 7 of 23 fl fi  ff   Fungi Transmission Morphology and Clinical manifestations Risks Detection method Treatment Pathophysiology Coccidioidomycosis Inhalation of infectious Dimorphic fungi that Primary C. immitis: found in Microscopic examination Primary arthroconidia exists as mold in nature coccidioidomycosis California Culture coccidioidomycosis: Caused by either C. Found in soil Endosporulating Inhalation of a FEW C. posadasii: found Serology do not require speci c immitis or C. posadasii Enhanced by bat and spherule in tissue arthroconidia anywhere outside of PCR antifungal treatment rodent droppings Hyphae give rise to Can cause California UNLESS fertile hyphae that asymptomatic Cycles of drought and immunosuppressed produce alternating pulmonary disease rain facilitate the Secondary hyaline arthroconidia Self-limited ulike dispersion of organism coccidioidomycosis: or Infectious conidia are illnesses Filipino, African immunosuppressed typically “barrel-shaped” Allergic reactions American, Native should be treated with and have frill at both secondary to immune American, and Hispanic amphotericin B followed ends complex formation; have highest risk of by an azole; total length Arthroconidia become include macular rash, dissemination with should be one year rounded in the lungs erythema multiforme, meningeal involvement minimum after inhalation; convert and erythema nodosum Pregnant women to spherules Cellular immunode cient Spherules will produce Secondary patients (AIDS, organ endospores; this is transplants, TNF coccidioidomycosis called progressive Patients symptomatic for antagonists) cleavage 6+ weeks with primary Old age Rupture of ferule walls disease produce endospores, Leads to lung nodules, which produce new cavitary disease, or spherules progressive pulmonary disease Single/multisystem dissemination occurs in 1% of people infected Dissemination can a ect skin, soft tissues, bones, joints, and meninges Page 8 of 23  fl  fi fi ff  Fungi Transmission Morphology and Clinical manifestations Risks Detection method Treatment Pathophysiology Histoplasmosis Aerosolization of Morphology Histoplasmosis capsulati Histoplasmosis Microscopic examination Treatment with Dependent on the intensity of microconidia and hyphal Thermally dimorphic exposure and immunologic status capsulati: localized to Culture of blood, bone itraconazole for Caused by H. fragments in the fungi existing as a of host the broad regions of the marrow, or other clinical immunocompromised capsulatum var. disturbed soil or hyaline mold in nature Asymptomatic infection occurs Ohio and Mississippi, material patients with 90% of cases capsulatum and H. inhalation by exposed and in culture at 25 Acute pulmonary histoplasmosis: Mexico, Central Serology Severe pulmonary capsulatum var. duboisii individuals degrees celsius self-limited form; ulike symptoms America, and South histoplasmosis with Found in soil with high Intracellular budding with chest pain America hypoxia should be Radiographic evidence shows hilar nitrogen content like yeast in tissue and in or mediastinal adenopathy and Histoplasmosis treated acutely with areas with bat or bird culture at 27 degrees patchy pulmonary in ltrates amphotericin B followed duboisii: also known as droppings celsius Can cause acute respiratory by oral itraconazole distress syndrome but rare African histoplasmosis, Outbreaks are seen with Grow slowly and Can cause mediastinal brosis but is con ned to the caves, decaying develop as white or rare tropical areas of Africa buildings, or bird roosts brown hyphal colonies With 10% of patients, in ammatory sequelae can be seen with Mold form produces persistent lymphadenopathy, two conidia: bronchial obstruction, arthritis, or pericarditis 1. Large, thick-walled, Progressive pulmonary spheric macroconidia histoplasmosis: can follow acute with spikelike infection due to apical cavities and brosis; more likely to occur with projections that arise patients with underlying pulmonary from short disease conidiophores Disseminated histoplasmosis: follows acute infection and higher 2. Small, oval with children and microconidia with immunocompromised; smooth or slightly rough characterized by weight loss, fatigue, oral ulcers, and walls that are senile or hepatosplenomegaly on short stalks Subacute disseminated histoplasmosis: with severely Yeast form: var. immunosuppressed individuals; capsulatum are small, causes fever, weight loss, malaise, thin-walled, oval and var. leukopenia, anemia, thrombocytopenia, hypotension, duboisii are larger and pulmonary in ltrates, and acute thicker-walled respiratory distress; sometimes GI/ oral ulcers/bleeding, meningitis, and endocarditis are seen Pathophysiology Can cause death within 2-24 Inhalation of months if untreated microconidia leads to Histoplasmosis duboisii germination into yeast Chronic disease characterized by within the lungs regional lymphadenopathy, wwith May remain localized or lesions of the skin and bone Skin lesions are papular or nodular; disseminated through usually progress to abscesses, the blood or lymph which then ulcerate system 30% of patients have osseous lesions characterized by osteolysis Microconidia are readily and contagious joints phagocytosed by Fulminant disseminated form: pulmonary seen with immunosuppressed individuals; causes blood and macrophages/ lymph dissemination to the bone neutrophils marrow, liver, spleen; causes fever, lymphadenopathy, anemia, weight loss, and organomegaly Can cause death if not diagnosed and treated Page 9 of 23 fi fi fi  fl fi fi fl   Fungi Transmission Morphology and Clinical manifestations Risks Detection method Treatment Pathophysiology Paracoccidioidomycosis Inhalation or traumatic Mold form: grows Primary infections Endemic throughout Microscopic examination Itraconazole for at least (South American inoculation slowly and shows white Usually self-limited Latin America; more Scrapings 6 months Found in soil Organism can become prevalent in South Biopsy of ulcers Severe cases require blastomycosis) colonies, taking on a dormant for long periods of Natural infection has velvety appearance time and reactive with America due to high Stains amphotericin B therapy; Caused by P. brasiliensis only been documented Can sometimes look immunosuppression humidity, moderate Serology followed by itraconazole and P. lutzii with armadillos wrinkled or brownish temperatures, and acid or sulfonamide therapy Myecelial form: is Subacute disseminated form soil nondescript showing Seen with Usually seen with immunocompromised children hyaline, septate, hyphae individuals and young with intercalated patients chlamydoconidia; Causes lymphadenopathy, requires conversion to organomegaly, bone marrow the yeast form for involvement, and speci c diagnosis osteoarticular manifestations Can also cause recurrent Yeast form: seen in fungemia and frequent skin tissue and in cultures lesions with double refractive walls and single/multiple Chronic pulmonary form buds (blastoconidia); Adults most often present these are connected to with this form the parent cell causing Marked by respiratory problems that progresses the “pilot-wheel” over months to years morphology Causes persistent cough, purulent sputum, chest pain, weight loss, dyspnea, and fever Pulmonary lesions are nodular, in ltrative, brotic, and cavitary Infection can disseminate to extra pulmonary locations, like skin, mucosa, lymph nodes, adrenal glands, liver, spleen, CNS, and bones Mucosal lesions are usually painful and ulcerated; con ned to mouth, lips, gums, and palate Page 10 of 23 fi fi fi  fi   Opportunistic mycoses Fungi Transmission Morphology and Clinical manifestations Risks Detection method Treatment Pathophysiology Candidiasis Endogenous infection Morphology Can cause clinically apparent Found in ICUs due to Microscopic examination Removal of object infection of any organ system where the normal host Exist as oval, yeastlike Range from super cial mucosal hands of healthcare Culture inserted Commonly caused by ora takes advantage of forms that produce buds and cutaneous candidiasis to workers Scraping of lesions Topical creams, lotions, C. albicans (most the opportunity to cause or blastoconidia widespread hematogenous Age suppositories containing dissemination with target organs common), C. glabrata, C. infection Candida (other than C. (liver, spleen, kidney, heart, and Immunosuppressed azole antifungal agents parasilosis, and C. Exogenous glabrata) produce brain) Antifungal drug Systemic therapy like tropicalis transmission from things pseudohyphae and true exposure uconazole for Thrush like contaminated hyphae, along with Mucosal infections Antibiotics hematogenous irrigation solutions, terminal, thick-walled Can be limited to oropharynx or MOST ASSOCIATED infections parenteral nutrition chlamydoconidia extend to the esophagus/entire GI WITH DEATH IN IV antifungal tract uids, vascular pressure Form smoother, white, Present as white, cottage cheese- NOSOCOMIAL transducers, cardiac creamy, domed colonies like patches BLOODSTREAM Pseudomembranous type: raw valves, and corneas in culture bleeding when scraped INFECTIONS Colonizers of humans Erythematous type: at, red, and and other warm-blooded Pathophysiology occasionally sore areas Leukoplakia: non-removable, white animals Can undergo thickening of epithelium Primary site of phenotypic switching Angular cheilitis: sore tissues at the colonization is the GI to other morphotypes of corners of the mouth tract from mouth to Candida Localized skin infection rectum; also found on Can allow for survival in Groin, axillae, toe webs, breast vagina, skin, under many di erent folds Present as pruritic rash with ngernails and toenails environments within the erythematous vesiculopustular human host lesions Onchomycosis and paronchia may occur Skin lesions can appear during hematogenous dissemination Chronic mucotaneous candidiasis Marked by de ciency in T- lymphocystes Severe, unremitting mucocutaneous lesions Include invasive nail and vaginitis Can cause dis guring granulomatous appearance Other involvement Usually due to surgical procedure or things inserted into area Urinary tract: asymptomatic or can cause renal abscesses due to hematogenous seeding Intraabdominal: peritonitis, abdominal abscess, and purulent/ necrotic infections at sites of GI perforations Hematogenous: acute or chronic; can occur with CNS, heart, eyes, joints, abdominal viscera Page 11 of 23 fi fl fl fl ff fi  fi fi fl   Fungi Transmission Morphology and Clinical manifestations Risks Detection method Treatment Pathophysiology Cryptococcosis Inhalation of aerosolized Spheric to oval, C. neoformans: major Immunocompromised India ink stain due to Amphotericin B followed cells from the encapsulated, yeastlike opportunistic pathogen of (speci cally AIDS capsule by uconazole environment patients with AIDS; low CD4 patients) Culture of blood or CSF E ective management of Caused by C. organisms counts are at high risk for neoformans and C. gattii Rare transcutaneous Replications buds from a CNS and disseminated Microscopic examination CNS pressure inoculation relatively narrow base cryptococcosis AIDS patients require C. neoformans: found Single buds are usually C. gattii: tends to occur in lifelong maintenance in soil enriched with formed; sometimes there immunocompetent uconazole or pidgin droppings are multiple buds/chains individuals and has a lower itraconozole of buds present rate of mortality but a more Repeat lumbar severe neurologic sequelae punctures at end of 2- In tissue and stained, due to CNS granuloma cells are variable in size, formation week therapy and end of spheric, oval, or elliptic, Both are HIGHLY total therapy and are surrounded by a NEUROTROPIC halo that represents the polysaccharide Pulmonary cryptococcosis Can range from capsule asymptomatic to fulminant bilateral pneumonia Nodular in ltrates may be either unilateral or bilateral becoming more di use in severe infections Cerebromeningeal disease CNS infection secondary to hematogenous and lymphatic spread from pulmonary focus Ost common form of disease Fatal if left untreated Brain tissue and meninges are a ected, causing fever, headache, visual disturbances, abnormal mental state, and seizures Highly dependent on the patient’s immune system C. gattii causes parenchymal lesions (cryptococcomas) Can include skin lesions (look like molluscum congtagiosum), ocular nerve infections, vitritis, and ocular infections Fatal if untreated Page 12 of 23 fl ff fl ff fi fi  ff   Fungi Transmission Morphology and Clinical manifestations Risks Detection method Treatment Pathophysiology Aspergillosis Inhalation of infected air, Grows as hyaline mold Host factors (including reaction) are Immunocompromised Isolation with clinical Surgical excision of dependent for the ultimate soil, or decaying matter in culture and may be outcome of the infection Existing pulmonary specimens fungal ball Caused by members of black, brown, green, infections/structure Biopsy Radical debridement of the genus Aspergillus yellow, or white Bronchopulmonary form issues Microscopic examination sinuses Asthmas, pulmonary in ltrates, depending on species peripheral eosinophilia, elevated Enzyme immunoassay in Oral antifungal therapy Grow branched, septate serum IgE, and hypersensitivity to serum, bronchial alveolar High risk patients should hyphae that produce Aspergillus antigens on skin test lavage uid, and CSF lter their air to avoid may be seen conidial heads when Allergic sinusitis can cause nasal exposure exposed to air in culture obstruction, discharge, headache, and in tissue and facial pain Identi cation of species Aspergillus bronchitis and true of Aspergillus depends aspergilloma on the di erence of the Paranasal sinuses and lower airways are colonized coni dial heads, Usually occurs in setting of including the underlying pulmonary disease arrangement and Formation of bronchial casts or plugs composed of hyphal morphology of the elements and mutinous material conidia An aspergilloma (fungus ball) may form in the paranasal sinus or in pulmonary cavity Usually asymptomatic but can bee seen on radiographic examination Necrotizing pseudomembranous bronchial aspergillosis and chronic necrotizing pulmonary aspergillosis Destructive, locally invasive pulmonary or disseminated aspergillosis Can cause wheezing, dyspnea, and hemoptysis Most patients with this have underlying structural pulmonary disease In ltrates and fungus balls are seen on radiographic examination Invasive pulmonary aspergillosis Disseminated infections Seen with severely neutropenic and immunode cient patients Present with fever and pulmonary in ltrates often accompanied by pleuritic chest pain and hemoptysis Mortality with antifungal treatment is about 70% Hematogenous dissemination of infection to other areas are common due to angioinvasive nature of the fungus