Aspergillosis manifests as invasive, noninvasive, chronic, or allergic disease depending on the immune status of the host.

• Invasive aspergillosis occurs almost exclusively in immunocompromised patients with prolonged neutropenia (eg, cytotoxic chemotherapy), graft-versus-host disease, or impaired phagocyte function (eg, chronic granulomatous disease, immunosuppressive therapy, corticosteroids). Invasive infection usually involves pulmonary, sinus, cerebral, or cutaneous sites. Rarely, endocarditis, osteomyelitis, meningitis, infection of the eye or orbit, and esophagitis occur. The hallmark of invasive aspergillosis is angioinvasion with resulting thrombosis, dissemination to other organs, and occasionally, erosion of the blood vessel wall with catastrophic hemorrhage. Aspergillosis in patients with chronic granulomatous disease rarely displays angioinvasion.


• Aspergillomas and otomycosis are 2 syndromes of nonallergic colonization by Aspergillus species in immunocompetent children. Aspergillomas ("fungal balls") grow in preexisting pulmonary cavities or bronchogenic cysts without invading pulmonary tissue; almost all patients have underlying lung disease, such as cystic fibrosis or tuberculosis. Patients with otomycosis have chronic otitis media with colonization of the external auditory canal by a fungal mat that produces a dark discharge.


• Allergic bronchopulmonary aspergillosis is a hypersensitivity lung disease that manifests as episodic wheezing, expectoration of brown mucus plugs, low-grade fever, eosinophilia, and transient pulmonary infiltrates. This form of aspergillosis occurs most commonly in immunocompetent children with asthma or cystic fibrosis and can be a trigger for asthmatic flares.


• Allergic sinusitis is a far less common allergic response to colonization by Aspergillus species than is allergic bronchopulmonary aspergillosis. Allergic sinusitis occurs in children with nasal polyps or previous episodes of sinusitis or children who have undergone sinus surgery. Allergic sinusitis is characterized by symptoms of chronic sinusitis with dark plugs of nasal discharge.