![Asp[1]fumigatus](https://www.aspergillus.org.uk/wp-content/uploads/2013/11/Asp1fumigatus.jpg)
Date: 7 May 2013
A four day A. fumigatus culture on malt extract agar (above). Light microscopy pictures are taken at 1000x mag., stained with lacto-phenol cotton blue (right).
Copyright:
With thanks to Niall Hamilton.
Notes:
Colonies on CYA 40-60 mm diam, plane or lightly wrinkled, low, dense and velutinous or with a sparse, floccose overgrowth; mycelium inconspicuous, white; conidial heads borne in a continuous, densely packed layer, Greyish Turquoise to Dark Turquoise (24-25E-F5); clear exudate sometimes produced in small amounts; reverse pale or greenish. Colonies on MEA 40-60 mm diam, similar to those on CYA but less dense and with conidia in duller colours (24-25E-F3); reverse uncoloured or greyish. Colonies on G25N less than 10 mm diam, sometimes only germination, of white mycelium. No growth at 5°C. At 37°C, colonies covering the available area, i.e. a whole Petri dish in 2 days from a single point inoculum, of similar appearance to those on CYA at 25°C, but with conidial columns longer and conidia darker, greenish grey to pure grey.
Conidiophores borne from surface hyphae, stipes 200-400 µm long, sometimes sinuous, with colourless, thin, smooth walls, enlarging gradually into pyriform vesicles; vesicles 20-30 µm diam, fertile over half or more of the enlarged area, bearing phialides only, the lateral ones characteristically bent so that the tips are approximately parallel to the stipe axis; phialides crowded, 6-8 µm long; conidia spherical to subspheroidal, 2.5-3.0 µm diam, with finely roughened or spinose walls, forming radiate heads at first, then well defined columns of conidia.
Distinctive features
This distinctive species can be recognised in the unopened Petri dish by its broad, velutinous, bluish colonies bearing characteristic, well defined columns of conidia. Growth at 37°C is exceptionally rapid. Conidial heads are also diagnostic: pyriform vesicles bear crowded phialides which bend to be roughly parallel to the stipe axis. Care should be exercised in handling cultures of this species.
Images library
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This 24-year-old male with AML on chemotherapy developed recent onset fever and cough. B- Representative section of High Resolution CT shows centri-lobular nodules, ‘tree-in-bud’ appearance consistent with bronchogenic spread of disease.
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This 24-year-old male with AML on chemotherapy developed recent onset fever and cough. A: Chest radiograph showing patchy air space consolidation involving both lungs.
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This man with severe chronic fibrosing alveolitis underwent a single left lung transplant at the end of November 2004. Postoperatively he developed reperfusion pulmonary oedema and was difficult to ventilate. He also developed acute renal failure requiring haemodialysis/haemofiltration which corrected his fluid overload and rising creatinine.Rejection was prevented with cyclosporin, mycophenolate and a decreasing dose of methylprednisolone. Cardiovascular problems identified mild pulmonary anastomostic stenosis with a 5% pressure gradient. He had a tracheostomy about 12 days post transplant. He then developed episodes of hypoxia and increased ventilatory pressures. Several bronchoscopies showed mucus plugging in the trachea and major bronchi. These were aspirated, with improvement of oxygenation. Cultures of one of these plugs grew A. fumigatus. These images show a bronchoscopy view of the trachea and anastomosis. Major obstruction of the airway is visible (70%) distal to the anastomosis which looks healthy. Some evidence of tracheal inflammation is visible.
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The chest x-ray shows a patient who had a left lung transplanted in May 2003 for cryptogenic fibrosing alveolitis, which was diagnosed post-transplant as sarcoidosis.
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Tracheal aspergillosis. Bronchoscopic views of the trachea showing nodules in the trachea that revealed Aspergillus on biopsy. The patient had chronic lymphocytic leukaemia treated with fludarabine and corticosteroids and presented with wheezing and bilateral alveolar shadows.
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Tracheal aspergillosis, Bronchoscopic views of the trachea showing nodules in the trachea that revealed Aspergillus on biopsy. The patient had chronic lymphocytic leukaemia treated with fludarabine and corticosteroids and presented with wheezing and bilateral alveolar shadows.
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Tracheal aspergillosis. Bronchoscopic views of the trachea showing nodules in the trachea that revealed Aspergillus on biopsy. The patient had chronic lymphocytic leukaemia treated with fludarabine and corticosteroids and presented with wheezing and bilateral alveolar shadows.
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Tracheal aspergillosis. Bronchoscopic views of the trachea showing nodules in the trachea that revealed Aspergillus on biopsy. The patient had chronic lymphocytic leukaemia treated with fludarabine and corticosteroids and presented with wheezing and bilateral alveolar shadows.
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Aspergillus tracheobronchitis in a normal child. This figure, drawn in 1890, illustrates the appearances of the trachea and main bronchi at autopsy in a 3 year old child. She had little else wrong at autopsy other than a minor degree of tuberculosis. She is the first recorded case of Aspergillus tracheobronchitis in the literature and illustrates well that this disease can affect previously well non-inimmunocompromised people. The full case is reported in Wheaton SW.
