![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 54 year old man developed right upper lobe shadowing after development of cough, chest pain and shortness of breath. He suffered from emphysema. Investigations, including a PET scan suggested carcinoma of the lung. He underwent an apical resection and histology showed bullae in the lung with one containing necrotic material and conidial heads consistent with Aspergillus.
Histology:
Two wedges of lung tissue were examined. The larger 90 x 35 x 35mm with adherent parietal pleura 100 x 45mm. Sectioning reveals irregular scarring and bullae in the lung tissue. No definite tumour is identified. A focus of possible necrosis up to 10mm in diameter is present, 10mm from the pleura and 20mm from the nearest staple line. Lung and adherent parietal pleura show dense fibrosis around a cavity (see fig A) arrow, lined by granulation tissue and fibrin. This is filled with necrotic material (Fig B) and branching septate fungal hyphae with conidial heads, consistent with Aspergillus and a fungal ball.(Fig C at higher power). A few scattered granulomata are seen away from the cavity. No invasion of lung parenchyma was seen. There is congestion of the lung parenchyma and collections of pigmented macrophages are seen within air spaces.Legends:
A- Section of lung showing a fungal ball within a cavity (x25). B- Showing branching septate hyphae with conidial heads (x250) C- Higher power magnification (x 500) showing the conidial heads more clearly. D – Edge of cavity showing from left to right – necrosis, granulaomatous reaction, fibrosis, chronic inflammation (x100). E- CT scan (July 08) showing a speculated nodular lesion in the right apex. F – Chest X-ray (May 08) – showing right upper lobe shadowing. G.PET scan (July 08)
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Pt DB This patient with longstanding pulmonary disease developed Mycobacterium avium pulmonary infection which was treated. X rays in Jan 05 through to May 06 revealed an aspergilloma in upper right lobe cavity. Following a severe prolonged bout of coughing up black material- X rays on 22/9/07 showed a disappearance of the aspergilloma.( Images G & H). Go to case history
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This 63 year old smoker presented with a new small mass in the right upper lobe. She had had tuberculosis as a teenager (1958) which recurred in 1962, requiring 2 long stays in a sanatorium. Since then she was well, until a new shadow was noticed on her chest X-ray. A CT showed a smooth round nodule, and to rule out carcinoma it was biopsied percutaneously. Histology showed fungal hyphae, consistent with Aspergillus , and serology confirmed infection with Aspergillus fumigatus. Following biopsy, an air fluid pocket has appeared, most consistent with an aspergilloma, as the lesion is solitary.
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Patient MD with kyphoscoliosis and chronic cavitary pulmonary aspergillosis and an aspergilloma. Patient exhibited azole resistant A. fumigatus.
Further details
Image A. This CT scan cut shown shows a grossly distorted thorax because of the kyphoscoliosis, a nearly normal appearing left lung, her trachea at an odd angle, demonstrating the normal cartilage rings and an aspergilloma in a cavity which has replaced the right upper lobe. The cavity is surrounded by significant pleural thickening and fibrosis.
Image B. The other cut (slightly inferior) shows a complex large cavity and some smaller ones posteriorly, with some material consistent with a fungal ball within the large cavity. There is a separate cavity anteriorly and small air spaces within the extensive pleural thickening. Her trachea is widened. the left lung appears normal.
This patient with repaired juvenile scoliosis first recognised that she had pulmonary aspergillosis when she coughed up large amounts of blood, she was admitted to ICU and underwent bronchial artery embolisation, followed by tranexamic acid orally. A. fumigatus was cultured from sputum. A diagnosis of chronic cavitary pulmonary aspergillosis with an aspergilloma was made. She didn’t improve with itraconazole (no fall in Aspergillus precipitins and continuing symptoms, despite good blood levels) and was treated with voriconazole. She had a good sympomatic response, with marginal improvement in her Aspergillus precipitins titre. Remission continued for over 3 years but then her symptoms of cough and general fatigue returned. Her sputum grew A. fumigatus again, which had MICs to itraconazole (>8 mg/L, resistant), voriconazole (8mg/L, resistant) and posaconazole (2mg/mL, resistant). She is being treated with amphotericin B.
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Histopathological appearance of a fungus ball: it consists of a tangled mass of branching, septate hyphal with vesicular swellings in the center (H&E, x 200).
