The first, ulcerative or pseudomembranous tracheobronchitis, has been seen both in AIDS patients and in other immunosuppressed patients. It is usually a locally invasive disease of the airways, often with systemic dissemination and occasionally with concomitant pulmonary invasion. Without aggressive therapy, this condition is rapidly fatal. Patients with this condition tend to have milder host defense defects, such as those caused by malnutrition, low-dose steroids, diabetes, and alcoholism, and usually have underlying chronic lung disease. X-rays reveal progressive destruction of areas of the lung parenchyma.
Management requires treatment of the underlying condition and antifungal therapy.
The diagnosis of invasive aspergillosis is difficult. Usually, cultures are transiently positive and organisms are isolated in relatively small numbers. To complicate matters further, Aspergillus species are frequent laboratory contaminants. This problem may be overstated, however. It is especially troubling if the species isolated is A. fumigatus or A. flavus .