Sketchy Micro: Aspergillus Fumigatus

Question 1

How can you associate the scene with the name of the fungus?

Answer 1

The scene takes place at an ASPaRaGUS farm being FUMIGATed.

Question 2

Which two fungi are catalase-positive?

Answer 2

Aspergillus (cat on the scarecrow) and Candida (cat sleeping in the snow)

Question 3

Aspergillus __________ can cause hepatocellular carcinoma.

Answer 3

flavus

FLAvus produces aFLAtoxins.

Question 4

How can you remember the association with HCC?

Answer 4

There is a cow with a liver spot next to a tractor with a crab on it.

Question 5

What morphologic presentation will you see in a sample of Aspergillus?

Answer 5

Hyphae that branch in acute (less than 45º) angles and have septations

(Think of the peanut plant –another association, because peanuts can be contaminated with aflatoxins –which has branches that divide in acute angles.)

Question 6

How is Aspergillus transmitted?

Answer 6

Aspergillus forms conidiophores, which are fruiting bodies on top of stems (this is how Aspergillus got its name, because it looks like an aspergillum – a device for sprinkling holy water). These fruiting bodies send out spores that are inhaled.

(Think of the fruiting bodies on the peanut plant.)

Question 7

Describe ABPA.

Answer 7

Allergic bronchopulmonary aspergillosis is a type I hypersensitivity reaction common in asthmatics and those with CF that produces wheezing. It presents with a migrating lung infiltrate.

(Think of the MIGRAnT worker running from the plane with ABPA on its wings – he has an inhaler in his hand.)

Question 8

What Aspergillus infection is associated with TB and other cavitating lung diseases?

Answer 8

Aspergillomas, which are balls of fungi

These present in a lung cavity and are gravity-dependent, meaning they’ll be inferior in an upright chest x-ray.

(Think of the guy coughing next to the TB cactus. Also, there are masses of peanuts beneath the cactus.)

Question 9

What Aspergillus infection presents in those with neutropenia from chemotherapy?

Answer 9

Angioinvasive aspergillosis

Think of the farm worker with the cane next to the red irrigation equipment.

Question 10

What are the symptoms of angioinvasive aspergillosis?

Answer 10

• Hemoptysis (worker coughing into red handkerchief)
• Fever (worker sweating)
• Dissemination throughout body (like the name angioinvasive)
• Kidney failure (like the scarecrow’s patched knees)
• Endocarditis (like the patch on the scarecrow’s heart)
• Ring-enhancing brain lesions (like the patches on the scarecrow’s brain)
• Necrosis of the nose (like the black spot where the scarecrow’s nose should be)

Question 11

How should Aspergillus infections be treated?

Answer 11

• Voriconazole for mild infections (like the pine cones in the tornado –the VORtex)
• Surgical debridement for aspergillomas
• Amphotericin B for serious infection (like the frogs jumping around the guy with the cane)