| Form | Dominant host state/risk | Mechanism | Hallmark phenotype/imaging/biomarker | Typical course | Core treatment |
|---|---|---|---|---|---|
| ABPA | Asthma or cystic fibrosis; also reported with COPD/bronchiectasis | Allergic/type-2 immune reaction to Aspergillus colonization/sensitization | A. fumigatus-specific IgE ≥0.35 kUA/L; total IgE ≥500 IU/mL; often eosinophils ≥500/µL; suggestive CT findings and/or mucus plugging/bronchiectasis | Relapsing exacerbations; can progress to bronchiectasis or pleuropulmonary fibrosis | Oral prednisolone or itraconazole monotherapy for acute disease; combination prednisolone+itraconazole for recurrent exacerbations; biologics/nebulized amphotericin in selected cases |
| Aspergillus bronchitis / sensitization | Chronic airway disease, especially severe asthma or cystic fibrosis; risk increased by inhaled corticosteroids, antibiotics, prior exacerbations | Persistent superficial airway infection or immune sensitization without invasive tissue disease | Sensitization: fungus-specific IgE ≥0.35 kUA/L; bronchitis: positive sputum/BAL culture or PCR with elevated Aspergillus IgG | Chronic or recurrent airway symptoms | Itraconazole-based antifungal therapy in selected bronchitis; airway-disease optimization |
| Aspergilloma / CPA | Structural lung disease, especially pulmonary cavitation; COPD, prior TB or other chronic lung damage | Chronic colonization/infection of cavities with local tissue destruction but no deep invasion | CT cavitary disease or fungal ball; Aspergillus IgG positive; hemoptysis common (∼50%) | Chronic, progressive over months to years; high long-term mortality | Oral azoles first line (itraconazole/voriconazole; alternatives posaconazole/isavuconazole) with prolonged therapy >6 months and often ≥12 months; surgery for localized/simple aspergilloma; bronchial artery embolization for major hemoptysis |
| Invasive pulmonary aspergillosis | Prolonged severe neutropenia, graft-versus-host disease, hematologic malignancy, transplant, prolonged corticosteroids/immunosuppressants; also severe viral critical illness | Inhaled conidia germinate to hyphae with tissue invasion, angioinvasion, thrombosis, necrosis, and hemorrhage | CT dense well-circumscribed lesion ± halo sign, air-crescent sign, cavity, or wedge-shaped consolidation; serum or BAL galactomannan ≥1.0; Aspergillus PCR positivity; culture/microscopy supportive | Acute/subacute, rapidly progressive, high mortality if delayed diagnosis | Triazoles first choice, individualized (voriconazole or isavuconazole commonly used); adjunctive immune optimization/immunomodulation when feasible |
| Extrapulmonary / disseminated aspergillosis | Usually profoundly immunocompromised patients following pulmonary invasion and hematogenous spread | Dissemination from a primary focus with organ invasion outside lung | Evidence of Aspergillus in extrapulmonary tissue or compatible multisite disease; no single universal biomarker threshold established here | Acute, severe, often life-threatening | Systemic antifungal therapy centered on triazoles; organ-directed management and reduction of immunosuppression when possible |


*Table: This table summarizes the major clinical forms of aspergillosis across host states, mechanisms, hallmark findings, course, and core treatments. It is useful as a quick disease-spectrum reference built only from gathered evidence. (pqac-00000002, pqac-00000003, pqac-00000004, pqac-00000006, pqac-00000010, pqac-00000014, pqac-00000016, pqac-00000017)*