Sección 3. Consenso colombiano para el diagnóstico y tratamiento la aspergilosis extrapulmonar en pacientes adultos
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Las manifestaciones clínicas de las enfermedades asociadas con Aspergillus spp. son variables y dependen de la interacción entre la dosis de inoculación (que se desconoce y probablemente varía ampliamente), la capacidad del paciente para resistir la infección a nivel local y sistémico, y la virulencia del agente etiológico, donde la mayor dificultad para establecer un esquema de clasificación clínica radica en la existencia de un espectro amplio y continuo de enfermedad, asociado a un diagnóstico y manejo clínico complicado. Una aspergilosis invasiva (AI) puede presentarse como una infección localizada en un órgano, o como parte de una infección diseminada, que se presentan en un variado espectro de cuadros clínicos, sin embargo, no se han completado ensayos clínicos que evalúen los diferentes abordajes terapéuticos específicos, de acuerdo al tipo de compromiso en estos pacientes. Las formas clínicas más comunes de AI tienen lugar a nivel de pulmón y de senos paranasales, una aspergilosis pulmonar crónica (APC) puede complicarse al extenderse a estructuras contiguas como el espacio pleural, el pericardio, la pared torácica y las estructuras mediastínicas como el esófago y los grandes vasos. La capacidad de diseminación más allá del tracto respiratorio es frecuente, y puede comprometer afectar piel, SNC, ojos, hígado, riñones y otras estructuras.
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