Aspergillosis- A. flavus, A. fumigatus, A. niger; ubiquitous in nature (soil, decaying vegetation, dust, leaves); risk factors include neutropenia, bone marrow transplantation, age
- Primary cutaneous aspergillosis presents with local inoculation in weakened host; presents as erythematous macules → necrotic papules, hemorrhagic bullae, ulcers; typical portals of entry include IV catheters, burns, trauma, and surgical wounds; risk of dissemination significant with immunosuppression; of note, blood vessel involvement includes thrombosis, inflammation, and necrosis (A. flavus most common primary cutaneous pathogen)
- Other presentations: pulmonary disease and disseminated disease with hematogenous spread
- Histology: dichotomous branching (equal division) at 45–60°, often involving blood vessels
- Colony: A. flavus – yellow to green culture; A. fumigatus (most common species) – dark green to gray culture; A. niger – white woolly colony turns black with age
- Treatment: amphotericin B, voriconazole, itraconazole
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