Aspergillosis

Aspergillosis

Aspergillosis is a fungal infection caused by Aspergillus, a type of mold that is found all over the world. We all inhale Aspergillus spores every day, but they cause illness in only people with preexisting lung disease, a specific immune sensitivity to aspergillus, or weakened immune systems.

Learn about Aspergillosis - Key Facts:

Aspergillus is a type of mold commonly found indoors and out, in soil, dust, plant material and even food. It is harmless to healthy people but can cause illness in those with lung disease, a specific immune sensitivity to aspergillus, or weakened immune systems.

• Aspergillosis cannot be spread from person to person.
• Though most people with a healthy immune system can fight off the infection, anyone with a weakened immune system or underlying lung condition could be at risk of developing aspergillosis.
• There are three main forms – allergic, chronic and invasive.

Who Is at Risk?

If you are in good health, your body should be able to defend itself against inhaled Aspergillus spores before they can cause an infection. However, anyone with a weakened immune system or an underlying health condition could be at risk. Certain factors that make you particularly susceptible are:

• Low white blood cell count. This includes anyone undergoing chemotherapy, who is living with HIV/AIDS, who has had an organ transplant or patients with leukemia.
• Long-term lung disease, such as COPD or tuberculosis, that may cause cavities in lung tissue where the infection can take hold.
• Having asthma or cystic fibrosis, that can make you more susceptible to having an immune sensitivity to the Aspergillus mold.
• Long term use of corticosteroids or other immune-suppressing medications.

What Causes it?

Aspergillus, the mold that causes the disease, is found everywhere, indoors and outdoors. For people with a healthy immune system, it rarely causes a problem because their body can destroy the spores. That is why people with weakened immune systems are at the highest risk—they are unable to fight off the infection before the fungus invades the lungs and other parts of the body.

How Aspergillosis Affects the Body

Aspergillosis severity varies depending on what form you have. There are three main categories—allergic, chronic and invasive.
Allergic bronchopulmonary aspergillosis occurs when people develop an immune sensitivity to aspergillus after inhaling the mold. While not common, this disease tends to be seen more often in people with asthma or cystic fibrosis.
Chronic pulmonary aspergillosis occurs in people who already have a chronic lung condition, such as TB, emphysema, COPD or advanced sarcoidosis. The fungus starts to grow in existing cavities in the lung caused by the underlying lung disease. Over time, the aspergillosis may cause these cavities to enlarge and increase in number. This process can also damage or alter the blood vessels in the lungs, which can result in bleeding.
Invasive aspergillosis is the most uncommon but most severe form of the disease because it affects all parts of the body. This is most common in someone with a weakened immune system, such as patients undergoing chemotherapy or people who have had an organ transplant. In these patients, the infection spreads rapidly from the lungs to the brain, heart, kidneys or skin, and can be life-threatening.

Aspergillosis Symptoms and Diagnosis - What are the Symptoms of Aspergillosis

The signs and symptoms of aspergillosis vary depending on the specific form.
Allergic bronchopulmonary aspergillosis has symptoms similar to asthma. They include coughing, wheezing and shortness of breath.
In chronic pulmonary aspergillosis, it usually takes a while for patients to develop symptoms. When they finally do emerge, symptoms include wheezing, shortness of breath, fatigue and weight loss. It is also common for chronic pulmonary aspergillosis patients to develop a tangled mass of fungus fibers called an aspergilloma or “fungus ball” in cavities within the lungs. Symptoms that accompany this growth are frequent and bloody coughing as well as shortness of breath.
Because patients with invasive aspergillosis usually suffer from other medical conditions, it can be hard to identify symptoms related to the aspergillosis infection. Symptoms may also differ depending on what organs are affected as the infection spreads. However, they commonly include coughing up blood, fever and chills, headaches, chest pain and shortness of breath.
Additionally, Aspergillus can cause localized infections of the nails, eyes, skin, sinuses or ear canals.

How Aspergillosis Is Diagnosed

When diagnosing aspergillosis, your doctor will want to consider your risk factors and medical history in conjunction with your symptoms and a physical exam. Then, they may suggest lab tests including skin, blood and sputum tests. Imaging tests such as a chest X-ray or CT scan can help with diagnosis because your doctor may be able to spot a nodule or fungal mass on your lung, caused by the mold, that would prompt your doctor to do further testing. If they are still unsure, a tissue biopsy may be the best way to get a clear diagnosis.
Treating and Preventing Aspergillosis

How Aspergillosis Is Treated

In patients with milder forms of the disease who are experiencing fewer symptoms, the infection may not require treatment and eventually clear up on its own. A single fungal ball, for example, may persist unchanged for a long time without treatment. It is recommended that, in these cases, your doctor monitor you to ensure that the disease does not progress.
If treatment is required, your doctor’s recommendation will depend on the type that is diagnosed.
If you are diagnosed with allergic bronchopulmonary aspergillosis, an antifungal medication, such as itraconazole, is the most common course of action. If it is not effective, your doctor may suggest an oral corticosteroid as an alternative medication.
For chronic pulmonary aspergillosis patients who develop a fungal ball, surgery is the best option if the mass is in a good location to be removed. Though sometimes prescribed, antifungal medications have been found to have little effect.
In the most severe cases, a combination of antifungal medication and surgery may be necessary. Other medications that are suppressing the immune system may also need to be discontinued during treatment. Your doctor will help you determine the correct treatment for you.

Preventing Aspergillosis

Though it can be difficult to avoid exposure to Aspergillus, if you have severe lung disease or a weakened immune system, you should take special precautions, such as minimizing your exposure to soil and dust. If you are at high risk, your doctor may suggest taking antifungal drugs as a preventive measure.
Visit our mold and dampness page for more information about how to handle mold infestation safely.

Finding Support

If you have questions about your diagnosis or what to expect, you can call the Lung Association's Lung HelpLine at 1-800-LUNGUSA to talk to a trained respiratory professional who can help answer your questions and connect you with support. Learn More 
Source: https://www.lung.org/lung-health-diseases/lung-disease-lookup/aspergillosis