Aspergillosis

Aspergillosis is a term for illnesses caused by several types of Aspergillus fungi. Common symptoms include fever, cough and shortness of breath.

Aspergillus (pronounced “as-per-JILL-us”) is usually found outdoors, in dead leaves, plants, soil or compost. It’s occasionally found in moist environments indoors. Most people breathe in Aspergillus spores without getting sick.

In some people, Aspergillus can cause an infection or allergic reaction that’s called aspergillosis. This is more likely if you have a long-term airway or lung disease, like asthma or COPD (chronic obstructive pulmonary disease), or a weakened immune system.

Types

Types of aspergillosis include:

• Allergic bronchopulmonary aspergillosis (ABPA): This is an allergic reaction to the fungus that causes inflammation in your lungs. This most often affects people with asthma or cystic fibrosis.
• Chronic pulmonary aspergillosis: This is a long-lasting infection that can damage your lungs. It can cause aspergillomas (“fungus balls”), nodules, scarring or cavities in your lungs. This most often affects people with COPD, sarcoidosis or tuberculosis.
• Invasive aspergillosis: This is when the fungus starts growing into the structures of your lungs. It can get into your bloodstream and move to other parts of your body. This usually only happens if you have a weakened immune system.

Symptoms of aspergillosis

Symptoms of aspergillosis vary depending on the type and location in your body. The most common symptoms include:

• Cough (sometimes coughing up blood)
• Shortness of breath
• Noisy breathing (wheezing)
• Chest pain
• Fever
• Fatigue
• Unexplained weight loss

If the infection spreads to other parts of your body, you might also have:

• Eye symptoms: Red eyes, eye pain, blurred vision, black pus or tears, droopy eyelids
• Gastrointestinal symptoms: Abdominal pain, diarrhea, constipation
• Neurological symptoms: Mood changes, confusion, seizures, weakness
• Sinus symptoms: Stuffy or runny nose, headache, reduced sense of smell, bloody or black mucus
• Skin changes: Red, hardened patches that may break open and turn black

Aspergillosis causes

Many different species of the fungi Aspergillus cause aspergillosis. A. fumigatus is the most common cause. Aspergillus lives in the environment around us, often in soil or dead leaves. Most of us breathe it in all the time without knowing it.

Inhaling Aspergillus from the air can cause an allergic reaction or an infection in your sinuses or lungs. It can also get into your body through a cut in your skin.

Most people’s bodies get rid of Aspergillus fungus without getting sick. But certain conditions, like a weakened immune system or chronic lung disease, can make you more likely to get sick from it. If your immune system can’t fight off the infection, it can move to other parts of your body.

Risk factors

Different types of aspergillosis are more likely to affect certain people. You’re at higher risk for allergic and chronic aspergillosis if you have conditions that affect your airways or lungs:

• Allergic aspergillosis most often affects people with asthma or cystic fibrosis.
• Chronic forms of aspergillosis most often affect people with COPD, sarcoidosis or tuberculosis.

You’re at higher risk for invasive aspergillosis if you have a weakened immune system, especially if you’ve had an organ or stem cell transplant or have neutropenia.

Complications

Your risk of experiencing complications depends on which type of aspergillosis you have. All types can cause lung damage, including:

• Scarring (fibrosis)
• Widening of your airways
• Collapsed areas of lung (atelectasis)

Invasive and chronic aspergillosis can cause additional complications, including:

• Spread to other organs
• Tissue destruction
• Respiratory failure
• Sepsis

How doctors diagnose aspergillosis

How a healthcare provider diagnoses aspergillosis depends on your symptoms and health history. They may recommend tests, including:

• Allergy tests: Your provider may order blood or skin tests to diagnose allergic or chronic forms of aspergillosis.
• Biopsy: Your provider may take samples of tissue or fluid to test for signs of an Aspergillus infection.
• Blood tests: A blood test can help diagnose invasive aspergillosis early in people who have severely weakened immune systems.
• Culture: Your provider may take samples of your body fluids — like blood or mucus (sputum) or fluid from around your lungs, brain or spinal cord — and try to grow Aspergillus from it.
• Imaging: Your provider may use X-rays or CT scans to look for signs of Aspergillus in your lungs or other parts of your body that could be infected.

Symptoms of aspergillosis look similar to many other illnesses. Your provider may need to do additional tests to rule out other conditions.

How is aspergillosis treated?

How your provider treats aspergillosis depends on the type and any underlying conditions you have. Treatments could include:

• Antifungal medications can treat many kinds of aspergillosis. If one type of antifungal isn’t working, your provider may prescribe a different one.
• Surgery can remove a single fungus ball. Surgery is also sometimes used to treat invasive and allergic aspergillosis in certain circumstances.
• Omalizumab (Xolair®) can treat allergic aspergillosis. It reduces inflammation and your risk of allergic reactions.
• Corticosteroids can treat allergic aspergillosis or skin infections. Depending on where the infection is, this might be a pill, an inhaled medication, a nasal mist, or a skin cream or lotion.

When should I see my healthcare provider?

If you have symptoms of an infection and you have a weakened immune system, talk to your provider right away or seek emergency care. Go to the nearest emergency room if you have symptoms of serious illness, including:

• High fever (over 103 degrees Fahrenheit/40 degrees Celsius)
• Difficulty breathing
• Coughing up blood
• Confusion or other mental changes
• Seizures
• Black skin, tissue or mucus
• Blue or gray skin, lips or nails (cyanosis)

Can aspergillosis be cured?

Surgery or antifungals can cure some types of noninvasive aspergillosis. In some cases, it may go away and come back again (recur).

In general, what to expect depends on the form:

• Aspergillomas that haven’t invaded tissue usually aren’t dangerous and can be successfully treated with surgery.
• Allergic forms of aspergillosis aren’t usually life-threatening, but can cause lung damage if they go untreated for a long time.
• Chronic pulmonary aspergillosis can complicate underlying conditions, like COPD. It can be life-threatening. Treatment often helps symptoms, but the infection can come back again and again.
• Invasive aspergillosis can be life-threatening. As people with invasive aspergillosis almost always have an immune system that can’t fight off the infection, it can be hard to treat. If you have invasive aspergillosis, you’ll need to be treated as soon as possible and monitored closely.

Talk to your provider about what to expect in your specific situation.

Can this be prevented?

It’s hard to avoid Aspergillus molds. You might be able to reduce your exposure by:

• Avoiding areas with lots of dust or mold, like construction sites or compost piles
• Avoiding activities such as gardening or lawn mowing
• Wearing an N95 face mask or a respirator mask if you’ll be exposed to airborne dust or mold

Ask a healthcare provider how to prevent and detect fungal infections early if you:

• Have a chronic lung or airway condition
• Have had an organ or stem cell transplant
• Are on chemotherapy for cancer
• Have HIV
• Have conditions or take medications that weaken your immune system

If you’re at high risk for infection, your provider might prescribe antifungals to prevent infection and test for signs of infection to make sure you get treated early.