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Aspergillosis is an infection caused by a specific type of mold known as aspergillus, which is present both indoors and outdoors. While many strains of this mold are harmless, certain varieties can lead to significant health issues, primarily affecting the respiratory system. The severity and symptoms of illnesses resulting from aspergillosis infection can vary widely.
The mold called aspergillus that can cause illnesses is found all around us – both inside our buildings and outside. While most forms of this mold aren’t dangerous, a couple of them can lead to serious sickness, especially for people with weaker immune systems, existing lung issues, or asthma, when they breathe in the mold’s tiny seeds.
There are different types of aspergillosis:
- Allergic Reaction: Some individuals with asthma or cystic fibrosis can experience an allergic reaction to aspergillus mold, known as allergic bronchopulmonary aspergillosis.
- Aspergilloma: In the presence of certain chronic lung conditions like emphysema, tuberculosis, or advanced sarcoidosis, lung cavities may form. Aspergilloma occurs when the aspergillus infection enters these cavities and develops into masses called fungus balls.
- Invasive Aspergillosis: Invasive aspergillosis is the most severe form, characterized by the rapid spread of the infection from the lungs to organs like the brain, heart, kidneys, or skin. It typically affects individuals with weakened immune systems due to factors like cancer chemotherapy or bone marrow transplantation.
- Other Types of Aspergillosis: Aspergillus can also invade areas beyond the lungs, such as the sinuses. This can lead to symptoms like a stuffy nose, drainage, and even facial pain or headaches.
Treatment for aspergillosis may involve observation, the use of antifungal medications, or, in rare cases, surgical intervention. The approach varies depending on the specific type of infection.
Symptoms
The signs and symptoms of these illnesses depend on the specific form of aspergillosis a person develops.
Allergic Reaction (Allergic Bronchopulmonary Aspergillosis):
- Fever
- Cough with potential blood or mucus plug expulsion
- Aggravated asthma
Aspergilloma: Aspergillomas might initially be asymptomatic or lead to only a mild cough. Progression can lead to:
- Coughing up blood (hemoptysis)
- Wheezing
- Shortness of breath
- Unintentional weight loss
- Fatigue
Aspergilloma: Aspergillomas might initially be asymptomatic or lead to only a mild cough. If left untreated, progression can lead to:
- Coughing up blood (hemoptysis)
- Wheezing
- Shortness of breath
- Unintentional weight loss
- Fatigue
Invasive Aspergillosis: Occurs in weakened immune systems Symptoms depend on affected organs:
- Fever and chills
- Coughing up blood (hemoptysis)
- Shortness of breath
- Chest or joint pain
- Headaches or eye symptoms
- Skin lesions
Other Types of Aspergillosis: Impact beyond lungs, especially sinuses. Symptoms include:
- Nasal congestion with blood-tinged drainage
- Fever
- Facial pain
- Headaches
If you have asthma or cystic fibrosis and you notice a change in your breathing, it’s important to see your doctor. Even though the cause might not be aspergillosis, getting your breathing problems checked is necessary.
If your immune system is weak and you suddenly have a fever, trouble breathing, or cough with blood, seek medical help right away. For invasive aspergillosis, quick treatment is very important. Sometimes, doctors start antifungal medicine when they suspect aspergillosis, even before confirming it with tests.
Causes
Aspergillosis, caused by various Aspergillus fungi, with A. fumigatus being the most common, typically affects individuals with weakened immune systems or chronic lung issues. While Aspergillus is present in the environment and commonly inhaled, healthy immune systems usually fend off the fungus. Nonetheless, those with compromised immunity are vulnerable as the mold can colonize the lungs and potentially spread to other body parts. Although widespread in nature, aspergillosis isn’t contagious among individuals.
Risk factors
Factors that increase the susceptibility to aspergillosis include:
- Weakened immune system: Individuals with suppressed immunity due to post-transplant medication, certain cancers like blood cancers, or advanced AIDS stages are at high risk.
- Low white blood cell count: People who’ve had treatments like chemotherapy, organ transplants, or have conditions like leukemia or chronic granulomatous disease are more vulnerable.
- Long-term corticosteroid use: Prolonged corticosteroid therapy, based on the underlying condition and concurrent medications, can elevate the risk of opportunistic infections.
- Lung cavities: Those with existing air spaces in their lungs have an elevated risk of aspergillomas.
- Asthma or cystic fibrosis: Individuals with longstanding, uncontrolled asthma or cystic fibrosis have a higher likelihood of allergic reactions to aspergillus mold.
Diagnosis
Diagnosing aspergilloma or invasive aspergillosis can pose challenges. Your doctor is likely to utilize one or more of the following tests to accurately determine the underlying cause of your symptoms:
- Allergy tests: Your healthcare provider might request blood tests or skin tests to diagnose allergic or chronic variations of aspergillosis. These tests help determine if your immune system exhibits reactions to aspergillus antigens, aiding in the identification of allergic or prolonged forms of the condition.
- Imaging test: An imaging test such as a chest X-ray or computerized tomography (CT) scan — which is a form of X-ray producing more detailed images than conventional X-rays — can typically uncover a fungal mass (aspergilloma). It can also reveal characteristic indications of invasive aspergillosis and allergic bronchopulmonary aspergillosis.
- Respiratory secretion (sputum) test: In this assessment, a sample of your sputum is stained with a dye and examined for the presence of aspergillus filaments. The sample is subsequently placed in a culture that fosters the mold’s growth, aiding in confirming the diagnosis.
- Tissue and blood tests: Skin testing, in conjunction with sputum and blood tests, can be beneficial in confirming allergic bronchopulmonary aspergillosis. For the skin test, a minor quantity of aspergillus antigen is introduced into the skin of your forearm. If your blood contains antibodies to the mold, you will develop a firm, red bump at the injection site. Blood tests search for elevated levels of specific antibodies, indicative of an allergic response.
- Biopsy: In some cases, the examination of a tissue sample from your lungs or sinuses under a microscope may be necessary to confirm a diagnosis of invasive aspergillosis.
Treatment
Aspergillosis treatment varies by disease type:
- Observation: Simple aspergillomas may not need immediate treatment; monitoring with X-rays suffices. Progression may prompt antifungal medication.
- Oral Corticosteroids: Allergic bronchopulmonary aspergillosis management involves the administration of corticosteroids. Often, a combination with antifungal agents is prescribed to not only mitigate symptoms but also optimize lung function.
- Antifungal Medications: In cases of invasive pulmonary aspergillosis, antifungal medications are the standard treatment. Voriconazole is often the first-line choice due to its effectiveness against Aspergillus species. Amphotericin B serves as an alternative when Voriconazole isn’t suitable. However, these medications carry the risk of adverse effects, such as liver and kidney damage. Furthermore, potential interactions with other medications need to be taken into consideration.
- Surgery: Due to limited penetration of antifungal medications into aspergillomas, surgical removal of the fungal mass becomes the primary treatment option when such growths result in lung bleeding.
- Embolization: To stop lung bleeding from aspergillomas, embolization temporarily blocks arterial blood supply via catheter injection.
