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Aspergillosis

Aspergillus infection

 

Aspergillosis is an infection or allergic response due to the Aspergillus fungus.

Causes

 

Aspergillosis is caused by a fungus called Aspergillus. The fungus is often found growing on dead leaves, stored grain, compost piles, or in other decaying vegetation. It can also be found on marijuana leaves.

Although most people are often exposed to Aspergillus, infections caused by the fungus rarely occur in people who have a healthy immune system.

There are several forms of aspergillosis:

  • Allergic pulmonary aspergillosis is an allergic reaction to the fungus. This infection usually develops in people who already have lung problems such as asthma or cystic fibrosis.
  • Aspergilloma is a growth (fungus ball) that develops in an area of past lung disease or lung scarring such as tuberculosis or lung abscess.
  • Invasive pulmonary aspergillosis is a serious infection with pneumonia. It can spread to other parts of the body. This infection occurs most often in people with a weakened immune system. This can be from cancer, AIDS, leukemia, an organ transplant, chemotherapy, or other conditions or drugs that lower the number or function of white blood cells or weaken the immune system.

 

Symptoms

 

Symptoms depend on the type of infection.

Symptoms of allergic pulmonary aspergillosis may include:

  • Cough
  • Coughing up blood or brownish mucus plugs
  • Fever
  • General ill feeling (malaise)
  • Wheezing
  • Weight loss

Other symptoms depend on the part of the body affected, and may include:

  • Bone pain
  • Chest pain
  • Chills
  • Decreased urine output
  • Headaches
  • Increased phlegm production, which may be bloody
  • Shortness of breath
  • Skin sores (lesions)
  • Vision problems

 

Exams and Tests

 

Tests to diagnose Aspergillus infection include:

  • Aspergillus antibody test
  • Chest x-ray
  • Complete blood count
  • CT scan
  • Galactomannan (a molecule from the fungus that is sometimes found in the blood)
  • Immunoglobulin E (IgE) blood level
  • Lung function tests
  • Sputum stain and culture for Aspergillus
  • Tissue biopsy

 

Treatment

 

A fungus ball is usually not treated with antifungal medicines unless there is bleeding into the lung tissue. In such a case, surgery and medicines are needed.

Invasive aspergillosis is treated with several weeks of an antifungal medicine. It can be given by mouth or IV (into a vein). Endocarditis caused by Aspergillus is treated by surgically removing the infected heart valves. Long-term antifungal drugs are also needed.

Allergic aspergillosis is treated with drugs that suppress the immune system (immunosuppressive drugs), such as prednisone.

 

Outlook (Prognosis)

 

With treatment, people with allergic aspergillosis usually get better over time. It is common for the disease to come back (relapse) and need repeat treatment.

If invasive aspergillosis does not get better with drug treatment, it eventually leads to death. The outlook for invasive aspergillosis also depends on the person's underlying disease and immune system health.

 

Possible Complications

 

Health problems from the disease or treatment include:

  • Amphotericin B can cause kidney damage and unpleasant side effects such as fever and chills
  • Bronchiectasis (permanent scarring and enlargement of the small sacs in the lungs)
  • Invasive lung disease can cause massive bleeding from the lung
  • Mucus plugs in the airways
  • Permanent airway blockage
  • Respiratory failure

 

When to Contact a Medical Professional

 

Call your health care provider if you develop symptoms of aspergillosis or if you have a weakened immune system and develop a fever.

 

Prevention

 

Precautions should be taken when using medicines that suppress the immune system. Preventing HIV/AIDS also prevents certain diseases, including aspergillosis, that are associated with a damaged or weakened immune system.

 

 

References

Patterson TF. Aspergillus species. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 259.

Walsh TJ. Aspergillosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 339.

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  • Aspergilloma

    Aspergilloma

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  • Pulmonary aspergillosis

    Pulmonary aspergillosis

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  • Aspergillosis - chest X-ray

    Aspergillosis - chest X-...

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    • Aspergilloma

      Aspergilloma

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    • Pulmonary aspergillosis

      Pulmonary aspergillosis

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    • Aspergillosis - chest X-ray

      Aspergillosis - chest X-...

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    Tests for Aspergillosis

     
     

    Review Date: 5/1/2015

    Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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