Aspergillosis

Definition

Aspergillosis is an infection, growth, or allergic response caused by the Aspergillus fungus.

Causes, incidence, and risk factors

Aspergillosis is caused by a fungus (Aspergillus), which is commonly found growing on dead leaves, stored grain, compost piles, or in other decaying vegetation.

There are several forms of aspergillosis:

• Pulmonary aspergillosis - allergic bronchopulmonary type is an allergic reaction to the fungus that develops in with asthma.
• Aspergilloma is a growth (fungus ball) that develops in an area of previous lung disease such as tuberculosis or lung abscess
• Pulmonary aspergillosis - invasive type is a serious infection with pneumonia that spreads to other parts of the body. This infection occurs almost exclusively in people with weakened immune systems due to cancer, AIDS, leukemia, organ transplantation, chemotherapy, or other conditions or events that reduce the number of normal white blood cells.

Symptoms

Symptoms depend on the actual type of infection. For symptoms of aspergillosis-related growth, see aspergilloma.

Symptoms of allergic aspergillosis may include:

• Fever
• Malaise
• Cough
• Coughing up blood or brownish mucous plugs
• Wheezing
• Weight loss
• Recurrent episodes of lung obstruction

• Chills
• Headaches
• Shortness of breath
• Chest pain
• Increased sputum production, which may be bloody
• Bone pain
• Blood in the urine
• Decreased urine output
• Meningitis
• Vision problems
• Sinusitis
• Endocarditis

Signs and tests

Tests to diagnose aspergillosis infection may include:

• Chest x-ray
• CT scan
• Sputum stain and culture for Aspergillus
• Tissue biopsy (see bronchoscopy with transtracheal biopsy)
• Aspergillus antigen skin test
• Aspergillosis precipitin antibody
• Complete blood count

Treatment

A fungus ball usually does not require treatment unless bleeding into the lung tissue is associated with the infection, then surgery is required.

Invasive aspergillosis is treated with several weeks of amphotericin B, an antifungal medication given by an IV. Itraconazole or voriconazole can also be used.

Endocarditis caused by Aspergillus is treated with by surgically removing the infected heart valves. Long-term amphotericin B therapy is also needed.

Antifungal agents do not help people with allergic aspergillosis. Allergic aspergillosis is treated with prednisone taken by mouth.

Expectations (prognosis)

Gradual improvement is seen in patients with allergic aspergillosis.

If invasive aspergillosis resists drug treatment, it eventually leads to death. The outlook for a person with invasive aspergillosis also depends on the underlying disease and immune system function.

Complications

• Amphotericin B can cause kidney impairment and severely unpleasant side effects.
• Invasive lung disease can cause massive bleeding from the lung.

Calling your health care provider

Call the health care provider if symptoms of aspergillosis develop.

Prevention

Be careful when using medications that suppress the immune system. Prevention of AIDS prevents certain diseases, including aspergillosis, that are associated with a damaged or weaken immune system.