×

Please Remove Adblock
Adverts are the main source of Revenue for DoveMed. Please remove adblock to help us create the best medical content found on the Internet.

Aspergillosis

Last updated May 2, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Fujisawa Takashi

Microscopic pathology image showing Aspergillosis vertigus. H&E stain.


What are the other Names for this Condition? (Also known as/Synonyms)

  • ABPA (Allergic Bronchopulmonary Aspergillosis)
  • Fungal Infection by Aspergillus
  • Invasive Aspergillosis

What is Aspergillosis? (Definition/Background Information)

  • Aspergillosis is an infection or allergic condition caused by inhaling Aspergillus fungus commonly found in the environment. These fungi are found growing on the soil, plants, building materials, compost piles, and other decaying vegetation
  • Aspergillus causes allergic reactions, lung infection, and infection of other organs of the body. Individuals with suppressed immune system or with an underlying lung condition, such as asthma, are at an increased risk of infection
  • There are various forms of Aspergillosis such as:
    • Allergic Bronchopulmonary Aspergillosis (ABPA): The fungus causes allergic respiratory symptoms such as wheezing and coughing. It does not actually invade and destroy tissues in the body
    • Invasive Aspergillosis: Individuals with weakened immune system are affected by this infection. The infection spreads from the lungs to the bloodstream and then to the brain, heart, kidneys, and skin. The fungus invades and damages the tissues in the body
    • Aspergilloma: A fungus ball that develops in an area of previous lung disease, such as in asthmatics
  • Severe attacks of Aspergillosis are caused by Aspergillus fumigatus and Aspergillus niger, while less severe effects are caused by Aspergillus flavus and Aspergillus clavatus
  • The signs and symptoms associated with Aspergillosis are cough with sputum and blood, breathing difficulties, wheezing, fever, and chest pain
  • Treatment of this fungal infection depends upon the type and health condition of the affected individual. those with asthma, weakened immune system, or lung disease should avoid areas, such as marshlands, forests, grain stores, piles of dead leaves, where the Aspergillus fungus are found in plenty
  • With correct diagnosis and appropriate treatment, Aspergillus Infection has good prognosis. But, Invasive Aspergillosis is a serious condition and requires urgent medical attention; otherwise, it may become fatal

Who gets Aspergillosis? (Age and Sex Distribution)

  • Aspergillosis can affect any individual irrespective of age, gender, and race
  • However, individuals with weak immune systems have a higher risk of infection

What are the Risk Factors for Aspergillosis? (Predisposing Factors)

The risk factors associated with Aspergillosis differs for Allergic Bronchopulmonary Aspergillosis and for Invasive Aspergillosis.

The risk factors for Allergic Bronchopulmonary Aspergillosis include:

  • Asthma patients
  • Cystic fibrosis patients

The risk factors for Invasive Aspergilloma include:

  • Individuals with weak immune system
  • Those who have had a bone marrow transplant, solid organ transplant
  • Individuals taking high dosage of corticosteroids for various health conditions
  • Individuals undergoing chemotherapy for cancer treatment
  • HIV-infected individuals
  • Low white blood cells level: White blood cells (WBCs) fight against infections in the body. When low levels of WBCs are present in blood, due to chemotherapy treatment, organ transplant, or leukemia, it increases one’s susceptibility to Aspergillosis
  • Lung cavities: Aspergillosis can develop when the fungus germinates in cavity (airspace) of the lungs
  • Ankylosing spondylitis: It is a rheumatologic lung disease that mainly affects the spinal cord, which increases the risk of an individual to contract Aspergillosis. The risk is more when the individual is also a male with smoking habits
  • Hospitalization: Sometimes, Aspergillus thrive on the hospital surfaces, such as bed rails, plants, surgical instruments, air conditioning ducts, and insulation pads, which adds to the risk
  • The genetic make-up of an individual also plays an important role in elevating one’s risk for Aspergillosis Infection

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Aspergillosis? (Etiology)

  • Aspergillosis is an infection or allergic condition chiefly affecting the lungs, caused by inhaling Aspergillus fungus commonly found in the environment
  • The Aspergillus fungi are found worldwide growing mostly on dead and decaying plant matter. They may also be found on the soil, household dust, building materials, stored grains, compost piles, and even on marijuana leaves
  • Severe attacks of Aspergillosis are cussed by Aspergillus Fumigatus and Aspergillus Niger while less severe effects are caused by Aspergillus Flavus and Aspergillus Clavatus.

What are the Signs and Symptoms of Aspergillosis?

The signs and symptoms, which distinguish Aspergillosis, differ with different types of the fungal infection.

The signs and symptoms for Allergic Bronchopulmonary Aspergillosis include:

  • Fever
  • Hemoptysis or cough with blood
  • Cough with plugs of mucus
  • Worsening asthma

The signs and symptoms exhibited by Aspergilloma include:

  • Hemoptysis or cough with blood
  • Breathing associated signs and symptoms
  • Wheezing
  • Weight loss
  • Fatigue

The signs and symptoms exhibited by Invasive Pulmonary Aspergillosis include:

  • Cough with blood-streaked sputum or hemoptysis
  • Severe bleeding in the lungs
  • Breathing associated signs and symptoms
  • Chest pain, joint pain
  • Nose bleeding
  • Facial swelling on one side
  • Skin lesions

When the infection affects the sinuses, the following may be seen:

  • Bloody nasal discharge
  • Stuffy nose
  • Fever
  • Facial pain
  • Headache

How is Aspergillosis Diagnosed?

The diagnosis of Aspergillosis includes:

  • A complete evaluation of medical history along with a thorough physical exam
  • Imaging studies that may comprise of chest x-ray and computerized tomography (CT) scan that may reveal the presence of Aspergilloma
  • Sputum examination: A sample of sputum is stained with a die (dye) and checked for Aspergillus filaments. It is then placed on a substance that helps the fungus to grow, which can confirm the presence of Aspergillosis
  • Skin test: A small amount of Aspergillus antigen is injected into the skin of the forearm. If the blood contains any antibodies, then a red hard bump develops in the injected area confirming the presence of Aspergillosis
  • Tissue biopsy: A sample of tissue from the lungs or sinuses is examined under a microscope for confirming the presence of Aspergillus fungus
  • Aspergillus antibody test
  • Complete blood count
  • Galactomannan (a molecule from the fungus that is rarely found in blood)
  • Immunoglobulin E blood level
  • Lung infection tests: To assess how well the lungs are functioning

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Aspergillosis?

The following are the complications associated with Aspergillosis:

  • Bone destruction: Aspergillosis can destroy the facial bones when it affects the sinuses
  • Spread of infection: When the infection spreads from the lungs to the bloodstream and to the brain, heart, kidneys, and skin, it can become fatal and life-threatening. This condition is more dangerous in people with weak immune system
  • Bleeding: Aspergillosis leads to fatal bleeding in the lungs

How is Aspergillosis Treated?

The following are the treatment measures adopted for Aspergillosis; the treatment also depends upon the nature and form of infection.

  • Observation: Aspergillosis that does not cause any symptom may be closely monitored by regular chest x-rays at certain periodic intervals
  • Oral corticosteroids: The main aim while treating Allergic Bronchopulmonary Aspergillosis (ABPA) is to prevent the existing asthma or cystic fibrosis condition from worsening. This is achieved by administering oral corticosteroids. Antifungal medications alone are not effective in treating ABPA; they are usually given in combination with oral corticosteroids
  • Antifungal medications can be used to treat Invasive Pulmonary Aspergillosis

Surgery:


  • When excessive bleeding occurs in the lungs, antifungal medications alone may not be sufficient treatment. An immediate surgery may be required to remove the fungal mass
  • Sometimes an embolization procedure may be recommended by the physician. Under this procedure, the radiologist inserts a small catheter into the artery that supplies blood to the cavity containing the fungus ball. A special material is then injected to clog the artery. This procedure helps in stopping the bleeding, but it does not help in preventing recurrence of the infection. So this method is regarded as a temporary one only

How can Aspergillosis be Prevented?

The Aspergillus fungus is found almost everywhere in the environment; it may not be possible to completely avoid it. Nevertheless, some safety and precautionary measures may help in preventing Aspergillosis infection. These include:

  • Avoid exposure to Aspergillus fungus: Individuals with asthma, weakened immune system, or lung disease should avoid areas such as marshlands, forests, grain stores, piles of dead leaves, where the fungus grow and thrive in plenty
  • Good ventilation systems in buildings may be provided, including fitting open windows with suitable dust control
  • Keeping the room disinfected, where possible
  • Maintaining room temperature and ensuring adequate air flow or air circulation
  • Skin injuries: These must be cleaned well with soap and water
  • Wearing a face mask when undertaking any cleaning and dusting activity, or going to a place that is full of dust
  • Extensive activities involving soil and dust should be minimised or avoided; especially individuals at high risk for Aspergillosis infection
  • Use of air purifiers can reduce the risk
  • Educate people about the risk factors and adverse health effects of Aspergillosis; this will make them more careful
  • Avoid marijuana
  • A good hygiene and healthy lifestyle improves the body immune system against infections such as Aspergillosis

What is the Prognosis of Aspergillosis? (Outcomes/Resolutions)

  • With proper and timely treatment most individuals can be cured of Aspergillosis infection
  • The disease may recur, which may necessitate repeat treatment
  • A lack of proper treatment, the individual’s poor health status, and the presence of severe complications, are all factors that may affect the prognosis adversely. In such cases, Aspergillosis may become fatal and lead to death

Additional and Relevant Useful Information for Aspergillosis:

Generally, mild allergic forms of Aspergillosis are more common than invasive forms of the infection.

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 17, 2015
Last updated: May 2, 2018