Aspergillosis is an infection caused by mold (fungus). The infections caused by aspergillosis primarily affect the respiratory system, but their symptoms and severity vary widely.
Aspergillus, the mold that causes the infections, is found both indoors and outdoors. Most strains of this mold are innocuous, but a few might cause catastrophic infections when inhaled by persons with compromised immune systems, underlying lung disease, or asthma.
The spores cause an allergic response in some persons. Others suffer mild to severe lung infections. Invasive aspergillosis, the most deadly type of aspergillosis, arises when the infection spreads to blood vessels and beyond.
Treatment for aspergillosis may include monitoring, antifungal medicines, or, in rare situations, surgery.
WHAT ARE THE SYMPTOMS OF ASPERGILLOSIS?
The signs and symptoms of aspergillosis differ depending on the type of infection you have:
Allergic reaction
Aspergillus mold causes allergic reactions in certain persons who have asthma or cystic fibrosis. The following are signs and symptoms of allergic bronchopulmonary aspergillosis:
- Fever
- A cough that may produce blood or mucus plugs
- Worsening asthma
Aspergilloma
Certain chronic lung (pulmonary) disorders, such as emphysema, TB, and severe sarcoidosis, can result in the formation of air gaps (cavities) in the lungs. When aspergillus infects humans with lung cavities, fungal fibers can enter the cavities and form tangled masses (fungus balls) known as aspergillomas.
At initially, aspergillomas may cause no symptoms or simply a moderate cough. However, if left untreated, aspergillomas can aggravate the underlying chronic pulmonary illness and possibly cause:
- A cough that often produces blood (hemoptysis)
- Wheezing
- Breathing difficulty
- Unintentional weight loss
- Fatigue
Invasive aspergillosis
This is the most dangerous kind of aspergillosis. It happens when an infection quickly spreads from the lungs to the brain, heart, kidneys, or skin. Invasive aspergillosis occurs exclusively in persons whose immune systems have been compromised by cancer treatment, bone marrow transplantation, or other immune system disorder. This kind of aspergillosis can be lethal if left untreated.
The signs and symptoms of invasive aspergillosis vary depending on which organs are damaged, but in general, invasive aspergillosis can cause:
- Chills and fever
- A cough that produces blood (hemoptysis)
- Breathing difficulty
- Pain in the chest or joints
- Headaches or vision problems
- Skin blemishes
Other types of aspergillosis
Other than your lungs, Aspergillus can infiltrate other parts of your body, such as your sinuses. The fungus in your sinuses can create a stuffy nose, which may be followed by bloody leakage. Fever, face discomfort, and headache are all possible side effects.
WHAT ARE THE CAUSES OF ASPERGILLOSIS?
Aspergillus mold cannot be avoided. It may be found outside in decaying leaves and compost, as well as on plants, trees, and grain crops.
For persons with good immune systems, daily exposure to Aspergillus is rarely a concern. Inhaling mold spores causes immune system cells to encircle and kill them. People who have a weaker immune system due to disease or immunosuppressive medicines, on the other hand, have fewer infection-fighting cells. This permits Aspergillus to colonize the lungs and, in severe instances, other regions of the body.
Aspergillosis does not spread from person to person.
Your chance of having aspergillosis is determined by your general health and the intensity of your mold exposure. In general, the following variables make you more susceptible to infection:
- Weakened immune system: People who are on immune-suppressing medicines following transplant surgery, particularly bone marrow or stem cell transplants, or who have specific blood malignancies are most vulnerable to invasive aspergillosis. People in the latter stages of AIDS may also be more vulnerable.
- Low white blood cell level: Chemotherapy, organ transplantation, and leukemia patients have reduced white cell counts, rendering them more vulnerable to invasive aspergillosis. Having chronic granulomatous disease, a hereditary illness that damages immune system cells, also helps.
- Lung cavities: People with air gaps (cavities) in their lungs are more likely to develop aspergillomas.
- Asthma or cystic fibrosis: People with asthma and cystic fibrosis are more prone to develop an allergic reaction to aspergillus mold, especially if their lung issues are chronic or difficult to treat.
- Long-term corticosteroid treatment: Long-term corticosteroid treatment may raise the risk of opportunistic infections, depending on the underlying condition and other medicines administered.
WHAT ARE THE COMPLICATIONS OF ASPERGILLOSIS?
Aspergillosis can induce a number of significant problems depending on the kind of infection:
- Bleeding: Aspergillomas and invasive aspergillosis can both cause serious, and occasionally deadly, pulmonary hemorrhage.
- Systemic infection: The spread of the infection to other regions of your body, particularly your brain, heart, and kidneys, is the most significant consequence of invasive aspergillosis. Invasive aspergillosis spreads quickly and is potentially lethal.
HOW IS ASPERGILLOSIS DIAGNOSED?
Diagnosis of an aspergilloma or invasive aspergillosis might be challenging. Under the microscope, Aspergillus is abundant in all habitats but difficult to identify from other molds. Aspergillosis symptoms are very comparable to those of other respiratory illnesses such as TB.
To determine the source of your symptoms, your doctor will most likely employ one or more of the following tests:
- Imaging test: A chest X-ray or computed tomography (CT) scan — a form of X-ray that generates more precise pictures than traditional X-rays — may generally identify a fungal tumor (aspergilloma), as well as invasive aspergillosis and allergic bronchopulmonary aspergillosis.
- Respiratory secretion (sputum) test: A sample of your sputum is stained with a dye and tested for the presence of aspergillus filaments in this test. To assist confirm the diagnosis, the material is put in a culture that fosters mold growth.
- Blood and tissue tests: Skin, sputum, and blood tests may all be useful in confirming allergic bronchopulmonary aspergillosis. A little quantity of aspergillus antigen is injected into the skin of your forearm for the skin test. If your blood contains mold antibodies, you will develop a firm, red bump at the injection site. Blood tests check for high amounts of certain antibodies, which indicate an allergic reaction.
- Biopsy: In certain situations, a biopsy of tissue from your lungs or sinuses may be required to confirm a diagnosis of invasive aspergillosis.
WHAT ARE THE TREATMENTS FOR ASPERGILLOSIS?
Treatment for aspergillosis varies depending on the kind of sickness. Treatment options include:
- Observation: Simple aspergillomas seldom require treatment, and drugs are rarely useful in curing these fungal tumours. Aspergillomas that do not produce symptoms may instead be regularly monitored using a chest X-ray. If the illness worsens, antifungal drugs may be prescribed.
- Oral corticosteroids: The objective of treating allergic bronchopulmonary aspergillosis is to avoid the aggravation of existing asthma or cystic fibrosis. Oral corticosteroids are the most effective approach to do this. Antifungal drugs alone are ineffective for allergic bronchopulmonary aspergillosis, however they can be used with corticosteroids to lower the dose of steroids and improve lung function.
- Antifungal medicines: These medications are the mainstay of care for invasive pulmonary aspergillosis. Voriconazole, a newer antifungal medicine, is the most effective therapy (Vfend). Another alternative is amphotericin B.
All antifungal medications have the potential for major adverse effects, including kidney and liver damage. Antifungal medicine interactions with other treatments are also prevalent.
- Surgery: Because antifungal drugs do not penetrate an aspergilloma, surgery to remove the fungus mass is the preferred therapy when an aspergilloma causes pulmonary hemorrhage.
- Embolization: This technique prevents aspergilloma-caused lung hemorrhage. A radiologist inserts a catheter into an artery supplying a lung cavity where an aspergilloma is causing blood loss. The injected substance hardens, obstructing blood flow to the location and halting the bleeding. This therapy is temporary, but the bleeding is likely to resume.
HOW CAN ASPERGILLOSIS BE PREVENTED?
It's very hard to eliminate aspergillus exposure, but if you've had a transplant or are receiving chemotherapy, try to avoid locations where mold is prone to grow, such as construction sites, compost piles, and grain storage facilities. If your immune system is compromised, your doctor may urge you to wear a face mask to minimize exposure to aspergillus and other airborne infectious pathogens.