ASPERGILLOSIS

What is Aspergillosis? Aspergillosis is either an infection, a growth, or an allergic response due to the Aspergillus fungus.

What causes Aspergillosis?

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

It causes illness in three ways:

  • an allergic reaction in people with asthma (Pulmonary aspergillosis; allergic bronchopulmonary type)
  • a colonization and growth in an old healed lung cavity from previous disease such as tuberculosis or lung abscess where it produces a fungus ball called aspergilloma
  • as an invasive infection with pneumonia that is spread to other parts of the body by the blood stream (Pulmonary aspergillosis; invasive type)

What are the Symptoms of Aspergillosis?

Symptoms of allergic aspergillosis:

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

Symptoms of invasive infection:

  • Fever
  • Chills
  • Headaches
  • Cough
  • Shortness of breath
  • Chest pain
  • Increased sputum production, which may be bloody
  • Bone pain
  • Blood in the urine
  • Decreased urine output
  • Weight loss

How is Aspergillosis Diagnosed?

  • Abnormal chest x-ray or CT scan
  • Sputum stain and culture showing Aspergillus
  • Tissue biopsy (see bronchoscopy with transtracheal biopsy) for
  • aspergillosis
  • Aspergillus antigen skin test
  • Aspergillosis precipitin antibody
  • Elevated serum total IgE (immunoglobulin)
  • Peripheral eosinophilia with allergic disease

What is the Treatment for Aspergillosis?

The goal of treatment is to control symptomatic infection. A fungus ball usually does not require treatment unless bleeding into the lung tissue is associated with the infection, then surgical excision is required.

Invasive aspergillosis is treated with several weeks of intravenous amphotericin B, an antifungal medication.

Antifungal medications that are considered effective against aspergillosis:

  • Amphotericin B
  • Itraconazole

Endocarditis caused by aspergillus is treated by surgical removal of the infected heart valves and long term amphotericin B therapy.

Allergic aspergillosis is treated with oral prednisone. Some people may benefit from allergy desensitization. Antifungal agents do not help people with allergic aspergillosis.

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