Aspergillosis

Aspergillosis is a group of diseases affecting the lungs and sinuses.

It is caused by inhaling Aspergillus mould spores, a common fungus found in soil, plants, dust and damp environments.

For most healthy people, Aspergillus is harmless.

Aspergillosis is uncommon, but people weakened immune systems or existing lung disease (such as asthma, bronchiectasis, COPD (chronic obstructive respiratory disease), cystic fibrosis, or previous tuberculosis) have a greater risk of developing aspergillosis.

The symptoms of aspergillosis vary depending on the type of infection:

Allergic bronchopulmonary aspergillosis (ABPA) symptoms are similar to asthma and include wheezing, coughing and shortness of breath. It can make asthma harder to treat.

Chronic pulmonary aspergillosis (CPA) symptoms include coughing up blood, weight loss, fatigue and shortness of breath.

Invasive pulmonary aspergillosis (IPA) often occurs in people with other respiratory conditions, so it may be hard to know which symptoms due to the aspergillosis. Symptoms include: fever and chills, chest and joint pain, headaches or eye symptoms, coughing up blood, and shortness of breath. Some people with IPA will develop skin lesions on their head and limbs as aspergillosis develops. The lesions may be red or violet hardened plaques and can be painful to touch. They may darken and become ulcers or scabs. A health practitioner can advise as to what medicine is appropriate for these.

Aspergillus most commonly enters the body via inhalation.

People who are healthy with no respiratory conditions are at a very low risk of aspergillosis. If they have a weakened immune system such as an organ transplant or chemotherapy, or have an existing respiratory condition, are at higher risk.

The risk of infection can be lowered by keeping homes warm, dry and mould-free, wearing a mask in dusty places, and avoiding places where Aspergillus mould is often found, such as compost heaps.

Aspergillosis is often undiagnosed, or diagnosed incorrectly, because the symptoms are similar to the underlying disease (coughing, wheezing, shortness of breath).

Early diagnosis can avoid further damage to the lungs, so it is important for people in high-risk categories to inform their healthcare practitioner if they develop aspergillosis symptoms.

Diagnosis normally involves chest x-rays or scans, blood tests, and referral to a specialist.

• Antifungal medicines may be used to treat or suppress fungal disease. They may be used in chronic infection, invasive infection, and sometimes as part of treatment in allergic disease.
• Corticosteroid medicines (inhaled or oral) may be used to reduce inflammation, especially in treating allergic bronchopulmonary aspergillosis, where the goal is to prevent existing asthma or cystic fibrosis from getting worse.
• Surgery can sometimes to remove a fungal mass (aspergilloma) in the lungs.
• Monitoring:
  • Aspergilloma may not cause symptoms or need treatment, but are usually kept under observation.
  • The response to treatment is monitored by includes: blood tests, liver function tests, repeat CT scans and other chest imaging, sputum testing in some patients, and reviewing symptoms.

Together with treating the fungal infection and asthma symptoms, patients may need help with everyday tasks. This includes help with and managing:

• fatigue
• breathlessness
• nutrition
• airway clearance in some conditions