Health Encyclopedia

Aspergillosis

Definition

Aspergillosis is an infection, growth, or allergic response due to 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 people who already had lung problems (such as asthma or cystic fibrosis).
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 lower 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:

Cough
Coughing up blood or brownish mucous plugs
Fever
Malaise (general ill feeling)
Wheezing
Weight loss
Recurrent episodes of lung obstruction

Additional symptoms seen in invasive aspergillosis:

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

Signs and tests

Tests to diagnose Aspergillus infection include:

Aspergillus antigen skin test
Aspergillosis precipitin antibody
Chest x-ray
Complete blood count
CT scan
Galactomannan (a molecule from the fungus that is sometimes found in the blood)
Sputum stain and culture for Aspergillus
Tissue biopsy (see bronchoscopy with transtracheal biopsy)

Treatment

A fungus ball is usually not treated unless there is bleeding into the lung tissue. In that case, surgery is required.

Invasive aspergillosis is treated with several weeks of an antifungal drug called voriconizole. It can be given orally or in an IV (directly into a vein). Amphotericin B or itraconazole can also be used.

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

Antifungal drugs do not help people with allergic aspergillosis. Allergic aspergillosis is treated with immunosuppressive drugs -- most often prednisone taken by mouth.

Expectations (prognosis)

People with allergic aspergillosis usually get better gradually, with treatment.

If invasive aspergillosis does not get better with drug treatment, it eventually leads to death. What happens to 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 your health care provider if you develop symptoms of aspergillosis.

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.

References

Stevens DA. Aspergillosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 360.

Review Date:9/28/2008
Reviewed By:David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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