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Aspergillosis by Ricker Polsdorfer, MD

Definition

Aspergillus is a common type of fungus. It is found all over the world. Aspergillosis is an infection caused by this fungus. It can result in severe lung problems.

While this type of infection is rare, it is more common in people with:

Chronic lung disease
HIV infection and AIDS
Prolonged chemotherapy
Steroid usage

Most of these condition weaken the immune system. The body is less able to fight off infections. In these cases, the fungus can spread to other organs. This can include the eye, sinuses, and brain. It is a serious condition that requires treatment.

Another form of aspergillosis affects people with asthma :

Allergic bronchopulmonary aspergillosis —a type of allergic reactions to environmental agents

Causes

Inhaling fungus spores can be the first step to aspergillosis.

Inhalation of Spores

Risk Factors

Risk factors include:

Compromised immunity
- AIDS
- Drugs that accompany an organ transplant
- Certain cancer treatments
- Long-term, high-dose cortisone-like drugs
- Poorly functioning or too few white blood cells (neutropenia)
Chronic lung disease
Asthma

Asthma in Lungs

Symptoms

If you have any of these symptoms, do not assume it is due to aspergillosis. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

Chronic productive cough
Coughing up blood
Fever
Shortness of breath
Wheezing

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be referred to a specialist in lung diseases or infectious diseases. Tests may include the following:

Blood and urine samples
Sputum samples
Chest x-ray —a test that uses radiation to take a picture of structures inside the chest
CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
Bronchoscopy —visual examination of the air passages leading into the lungs

Treatment

The underlying disease must be treated along with the aspergillosis. Talk with your doctor about the best plan for you. Treatment options include:

Medicine
- Intravenous Amphotericin B—given for a prolonged period of time; may damage the kidneys
- Voriconazole —found to be highly effective for invasive aspergillosis and a preferred treatment option
- Itraconazole —effective in some cases
Surgery—Part of the lung may need to be removed if it contains a large mass of fungus.

Prevention

Aspergillus is everywhere. High concentrations may be found in soil or compost. Mildew in bathrooms or other moist places may also contain this fungus. If you are at risk for getting aspergillus infection, try to avoid close contact with soil or compost and take steps to keep your home mildew-free.

RESOURCES:

The Aspergillus Website http://www.aspergillus.org.uk/
Center for Disease Control http://www.cdc.gov/

CANADIAN RESOURCES:

The Canadian Lung Association http://www.lung.ca/home-accueil_e.php/
Health Canada http://www.hc-sc.gc.ca/index_e.html/

References:

Aspergillosis. DynaMed website. Available at: http://www.dynamicmedical.com/dynamed.nsf?opendatabase . Updated November 1, 2010. Accessed January 22, 2011.
Beers MH, Berkow R, eds. The Merck Manual . 17th ed. West Point, PA: Merck & Co;1999.
Bennett JE. Aspergillosis. In: Kasper DL, et al., eds. Harrison's Principles of Internal Medicine . 16th ed. New York: McGraw-Hill; 2005:1188-1190.
Mandell GL, Bennet JE, Dolin R, eds. Principles and Practices of Infectious Diseases . 6th ed. St. Louis, MD, Consult; 2005.
Sherif R, Segal BH. Pulmonary aspergillosis: clinical presentation, diagnostic tests, management and complications. Current Opinions in Pulmonary Medicine. 2010;16(3):242-250.

Last reviewed December 2011 by Rosalyn Carson-DeWitt, MD

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