Aspergillosis

Aspergillosis

Definition:

Aspergillosis is a group of illnesses caused by a certain type of mold. These illnesses usually affect the respiratory system. The mold that triggers the illnesses, aspergillus, occurs widely indoors and outdoors. Most strains of this mold are harmless. But a few can cause serious illnesses when their

spores are inhaled by people with a weakened immune system, underlying lung disease or asthma.

In some people, the spores trigger an allergic reaction. Other people develop mild to serious lung infections. The most serious form of aspergillosis — invasive aspergillosis — occurs when the infection spreads to blood vessels and beyond.

Depending on the type of aspergillosis, treatment may involve observation, antifungal medications or, in rare cases, surgery.

Symptoms:

The signs and symptoms of aspergillosis vary with the type of illness you develop:

Allergic reaction
Some people with asthma or cystic fibrosis have an allergic reaction to aspergillus mold. Signs and symptoms of this condition, known as allergic bronchopulmonary aspergillosis, include:

• Fever
• A cough that may bring up blood or plugs of mucus
• Worsening asthma

Fungal mass
A growth of tangled fungus fibers (fungus ball) may develop if there are air spaces (cavities) in the lungs. This type of aspergillosis is called aspergilloma. Lung cavities may develop in people with pre-existing lung conditions, such as emphysema, tuberculosis or advanced sarcoidosis. Aspergilloma is a benign condition that may not initially produce symptoms, but over time it can cause:

• A cough that often brings up blood (hemoptysis), sometimes large amounts
• Wheezing
• Shortness of breath
• Unintentional weight loss
• Fatigue

Infection
The most severe form of aspergillosis, invasive pulmonary aspergillosis, occurs when the infection spreads rapidly from the lungs through your bloodstream to your brain, heart, kidneys or skin. This occurs only in people whose immune system is weakened, commonly from chemotherapy. Signs and symptoms depend on which organs are affected, but in general, invasive aspergillosis can cause:

• Fever and chills
• Cough that brings up blood-streaked sputum (hemoptysis)
• Severe bleeding from your lungs
• Shortness of breath
• Chest or joint pain
• Nosebleed
• Facial swelling on one side
• Skin lesions

Other types of aspergillosis
In addition to your lungs, aspergillus can invade other areas of the body, such as your sinuses. In your sinuses, it can cause a stuffy nose, drainage (possibly bloody), inflammation, fever, facial pain and headache.

When to see a doctor
If you have asthma or cystic fibrosis, see your doctor whenever you notice a change in your symptoms. Although aspergillosis may not be the cause, it's important to have any problems evaluated. If you have a weakened immune system and develop an unexplained fever, shortness of breath or a cough that brings up blood, get immediate medical care. In the case of invasive aspergillosis, prompt treatment is so crucial that treatment is often started before the infection is diagnosed.

Causes:


Aspergillus mold is virtually unavoidable. Outdoors, it's found in decaying leaves and compost and on plants, trees and grain crops. Inside, the spores — the reproductive parts of mold — thrive in air conditioning and heating ducts, insulation, and some food and spices. Aspergillus is so common in old buildings, even in older hospitals, that small epidemics have occurred among people with weakened immune systems when nearby buildings have been torn down.

Everyday exposure to aspergillus is rarely a problem for people with healthy immune systems. When mold spores are inhaled, immune system cells simply surround and destroy them. But people who have a weakened immune system from illness or immunosuppressant medications have fewer infection-fighting cells. This allows aspergillus to take hold, invading the lungs and, in the most serious cases, other parts of the body.

Aspergillosis is not contagious from person to person.

Complications:

Depending on the type of infection, aspergillosis can cause a variety of serious complications:

• Bone destruction and spread of infection. An aspergillus infection in your sinuses can destroy facial bones. It can also spread beyond your sinuses and may be life-threatening if you have a weakened immune system.
  
• Bleeding. Both aspergillomas and invasive aspergillosis can cause severe, and sometimes fatal, bleeding in your lungs.
  
• Systemic infection. The most serious complication of invasive aspergillosis is the spread of the infection to other parts of your body, especially your brain, heart and kidneys. Invasive aspergillosis spreads rapidly and is often fatal in spite of early treatment.

Treatments and drugs:

Aspergillosis treatments vary with the type of disease. Possible treatments include:

• Observation. Aspergillomas often don't need treatment, and medications aren't usually effective in treating these fungal masses. Instead, aspergillomas that don't cause symptoms may simply be closely monitored by chest X-ray.
  
• Oral corticosteroids. The goal in treating allergic bronchopulmonary aspergillosis is to prevent existing asthma or cystic fibrosis from becoming worse. The best way to do this is with oral corticosteroids. Antifungal medications by themselves aren't helpful for allergic bronchopulmonary aspergillosis, but they may be used in combination with corticosteroids to reduce the dose of steroids and improve lung function.
  
• Antifungal medications. These drugs are the standard treatment for invasive pulmonary aspergillosis. Historically, the drug of choice has been amphotericin B, but the newer medication voriconazole (Vfend) is now preferred because it appears more effective and may have fewer side effects. All antifungals can cause serious problems, however, including kidney and liver damage, and they frequently interact with other medications given to people who have weakened immune systems.
  
• Surgery. Because antifungal medications don't penetrate aspergillomas very well, surgery to remove the fungal mass is the first-choice treatment when bleeding from the mass in the lungs occurs. But the surgery is risky, and your doctor may instead suggest embolization. In this procedure, your doctor, usually a radiologist, threads a small catheter into the artery that supplies blood to the cavity containing the fungus ball, and injects a special material that clogs the artery. Though this procedure can stop massive bleeding, it doesn't prevent it from recurring, so it's generally considered a temporary treatment.