Diagnosis

Diagnosing an infection caused by aspergillus mold can be difficult and depends on the type of aspergillus infection. Aspergillus is common in the environment and is sometimes found in the saliva and sputum of healthy people. What's more, it's hard to distinguish aspergillus from certain other molds under the microscope, and symptoms of the infection are similar to those of conditions such as tuberculosis.

Your doctor is likely to use one or more of the following tests:

  • Imaging test. A chest X-ray or computerized tomography (CT) scan — a type of X-ray that produces more-detailed images than conventional X-rays do — can usually reveal a fungal mass (aspergilloma), as well as characteristic signs of invasive and allergic bronchopulmonary aspergillosis.
  • Respiratory secretion (sputum) test. In this test, a sample of your sputum is stained with a dye and checked for the presence of aspergillus filaments. The specimen is then placed in a culture that encourages the mold to grow to help confirm the diagnosis.
  • Tissue and blood tests. Skin, sputum and blood tests may be helpful in confirming allergic bronchopulmonary aspergillosis. For the skin test, a small amount of aspergillus antigen is injected into the skin of your forearm. If your blood has antibodies to the mold, you'll develop a hard, red bump at the injection site. Blood tests look for high levels of certain antibodies, indicating an allergic response.
  • Biopsy. In some cases, examining a sample of tissue from your lungs or sinuses under a microscope may be necessary to confirm a diagnosis of invasive aspergillosis.

Treatment

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

  • Observation. Simple, single 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. If the condition progresses, then antifungal medications may be recommended.
  • Oral corticosteroids. The goal in treating allergic bronchopulmonary aspergillosis is to prevent existing asthma or cystic fibrosis from worsening. 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 combined 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 to be 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, a radiologist threads a small catheter into the artery that supplies blood to the cavity containing the fungus ball and injects a 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.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Preparing for your appointment

People who develop aspergillosis usually have an underlying condition, such as asthma or cystic fibrosis, or have a weakened immune system due to illness or to immune-suppressing medications. If you have symptoms of aspergillosis and are already being treated for a medical condition, call the doctor who provides your care for that condition. In some cases, when you call to set up an appointment, your doctor may recommend urgent medical care.

If you have a weakened immune system and develop an unexplained fever, shortness of breath or a cough that brings up blood, seek immediate medical care.

If you have time to prepare before seeing your doctor, here's some information to help you get ready for your appointment.

What you can do

  • Be aware of any pre- or post-appointment restrictions. When you call for the appointment, ask if there's anything you need to do in advance.
  • Write down your key medical information. If you are going to see a new doctor, bring a summary of other conditions for which you're being treated, as well as recent medical appointments or hospitalizations.
  • Bring all of your medications with you, preferably in their original bottles. If the doctor you are seeing doesn't have access to your medical records or previous imaging tests, such as X-rays or CT scans, try to get copies to take with you.
  • Take along a family member or friend. Aspergillosis can be a medical emergency. Take someone who can understand and recall all the information your doctor provides and who can stay with you if you need immediate treatment.
  • Write down questions to ask your doctor.

Prepare a list of questions so that you can make the most of your time with your doctor. For aspergillosis, some basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • Other than the most likely cause, what are other possible causes for my symptoms?
  • What tests do I need?
  • Do I need to be hospitalized?
  • What treatment do you recommend?
  • What are the possible side effects from the medications you're recommending?
  • How will you monitor my response to treatment?
  • Am I at risk of long-term complications from this condition?
  • I have another health condition. How can I best manage these conditions together?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you some questions, including:

  • What are your symptoms?
  • Have you seen other doctors for this?
  • When did you begin experiencing symptoms?
  • How severe are your symptoms? Do they seem to be getting worse?
  • Have you had a fever?
  • Are you having difficulty breathing?
  • Are you coughing up blood?
  • What else concerns you?
Aug. 05, 2014
References
  1. Aspergillosis. Centers for Disease Control and Prevention. http://www.cdc.gov/fungal/aspergillosis/. Accessed Nov. 12, 2013.
  2. Goldman L, et al. Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed Nov. 12, 2013.
  3. Ferri FF. Ferri's Clinical Advisor 2013: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2013. https://www.clinicalkey.com. Accessed Nov. 12, 2013.
  4. Marr KA. Treatment and prevention of invasive aspergillosis. http://www.uptodate.com/home. Accessed Nov. 11, 2013.
  5. Treatment of aspergillosis. Arlington, Va.: Infectious Diseases Society of America. Clinical Infectious Diseases. 2008;46:327.
  6. Marr KA. Epidemiology and clinical manifestations of of invasive aspergillosis. http://www.uptodate.com/home. Accessed Nov. 11, 2013.
  7. Denning DW, et al. Clinical manifestations and diagnosis of chronic pulmonary aspergillosis. http://www.uptodate.com/home. Accessed Dec. 6, 2013.