Aspergillosis

Diagnosing an aspergilloma or invasive aspergillosis can be difficult. Aspergillus is common in all environments but difficult to distinguish from certain other molds under the microscope. The symptoms of aspergillosis are also similar to those of other lung conditions such as tuberculosis.

Your doctor is likely to use one or more of the following tests to pinpoint the cause of your symptoms:

• 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 aspergillosis 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 testing, as well as 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.

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. The most effective treatment is a newer antifungal drug, voriconazole (Vfend). Amphotericin B is another option.

  All antifungal drugs can have serious side effects, including kidney and liver damage. Interactions between antifungal drugs and other medications are also common.

• Surgery. Because antifungal medications don't penetrate an aspergilloma very well, surgery to remove the fungal mass is the first-choice treatment when an aspergilloma causes bleeding in the lungs.
• Embolization. This procedure stops lung bleeding caused by an aspergilloma. A radiologist injects a material through a catheter that has been guided into an artery feeding a lung cavity where an aspergilloma is causing blood loss. The injected material hardens, blocking the blood supply to the area and stopping the bleeding. This treatment works temporarily, but the bleeding is likely to start again.

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 computed tomography (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?