Aspergillosis

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

Your healthcare professional 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 CT scan can usually reveal a fungal mass, called an aspergilloma. Imaging tests also may show signs of invasive aspergillosis and allergic bronchopulmonary aspergillosis.
• Respiratory secretion test. This test uses a sample of mucus that has been coughed up, also called sputum. The sputum is stained with a dye and checked for the presence of aspergillus fibers. The sample 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. High levels can indicate 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. Medicines 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 medicines may be recommended.
• Oral corticosteroids. The goal in treating allergic bronchopulmonary aspergillosis is to prevent existing asthma or cystic fibrosis from getting worse. The best way to do this is with medicines called oral corticosteroids. Antifungal medicines by themselves aren't helpful for allergic bronchopulmonary aspergillosis. However, they may be combined with corticosteroids to reduce the dose of steroids and improve lung function.
• Antifungal medicines. These medicines are the standard treatment for invasive pulmonary aspergillosis. The most effective treatment is a newer antifungal medicine, voriconazole (Vfend). Amphotericin B is another option.

  All antifungal medicines can have serious side effects. These may include kidney and liver damage. Interactions between antifungal medicines and other medicines also are common.

• Surgery. Because antifungal medicines don't treat 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. An 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.

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

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

Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down symptoms you're experiencing, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down key personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements you're taking and the doses.
• Take a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

Your time with your healthcare team is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For aspergillosis, some basic questions to ask include:

• What is likely causing my symptoms?
• 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 medicines 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

Be prepared to answer questions, such as:

• 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?