Aspergillosis

Aspergillosis is an infection caused by a mold called aspergillus. Aspergillus mold is a type of fungus. The illnesses resulting from aspergillosis infection usually affect the respiratory system. However, the illnesses can have very different symptoms, and some are more serious than others.

Aspergillus can be found indoors and outdoors. Most strains of this mold are harmless. However, a few strains can cause serious illnesses when certain people inhale the fungal spores. These strains are most dangerous for people with weakened immune systems, 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 is called invasive aspergillosis. This occurs when the infection spreads to blood vessels and beyond.

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

The symptoms of aspergillosis depend on the type of illness you develop:

Allergic reaction

Some people with asthma or cystic fibrosis have an allergic reaction to aspergillus mold. This allergic reaction is called bronchopulmonary aspergillosis. Symptoms of this condition include:

• Fever.
• Wheezing.
• A cough that may bring up blood or mucus.
• Worsening asthma.

Aspergilloma

Certain ongoing lung conditions can cause air spaces to form in the lungs, called cavities. These conditions may include emphysema, tuberculosis or advanced sarcoidosis. When people with lung cavities also are infected with aspergillus, fungus fibers may find their way into the cavities. These fibers can grow into tangled masses known as fungus balls or aspergillomas.

Aspergillomas may produce no symptoms or cause only a mild cough at first. Over time and without treatment, however, aspergillomas can worsen the underlying lung condition and possibly cause:

• A cough that often brings up blood, called hemoptysis.
• Fatigue.
• Shortness of breath.
• Unintentional weight loss.
• Wheezing.

Invasive aspergillosis

Invasive aspergillosis is the most severe form of aspergillosis. It occurs when the infection spreads rapidly from the lungs to the brain, heart, kidneys or skin. Invasive aspergillosis occurs only in people whose immune systems are weakened. The immune system may be weakened because of cancer chemotherapy, bone marrow transplantation or a disease of the immune system. Untreated, this form of aspergillosis may be fatal.

Symptoms depend on which organs are affected. In general, invasive aspergillosis can cause:

• A cough that brings up blood, called hemoptysis.
• Chest or joint pain.
• Fever and chills.
• Headaches or eye symptoms.
• Shortness of breath.
• Skin lesions.

Other types of aspergillosis

Aspergillus can invade areas of your body other than your lungs, such as your sinuses. In your sinuses, the fungus can cause a stuffy nose and drainage that may contain blood. Fever, facial pain and headache also may occur.

If you have asthma or cystic fibrosis, see your healthcare professional whenever you notice a change in your breathing. Although aspergillosis may not be the cause, it's important to have breathing problems checked out.

Get immediate medical care if you have a weakened immune system and develop an unexplained fever, shortness of breath or a cough that brings up blood. In the case of invasive aspergillosis, it is important to get treated right away. In some cases, treatment with antifungal medicine begins as soon as aspergillosis is suspected, even before testing has confirmed the diagnosis.

Aspergillus mold is unavoidable. Outdoors, it's found in soil, decaying leaves and compost. It's also found on plants, trees and grain crops.

Everyday exposure to aspergillus is rarely a problem for people with healthy immune systems. When mold spores are inhaled, immune system cells surround and destroy them. But people who have a weakened immune system 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.

Your risk of developing aspergillosis depends on your overall health and the extent of your exposure to mold. In general, these factors make you more vulnerable to infection:

• Weakened immune system. People taking medicines that suppress the immune system after having a transplant surgery have the highest risk of invasive aspergillosis. The risk is highest after bone marrow or stem cell transplants. People who have certain cancers of the blood also are at highest risk of invasive aspergillosis. People in the later stages of AIDS may be at increased risk.
• Low white blood cell level. People who have had chemotherapy, an organ transplant or leukemia have lower white cell levels. This makes them more vulnerable to invasive aspergillosis. Having an inherited disorder that affects immune system cells, called chronic granulomatous disease, also increases the risk.
• Lung cavities. People who have air spaces, called cavities, in their lungs are at higher risk of developing aspergillomas.
• Asthma or cystic fibrosis. People with asthma and cystic fibrosis are more likely to have an allergic response to aspergillus mold. The risk is higher in those whose lung problems are long-standing or hard to control.
• Long-term corticosteroid therapy. Long-term use of corticosteroids may increase the risk of infections. The risk depends on the underlying disease being treated and what other medicines are being used.

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

• 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. It may spread to your brain, heart and kidneys. Invasive aspergillosis spreads quickly and may be fatal.

It's nearly impossible to avoid exposure to aspergillus. If you have had a transplant or are undergoing chemotherapy, try to stay away from places where you're likely to encounter mold. Places may include construction sites, compost piles and buildings that store grain. If you have a weakened immune system, your healthcare professional may advise you to wear a face mask to avoid being exposed to aspergillus and other airborne infectious agents.