Overview

Aspergillosis is an infection caused by a type of mold. The illnesses resulting from aspergillosis infection usually affect the respiratory system, but their signs and severity vary greatly. The mold that triggers the illnesses, aspergillus, is everywhere, indoors and outdoors. Most strains of this mold are harmless, but a few can cause serious illnesses when people with weakened immune systems, underlying lung disease or asthma inhale their spores.

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 in air spaces (cavities) in the lung as part of chronic pulmonary aspergillosis. This type of aspergillosis is called simple 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 produce symptoms or may produce a mild cough only, but over time, the underlying condition can worsen and possibly cause:

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

Infection

Invasive pulmonary aspergillosis — the most severe form — occurs when the infection spreads rapidly from the lungs to your brain, heart, kidneys or skin. This occurs only in people whose immune system is weakened, commonly from chemotherapy. Untreated, this form of aspergilla disease is usually fatal.

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
  • Headaches or eye symptoms
  • Nosebleed
  • Facial swelling on one side
  • Skin lesions

Other types of aspergillosis

Aspergillus can invade areas of the body other than your lungs, such as your sinuses. In your sinuses, it can cause a stuffy nose, drainage that's 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 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 crucial, and treatment is sometimes started before the infection is diagnosed.

Causes

Aspergillus mold is 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.

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 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.

Risk factors

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 immune-suppressing drugs after undergoing transplant surgery — especially bone marrow or stem cell transplants — or people who have certain cancers of the blood are at highest risk of invasive aspergillosis. People in the later stages of AIDS also may be at increased risk.
  • Low white blood cell level. Having chemotherapy, an organ transplant or leukemia lowers your white cell level, making you more susceptible to invasive aspergillosis. So does having chronic granulomatous disease — an inherited disorder that affects immune system cells.
  • Lung cavities. People who have healed air spaces (cavities) in their lungs are at higher risk of developing a mass of tangled fungus fibers (aspergilloma). Cavities are areas that have been damaged by radiation to the lung or by lung diseases such as tuberculosis or sarcoidosis — a noncancerous, inflammatory illness.
  • Asthma or cystic fibrosis. People with asthma and cystic fibrosis, especially those whose lung problems are long-standing or hard to control, are more likely to have an allergic response to aspergillus mold.
  • Long-term corticosteroid therapy. Long-term use of corticosteroids may increase the risk of opportunistic infections, depending on the underlying disease being treated and what other drugs are being used.

Complications

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, especially your brain, heart and kidneys. Invasive aspergillosis spreads rapidly and is often fatal in spite of early treatment.

Prevention

It's nearly impossible to avoid exposure to aspergillus, but if you have had a transplant or are undergoing chemotherapy, try to stay away from the most obvious sources of mold, such as construction sites, compost piles and stored grain. If you have a weakened immune system, your doctor may advise you to wear a face mask to avoid being exposed to airborne infectious agents.

Aug. 05, 2014
References
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