Aspergillosis

Aspergillosis is a fungal infection. It's caused by a type of mold called aspergillus. This mold is common both inside and outside. Most aspergillus molds are harmless. However, some can cause problems, especially for people whose immune systems are weak, or who already have lung conditions like asthma or other lung diseases.

These problems usually affect the lungs, but the symptoms and how severe they are can be very different from person to person. When people breathe in the mold's tiny spores, some people have an allergic reaction. Others develop a lung infection, ranging from mild to serious.

A serious form of aspergillosis is called invasive aspergillosis. This happens when the infection spreads beyond the lungs into the bloodstream and other parts of the body.

Treatment for aspergillosis depends on the type and severity of the infection. Sometimes, doctors just need to monitor the person's condition. In other cases, antifungal medicines are needed. Rarely, surgery might be necessary.

The symptoms of aspergillosis depend on the specific form of the illness. Different types of aspergillosis cause different symptoms.

If you have asthma or cystic fibrosis, and you notice any changes in how you breathe, see your doctor right away. While another problem might be causing the issue, it's important to have any breathing difficulties checked by a medical professional.

If you have a weakened immune system and suddenly develop a fever you can't explain, feel short of breath, or cough up blood, seek immediate medical attention. This is especially important if you suspect invasive aspergillosis, a type of infection. Prompt treatment is very important with this condition. In some cases, doctors may start antifungal medicine as soon as they think you might have aspergillosis, even before the tests come back confirming the diagnosis.

Aspergillus mold is a common fungus found in many places. You'll often see it in nature, like on decomposing leaves, in compost piles, and on plants, trees, and even grains.

Most healthy people can easily handle exposure to aspergillus. Their bodies have a natural defense system. When mold spores are breathed in, the immune system's cells recognize and destroy them. Think of it like a cleanup crew.

However, if someone has a weakened immune system – maybe due to an illness like cancer or from taking medications that suppress the immune response – their body's defenses are less effective. This means the aspergillus mold can potentially grow and spread, sometimes invading the lungs. In the most severe cases, it can spread to other parts of the body.

Important to note: Aspergillosis, the illness caused by aspergillus, is not spread from one person to another. You can't catch it from someone else.

Getting aspergillosis, a fungal infection, depends on your health and how much mold you're around. Several things increase your risk:

• A weak immune system: If you're taking medicine to suppress your immune system, like after a bone marrow or stem cell transplant, or if you have certain blood cancers, you're at high risk for a serious form of aspergillosis called invasive aspergillosis. People with advanced stages of AIDS are also more vulnerable. Basically, if your body's defenses are low, you're more likely to get sick from the fungus.

• Low white blood cell count: Treatments like chemotherapy, organ transplants, or leukemia can lower the number of white blood cells in your body. These cells are crucial for fighting infection. A genetic condition called chronic granulomatous disease also lowers these protective cells, making you more susceptible to aspergillosis.

• Lung problems: If you have empty spaces (cavities) in your lungs, you're more likely to develop aspergillomas, which are clumps of fungus in the lungs.

• Asthma or cystic fibrosis: People with chronic asthma or cystic fibrosis, especially those whose conditions are difficult to manage, may have a stronger allergic reaction to the aspergillus mold. Their lungs might be more susceptible to the mold's effects.

• Long-term steroid use: Taking corticosteroids for a long time can make you more prone to infections. This is especially true if you have an underlying condition requiring the steroids, or if you're taking other medications. Steroids weaken your immune system, making you more vulnerable to a variety of illnesses, including aspergillosis.

Essentially, the more your body's defenses are weakened, or the more you're exposed to mold, the more likely you are to get aspergillosis. If you have any of these risk factors, it's important to talk to your doctor about preventing or managing potential infections.

Aspergillosis, a fungal infection, can lead to several serious problems, depending on the type.

• Lung bleeding: This infection can cause significant bleeding in the lungs, sometimes so severe it can be life-threatening. This can happen with a condition called aspergillomas, where fungus clumps form in the lungs, or with a more serious form called invasive aspergillosis.

• Spread throughout the body: The most dangerous outcome of invasive aspergillosis is the fungus spreading to other parts of the body. This can happen quickly and affect organs like the brain, heart, and kidneys. This widespread infection is often fatal.

Mold, called Aspergillus, is almost everywhere. You can't really stop breathing it in. However, if you've had an organ transplant or are getting cancer treatments like chemotherapy, it's smart to limit your exposure. Places with a lot of mold, like construction sites, piles of compost, or grain storage facilities, might be best avoided.

A weakened immune system can make you more vulnerable to Aspergillus and other germs that float in the air. If your immune system isn't strong, your doctor might suggest wearing a face mask to keep these things from getting into your lungs.

Identifying aspergilloma or invasive aspergillosis can be tricky. Mold called aspergillus is found almost everywhere, but it can be hard to tell it apart from other types of mold under a microscope. Also, the symptoms of aspergillosis can be similar to those of other lung problems, like tuberculosis.

Doctors use several tests to figure out what's causing your symptoms:

• Imaging Tests: A chest X-ray or CT scan (a more detailed type of X-ray) can often show a clump of fungus (aspergilloma) or telltale signs of invasive aspergillosis or an allergic reaction to aspergillus. These signs can help the doctor suspect what's going on.
• Sputum Test: A sample of your phlegm (sputum) is examined. The sample is stained with a special dye to look for aspergillus threads. The sample is also put in a special environment to encourage the mold to grow. This helps confirm whether aspergillus is present.
• Tissue and Blood Tests: If your doctor suspects an allergic reaction (allergic bronchopulmonary aspergillosis), they might do tests on your blood or skin. A small amount of aspergillus material is put under the skin. If you're allergic, a small, hard, red bump will form at the injection site. Blood tests can also measure the level of antibodies to aspergillus, which can show if you're having an allergic reaction.
• Biopsy: In some cases, a small piece of tissue from your lungs or sinuses needs to be examined under a microscope. This is usually done to confirm invasive aspergillosis. This is a more involved procedure to get a closer look at the affected area.

These tests help doctors pinpoint the specific problem and create a treatment plan.

Treating aspergillosis depends on the specific type. Here's a breakdown of common approaches:

Invasive Pulmonary Aspergillosis: This serious form is often treated with antifungal drugs. Voriconazole (Vfend) is a newer, more effective option. Another common drug is amphotericin B.

Important Note: All antifungal drugs can have significant side effects, such as problems with the kidneys or liver. They can also interact with other medicines you might be taking.

Simple Aspergillomas: If you have a single, small aspergilloma (a collection of fungus in the lungs) that isn't causing problems, treatment might not be needed. Doctors will likely just monitor the aspergilloma with regular chest X-rays. If the aspergilloma grows or starts causing symptoms, antifungal drugs might then be considered.

Allergic Bronchopulmonary Aspergillosis: This type is often linked to asthma or cystic fibrosis. The goal is to prevent these underlying conditions from worsening. Oral corticosteroids (steroids taken by mouth) are the primary treatment. While antifungal drugs aren't usually enough on their own, they can sometimes be combined with steroids to reduce the needed steroid dose and help lung function improve.

Aspergillomas Causing Bleeding: If an aspergilloma is causing bleeding in the lungs, surgery to remove the fungal mass is often the best first treatment. Antifungal drugs don't always reach the aspergilloma effectively to stop the bleeding.

Treating Lung Bleeding (Embolization): If surgery isn't an option, a procedure called embolization can temporarily stop the bleeding. A doctor uses a thin tube (catheter) to reach the blood vessel supplying the area where the aspergilloma is causing problems. They inject a special material that hardens and blocks the blood vessel, halting the bleeding. However, this is usually a temporary fix, and the bleeding may return.

In summary: The best treatment for aspergillosis depends on the specific type and its severity. Your doctor will consider your overall health, the location and size of any fungal growth, and any other medical conditions you have when deciding on the most appropriate course of action.