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Aspergillosis

Aspergillosis is an infection or allergic response due to the Aspergillus fungus.

Causes

Aspergillosis is caused by a fungus (Aspergillus). The fungus is commonly found growing on dead leaves, stored grain, compost piles, or in other decaying vegetation. It can also be found on marijuana leaves.

Although most people are often exposed to Aspergillus, infections caused by the fungus rarely occur in people who have a healthy immune system. Rare infections caused by aspergillus include pneumonia and fungus ball (aspergilloma).

There are several forms of aspergillosis:

  • Pulmonary aspergillosis is an allergic bronchopulmonary type that is an allergic reaction to the fungus. This infection usually develops in people who already have lung problems such as asthma or cystic fibrosis.
  • Aspergilloma is a growth (fungus ball) that develops in an area of past lung disease or lung scarring such as tuberculosis or lung abscess.
  • Pulmonary aspergillosis is an invasive type that is a serious infection with pneumonia that can spread to other parts of the body. This infection almost always occurs in people with a weakened immune system due to cancer, AIDS, leukemia, an organ transplant, chemotherapy, or other conditions or medications that lower the number or function of normal white blood cells or weaken the immune system.

Symptoms

Symptoms depend on the type of infection.

Symptoms of allergic bronchopulmonary aspergillosis may include:

  • Cough
  • Coughing up blood or brownish mucus plugs
  • Fever
  • General ill feeling (malaise)
  • Wheezing
  • Weight loss

Other symptoms depend on the part of the body affected, and may include:

  • Bone pain
  • Chest pain
  • Chills
  • Decreased urine output
  • Headaches
  • Increased phlegm production, which may be bloody
  • Shortness of breath
  • Skin sores (lesions)
  • Vision problems

Exams and tests

Tests to diagnose Aspergillus infection include:

Treatment

A fungus ball is usually not treated (with antifungal medicines) unless there is bleeding into the lung tissue. In such a case, surgery and medicines are needed.

Invasive aspergillosis is treated with several weeks of an antifungal medicine. It can be given by mouth or IV (into a vein). Endocarditis caused by Aspergillus is treated by surgically removing the infected heart valves. Long-term antifungal therapy is also needed.

Antifungal medicines alone do not help people with allergic aspergillosis. Allergic aspergillosis is treated with medicines that suppress the immune system (immunosuppressive drugs), such as prednisone.

Outlook (prognosis)

With treatment, people with allergic aspergillosis usually get better over time. It is common for the disease to come back (relapse) and need repeat treatment.

If invasive aspergillosis does not get better with drug treatment, it eventually leads to death. The outlook for invasive aspergillosis also depends on the person's underlying disease and immune system health.

Possible Complications

  • Amphotericin B can cause kidney damage and unpleasant side effects such as fever and chills
  • Bronchiectasis (permanent scarring and enlargement of the small sacs in the lungs)
  • Invasive lung disease can cause massive bleeding from the lung
  • Mucus plugs in the airways
  • Permanent airway blockage
  • Respiratory failure

When to Contact a Medical Professional

Call your health care provider if you develop symptoms of aspergillosis or if you have a weakened immune system and develop a fever.

Prevention

Precautions should be taken when using medicines that suppress the immune system. Preventing AIDS also prevents certain diseases, including aspergillosis, that are associated with a damaged or weakened immune system.

References

Patterson TF. Aspergillus species. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 258.

Walsh TJ. Stevens DA. Aspergillosis. In: Goldman L, Schafer AI, eds. Goldman'sCecil Medicine. 24th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 347.

Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical practice guidelines of the Infections Diseases Society of America. Clin Infect Dis. 2008;46(3):327-60.

Update Date: 5/19/2013

Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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