Aspergillosis

Aspergillosis is an infection or an allergic response caused by a fungus of the Aspergillus type. It may play a role in allergy, but is best known for causing serious pulmonary infections in immunocompromised patients, e.g. those with HIV/AIDS, on chemotherapy or longterm antibiotics. more...

Causes, incidence, and risk factors

Aspergillosis is caused by a fungus (Aspergillus), which is commonly found growing on dead leaves, stored grain, compost piles, or in other decaying vegetation.

It causes illness in three ways:

• as an allergic reaction in people with asthma (pulmonary aspergillosis - allergic bronchopulmonary type)
• as a colonization and growth in a lung injury (such as from tuberculosis or lung abscess) having healed with a resulting cavity, in a nasal sinus or in an aural cavity-where it produces a fungus ball called aspergilloma formed by febrile infiltration of blood or tissue.
• as an invasive systemic infection with pneumonia, nasal necrosis or aural inflammation and necrosis that is spread to other parts of the body by the bloodstream (pulmonary aspergillosis - invasive type).

The invasive infection can affect the eye, causing blindness, and any other organ of the body, but especially the heart, lungs, brain, and kidneys. The third form occurs almost exclusively in people who are immunosuppressed because of cancer, AIDS, leukemia, organ transplants, high doses of corticosteroid drugs, chemotherapy, or other diseases that reduce the number of normal white blood cells.

Symptoms

Allergic aspergillosis

• Fever
• Malaise
• Coughing
• Coughing up blood or brownish mucous plugs
• Wheezing
• Weight loss
• Recurrent episodes of lung obstruction

Invasive infection

• Fever
• Chills
• Headaches
• Cough
• Shortness of breath
• Chest pain
• Increased sputum production, which may be bloody
• Bone pain
• Blood in the urine
• Decreased urine output
• Weight loss
• Symptoms involving specific organs
  • Brain: meningitis
  • Eye: blindness or visual impairment
  • Sinuses: sinusitis
  • Heart: endocarditis

Signs and tests

Aspergillosis is detected by:

• Abnormal chest X-ray or CT scan
• Sputum stain and culture showing Aspergillus
• Tissue biopsy (see bronchoscopy with transtracheal biopsy) for aspergillosis
• Aspergillus antigen skin test
• Aspergillosis precipitin antibody or galactomannan positivity
• Elevated serum total IgE (immunoglobulin)
• Peripheral eosinophilia with allergic disease

Treatment

The goal of treatment is to control symptomatic infection. A fungus ball usually does not require treatment unless bleeding into the lung tissue is associated with the infection; then, surgical excision is required.

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