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Aspergillosis +as-pur-(+)ji-!lO-sus

by Alan M. Sugar, MD

Aspergillosis is infection, usually of the lungs, caused by the fungus Aspergillus.

  • A ball of fungus fibers, blood clots, and white blood cells may form in the lungs or sinuses.

  • People may have no symptoms or may cough up blood or have a fever, chest pain, and difficulty breathing.

  • If fungi spread to the liver or kidneys, these organs may malfunction.

  • Diagnosis usually involves an x-ray or computed tomography and, if possible, culture of a sample of infected material.

  • Antifungal drugs are used, and sometimes surgery is needed to remove the fungi.

Aspergilli are very common and frequently occur in compost heaps, air vents, and airborne dust. Inhalation of Aspergillus spores is the primary cause of aspergillosis. Aspergillosis has several forms:

  • Pulmonary aspergilloma: Aspergillosis usually develops in open spaces in the body, such as cavities in the lungs caused by preexisting lung disorders. The infection may also develop in the ear canals and sinuses. In the sinuses and lungs, aspergillosis develops as a ball (aspergilloma) composed of a tangled mass of fungus fibers, blood clots, and white blood cells. The ball gradually enlarges, destroying lung tissue in the process, but usually does not spread to other areas.

  • Invasive aspergillosis: Less often, aspergillosis becomes very aggressive and rapidly spreads throughout the lungs and often through the bloodstream to the brain, heart, liver, and kidneys. This rapid spread occurs mainly in people with a weakened immune system.

  • Allergic bronchopulmonary aspergillosis: Some people who have asthma or cystic fibrosis develop a chronic allergic reaction with cough, wheezing and fever if Aspergillus colonizes the lining of their airways (see Allergic Bronchopulmonary Aspergillosis).

Symptoms

A fungus ball in the lungs may cause no symptoms and may be discovered only when a chest x-ray is taken for other reasons. Or it may cause repeated coughing up of blood and, rarely, severe, even fatal bleeding. A rapidly invasive infection in the lungs often causes cough, fever, chest pain, and difficulty breathing. Without treatment, this form of invasive aspergillosis is fatal.

Aspergillosis that spreads to other organs makes people very ill. Symptoms include fever, chills, shock, delirium, and blood clots. Kidney failure, liver failure (causing jaundice), and breathing difficulties may develop. Death can occur quickly.

Aspergillosis of the ear canal causes itching and occasionally pain. Fluid draining overnight from the ear may leave a stain on the pillow. Aspergillosis of the sinuses causes a feeling of congestion and sometimes pain or discharge.

Diagnosis

Doctors suspect the diagnosis based on symptoms. An x-ray or computed tomography (CT) of the infected area also provides clues for making the diagnosis.

Whenever possible, doctors send a sample of infected material to a laboratory to grow (culture), examine, and confirm identification of the fungus. A viewing tube (bronchoscope or rhinoscope) may be used to obtain this material from the lungs or sinuses.

Treatment

Aspergillosis that affects only a sinus or a single area in the lung requires treatment but does not pose an immediate danger because it progresses slowly. However, if the infection is widespread or if people appear seriously ill, treatment is started immediately.

Invasive aspergillosis is treated with antifungal drugs, such as amphotericin B or voriconazole. However, some forms of Aspergillus do not respond to these drugs and may need to be treated with caspofungin, a newer antifungal drug, with or without the other drugs.

Doctors treat aspergillosis in the ear canal by scraping out the fungus and applying drops of antifungal drugs. Collections of fungi in the sinuses must usually be removed surgically. If fungus balls in the lungs grow near large blood vessels, they may also need to be removed surgically because they may invade the blood vessel and cause bleeding.

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