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Aspergillosis

Alternate Names

  • Aspergillus infection
  • Lungs and bronchial tree

Definition

Aspergillosis refers to any infection with a fungus called Aspergillus.

What is going on in the body?

The Aspergillus fungus is everywhere in the environment. It does not usually cause disease in healthy persons. In some persons, Aspergillus infection causes an allergic response in the lungs, or occasionally, an inflammatory response elsewhere in the body.

Risks

What are the causes and risks of the infection?

Aspergillosis can occur in anyone, a person in one of three categories is most likely to become infected and have symptoms:
  • those with immune system problems, such as a person with AIDS or cancer
  • those with old lung damage, usually from a previous tuberculosis lung infection or a genetic disease called cystic fibrosis
  • those with long-standing asthma, who may be allergic to Aspergillus or have an asthma attack when exposed to Aspergillus
The most important risks of the disease are worsening lung damage and respiratory failure requiring the use of a ventilator. Some of the most severe cases are fatal.

Prevention

What can be done to prevent the infection?

Usually, nothing can be done to prevent the disease. Some persons who are severely immunosuppressed, such as following a bone marrow transplant or intensive chemotherapy for cancer, need to be kept in protective isolation in a special hospital room with controlled airflow. This is the only effective way to prevent aspergillosis and other "opportunistic" infections.

Diagnosed

How is the infection diagnosed?

It is often difficult to make the diagnosis. The history and physical exam may cause the healthcare professional to suspect aspergillosis. Certain specific abnormalities that suggest aspergillosis can sometimes be seen on chest X-ray. A blood test called aspergillosis precipitin, and an aspergillosis antigen skin test can confirm the diagnosis.
Often, a tissue sample from the lungs is needed. This is usually obtained with a procedure called bronchoscopy. In bronchoscopy, a thin tube with a camera on the end of it is placed through the mouth and down into the lungs. Samples can be taken through the tube and are then sent to the lab to see if they contain Aspergillus.

Long Term Effects

What are the long-term effects of the infection?

A person with asthma may develop chronic lung irritation due to Aspergillus. In others, aspergillosis may cause permanent damage to the lungs. It can also spread throughout the body and even result in death.

Other Risks

What are the risks to others?

Aspergillosis is not contagious from person to person. People get the infection from the environment. Most people are exposed to Aspergillus early in life and have no problems with it.

Treatments

What are the treatments for the infection?

Antifungal medications can be used to treat serious infections. A person with asthma often needs treatment to reduce inflammation and open up the airways. This treatment usually includes corticosteroids, such as oral prednisone, instead of antifungal medications.

Side Effects

What are the side effects of the treatments?

All medications have side effects. Common ones include allergic reactions and stomach upsets. The side effects depend on the medications used. Oral prednisone can cause stomach upset, water retention, weight gain, and high blood pressure. Long-term adverse effects include increased risk of bacterial infections, osteoporosis, and cataracts. The skin can become thinner and bruise more easily.

After Treatment

What happens after treatment for the infection?

A person who recovers is often free to return to regular activities. Many people who get aspergillosis are quite sick and have other significant medical problems.

Monitor

How is the infection monitored?

Symptoms can be followed during periodic clinic visits, and physical exams and chest x-rays can repeated as needed. Blood tests or repeated bronchoscopy may also be required.

Sources

Cecil Textbook of Medicine, 1996, Bennett et al.

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