Aspergillosis: Causes, Symptoms, Diagnosis, and Treatment
Also known as: Aspergillus infection, Allergic bronchopulmonary aspergillosis (ABPA), Aspergilloma
What Is Aspergillosis?
Aspergillosis is an infection caused by Aspergillus, a common mold found throughout the environment in soil, air, and decaying vegetation such as dead leaves and compost. Most people breathe in its spores every day without any harm. The infection takes hold mainly in people whose immune defenses are weakened. It ranges from an allergic reaction in the airways to a chronic lung infection and, in its most serious form, invasive disease that spreads beyond the lungs. Invasive aspergillosis is a serious condition, with mortality that can exceed 50% in severe cases.
Causes and Risk Factors
Aspergillosis usually develops after inhaling fungal spores carried in the air. The main risk factors include:
- Severe immunosuppression: chemotherapy, bone marrow (stem cell) transplant, or organ transplant
- Prolonged neutropenia (a very low white blood cell count)
- Long-term, high-dose corticosteroid therapy
- Advanced HIV infection or AIDS
- Cystic fibrosis or chronic obstructive pulmonary disease (COPD)
- Occupational exposure to decaying organic matter, as in farming or gardening
Symptoms
The signs depend on the type of aspergillosis and the person’s immune status. Common ones include:
- Persistent cough, dry or productive, sometimes bringing up blood (hemoptysis)
- Fever that does not respond to standard antibiotics
- Shortness of breath and chest pain
- Wheezing and asthma-like flare-ups in the allergic form (ABPA, allergic bronchopulmonary aspergillosis)
- Sinus symptoms: nasal congestion, facial pain, and nosebleeds
- In invasive disease, spread to the brain, skin, or other organs
Diagnosis
The doctor reaches a diagnosis by combining the clinical picture with test results. These may include:
- Chest CT scan (a “halo sign” can point to invasive disease)
- Antigen testing in blood or lung fluid (galactomannan, beta-D-glucan)
- Fungal cultures of sputum or bronchial samples
- Lung biopsy when the diagnosis is unclear
- Blood work, including a complete blood count and total IgE levels for allergic forms
Treatment
Treatment depends on the form and severity of the infection:
- First-line antifungal therapy: voriconazole or isavuconazole, usually given intravenously and then by mouth
- Alternative: liposomal amphotericin B when azoles fail, are not tolerated, or the fungus is resistant
- Echinocandins (caspofungin, micafungin): used in combination rather than as a standalone treatment
- For ABPA: oral corticosteroids first, sometimes with an antifungal such as itraconazole
- Surgery: resection of an isolated, symptomatic aspergilloma (fungus ball) or a localized lesion
- Supportive care: pain relief, bronchodilators, and oxygen if needed
Treatment lasts from several weeks to several months depending on the form.
Prevention
Several measures lower the risk, especially for vulnerable patients:
- Antifungal prophylaxis (posaconazole as the first choice, or voriconazole) for severely immunosuppressed patients such as transplant recipients and people with leukemia
- Filtered air in hospital units that care for high-risk patients
- Avoiding gardening and contact with decaying vegetation while immunosuppressed
- Wearing a protective mask around dust or construction sites
- Regular monitoring of at-risk patients with fungal antigen testing
When Should You See a Doctor?
See a doctor promptly for a persistent fever that does not respond to antibiotics, coughing up blood, unusual shortness of breath, or chest pain, especially if you are immunocompromised, undergoing chemotherapy, or living with a chronic lung disease. These symptoms can signal invasive aspergillosis, which needs urgent care.
Key takeaway: Aspergillosis is a serious fungal infection that mainly affects people with weakened immune systems. Early diagnosis and appropriate antifungal treatment are essential to reduce the risk of death, especially in invasive forms.
Sources
- MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine information on aspergillosis causes, symptoms, tests, and treatment
- StatPearls, National Center for Biotechnology Information (NIH), clinical review of aspergillosis, including mortality, first-line antifungal therapy, management of allergic and invasive forms, and HEPA-filtered private rooms for hospitalized high-risk patients
- National Institutes of Health, National Library of Medicine (PMC), appraisal of guideline recommendations on drug therapy for invasive aspergillosis prevention and treatment