What Is Aspergillosis?

Aspergillosis is a type of fungal infection caused by Aspergillus, a common mold that lives everywhere in nature.

Most of the time, Aspergillus is harmless. In fact, most people breathe in Aspergillus spores every day without getting sick. However, people with weakened immune systems may develop serious disease from Aspergillus infection.

This article discusses the symptoms, causes, types, diagnosis, and treatment for aspergillosis.

Symptoms

Symptoms of aspergillosis depend on the organ system that is affected. This includes:

• Invasive aspergillosis: This affects the lungs and can present as shortness of breath, fever, cough, chest pain, or coughing up blood.
• Allergic Aspergillus sinusitis: This can present as congestion, runny nose, headache, and a reduced ability to smell.
  

Aspergillus can disseminate to almost any organ in the body—including the kidneys and brain—but the lungs are the most commonly affected organ.

Aspergillus infection can cause problems acutely and chronically. For example:

• Allergic bronchopulmonary aspergillosis, an acute version of the infection, has symptoms similar to asthma, including coughing, wheezing, and shortness of breath.
• Chronic pulmonary aspergillosis usually takes a while to develop. When symptoms finally do emerge, they look similar to acute aspergillosis symptoms but may progress over time to include fatigue, weight loss, and coughing up blood (hemoptysis). These indicate that an aspergilloma or “fungus ball” has formed in the lung cavities.
  

Causes

Aspergillosis is only caused by the aspergillus fungus.

Aspergillus is found naturally in nature—growing on dead leaves, stored grain, compost piles, in other decaying vegetation, and even on marijuana leaves—so humans routinely come into contact with these molds.

Types

There are several forms of aspergillosis. The three most common types are:

• Allergic pulmonary aspergillosis: People with underlying lung problems like asthma and cystic fibrosis may be at high risk of developing an allergic reaction to the aspergillus fungus. Common symptoms include wheezing, shortness of breath, and malaise.
• Chronic pulmonary aspergillosis: In some cases, aspergillus infection lays dormant in the system and causes symptoms down the line. Chronic cases may be characterized by the development of an aspergilloma, an entanglement of mold fibers that consolidate into a fungus ball. This generally occurs in an area of past lung disease or lung scarrings, such as tuberculosis or lung abscess.
• Invasive pulmonary aspergillosis: This is the most serious type of aspergillosis and is often accompanied by pneumonia. This occurs when aspergillus spreads to other parts of the body in people with a weakened immune system.

Diagnosis

Aspergillosis mimics many other respiratory conditions like asthma, sinusitis, and seasonal allergies so healthcare providers need to be on the lookout for it, especially in older populations and those with weakened immune systems.

When diagnosing aspergillosis, your healthcare provider will want to consider your risk factors and medical history in conjunction with your symptoms and a physical exam.

An official diagnosis is usually made after ordering lab tests, including:

• Skin, blood, and sputum tests
• Imaging tests like a CT scan or chest X-ray

Sometimes a nodule or mass can be spotted on imaging, making the diagnosis much easier, other times a nondescript mass can be found in the lungs requiring biopsy and further testing.

Still, there are times when nothing appears on imaging, prompting your provider to be on the lookout for aspergillosis in other parts of the body especially if you are at high risk for infection.

Treatment

Antifungal drugs are the standard treatment for invasive pulmonary aspergillosis, the most common type of aspergillosis infection.

Vfend (voriconazole) is the treatment of choice but isavuconazole and posaconazole have similar efficacy with less toxicity. Amphotericin B is another option if antifungals are not effective.

Combination therapy is used with extensive infection and in severe immunosuppression. All antifungal drugs can have serious side effects, including kidney and liver damage. 

Of note, treating any underlying conditions, especially those that weaken the immune system, may increase the effectiveness of your antifungal treatment.

Prognosis

If you are infected with aspergillosis and are in generally good health, your outlook is pretty good.  

If your infection becomes invasive and disseminates throughout the body—a sign of severe infection—your prognosis is poor.

Summary 

Aspergillosis is a fungal infection that most commonly develops in the lungs of those with weakened immune systems. Aspergillus is a mold that is commonly found in the environment and rarely causes disease in those with healthy immune systems.

A Word From Verywell

Aspergillosis mimics many other respiratory conditions so prompt diagnosis remains a challenge. Identification of risk factors, infection prevention, early diagnosis, and treatment are key, especially in light of growing antifungal resistance.

Invasive aspergillosis is a major cause of morbidity and mortality in immunocompromised people, therefore if you are sick and have a fever you should contact your healthcare provider.