Aspergillosis

Overview

Aspergillosis is a term for a fungal infection caused by the Aspergillus fungus. This infection primarily affects individuals with compromised immune systems or underlying lung conditions such as asthma. Many individuals inhale Aspergillus spores without experiencing any symptoms. However, it poses a serious health risk for those who are susceptible. So, it becomes imperative to approach health care immediately once you start noticing the symptoms.

What is Aspergillosis?

Aspergillosis is an infection caused by different types of Aspergillus fungi found in dead plants, leaves, compost, or moist environments indoors. It affects the respiratory system, causing allergic reactions and chronic lung diseases that are widespread to your kidneys, brain, and other organs.

Most people inhale Aspergillus spores every day without being affected. However, it affects individuals with underlying asthma, lung diseases, or weak immune systems. The mould also causes invasive aspergillosis, where the infection spreads beyond blood vessels. Treatment may involve monitoring and observation, antifungal medicines, or surgery in severe cases.

Different Types of Aspergillosis

Aspergillosis is an infection caused by inhaling the spores of Aspergillus, a group of conidial fungi. The following are its different types:

Allergic Bronchopulmonary Aspergillosis (ABPA)

Individuals with cystic fibrosis or asthma have a severe allergic reaction to Aspergillus fungi. On exposure to the fungi spores, the immune system overreacts and causes airway obstruction, inflammation, and mucus production. This worsens asthma by causing difficulty breathing or lung damage.

Chronic Pulmonary Aspergillosis (CPA)

An infection in the lungs caused by Aspergillus affects people with lung conditions such as cystic fibrosis or COPD. The fungi attack the damaged tissue in the long, causing scarring, chronic inflammation, and abnormal lung function. Common symptoms include coughing up blood, chest pain, persistent cough, and shortness of breath.

Invasive Aspergillosis

A life-threatening severe fungal infection that rapidly spreads throughout the body and commonly affects individuals who have undergone organ transplants, chemotherapy, or living with HIV or AIDS. It spreads to the brain, heart, and lungs and can cause severe symptoms such as chest pain, fever, cough, difficulty breathing, and sometimes organ failure.

Aspergilloma

A ball of Aspergillus fungi formed in a pre-existing lung cavity, caused by conditions like lung cancer or tuberculosis. It is often asymptomatic but can show symptoms such as discomfort in breathing, chest pain, or coughing up blood.

Cutaneous (Skin) Aspergillosis

The Aspergillus fungi cause a rare skin infection in individuals with skin injuries or weak immune systems. It results in redness, itching, scarring, and skin lesions.

Allergic Aspergillus Sinusitis

The fungi cause allergic reactions in the sinuses, causing runny nose, facial pain, congestion, and headache. It is commonly characterised by bone loss of one's facial bones.

Who is Affected by Aspergillosis?

Individuals with weak immune systems of underlying lung diseases are primarily affected by aspergillosis. These are the people who are at risk:

Lung Diseases: Cystic fibrosis, asthma, tuberculosis, or chronic obstructive pulmonary disease (COPD) patients are susceptible to aspergillosis fungal infections

Prolonged Corticosteroid: Individuals who use corticosteroids regularly that suppress their immune system

Immunodeficiency: Individuals with autoimmune diseases, cancer, HIV/AIDS, or organ transplants

What are the Causes and Risk Factors of Aspergillosis?

This fungal infection is caused by a group of mould that is unavoidable and commonly found in the air. Individuals with a healthy immune system, when inhaling Aspergillus spores, do not develop an infection.

However, when individuals with weak immune systems inhale a large number of Aspergillus spores, they are at high risk. This mold is found in various environments including indoor air, decaying plants and soil.

The following are the risk factors for this infection:

Weak Immune Systems: People in the later stages of HIV or aids are at increased risk. Additionally, people who are at certain cancer stages or taking immune-suppressing drugs after an organ transplant or surgery are at risk of developing invasive aspergillosis.

Prolonged Corticosteroid Usage: Persistent use of corticosteroids suppresses the immune system, escalating the risk of being affected by the infection.

Neutropenic: Individuals with lower blood cells due to conditions like leukaemia or chemotherapy are more susceptible to invasive aspergillosis.

Lung Diseases: People diagnosed with lung conditions such as cystic fibrosis, asthma, COPD, or tuberculosis are at increased risk of developing aspergillosis due to damaged lung tissue.

What are the Symptoms of Aspergillosis?

Symptoms of aspergillosis vary depending on the severity of the case and the infection type. Following are some common symptoms associated with different types of aspergillosis:

Allergic Bronchopulmonary Aspergillosis (ABPA):

• Weight loss
• Wheezing
• Fatigue
• Coughing
• Shortness of breath

Chronic Pulmonary Aspergillosis:

• Chest pain
• Sudden weight loss
• Difficulty in breathing
• Coughing
• Fatigue

Aspergilloma:

• Coughing up blood
• Shortness of breath
• Chest pain

Invasive Aspergillosis:

• Fever
• Chest pain
• Coughing up blood
• Symptoms related to heart, brain and lungs
• Breathing difficulty

Cutaneous (Skin) Aspergillosis:

• Lesions
• Red, hardened patches on the skin
• Ulcers that turn black

Allergic Aspergillus Sinusitis:

• Headache
• Facial pain
• Congestion
• Runny nose
• Facial bone loss
• Limited sense of smell

Diagnosis for Aspergillosis

Diagnosing the infection can be challenging in the early stages as most aspergillosis types are asymptomatic. However, the doctor may conduct the following tests to diagnose the disease:

Chest X-ray: Shows abnormalities in the lung, or areas that may be infected such as lung cavities

CT Scan: Produces detailed pictures of your lungs, identifying the areas of infection

Blood Test: Help detect signs of invasive aspergillosis

Sputum Culture: A sample of mucus or fluid from the spinal cord, brain or lungs helps to identify signs of the infection

Biopsy: Samples of fluid or tissue examined under a microscope help understand the signs of the immune system being attacked by Aspergillus

Allergy Tests: Blood or skin tests help diagnose cutaneous or allergic aspergillus sinusitis

Bronchoscopy: A thin tube with a camera is placed through the mouth or nose into the lungs to get tissue samples for testing

Treatment for Aspergillosis

Aspergillosis treatment options often include the following:

Oral Corticosteroids: Oral corticosteroids sweets allergic bronchopulmonary aspergillosis by preventing existing cystic fibrosis or asthma from worsening. Combined with antifungal medicines, corticosteroids improve lung function and reduce the steroid dose.

Embolisation: A material is injected through a catheter guided into an artery feeding a lung cavity, to prevent lung bleeding caused by aspergilloma. It blocks the blood supply to the lungs and hence stops the blood loss.

Antifungal Medicines: Antifungal Durga, such as voriconazole (Vfend) or amphotericin B, are standard drug treatments for invasive pulmonary aspergillosis.

Aspergillosis Complications

The following are some of the serious complications that can be caused by the different types of aspergillosis if left untreated:

Systemic Infection: Invasive aspergillosis spreads the infection to other parts of your body, including the kidneys, brain, and heart, causing fatal health repercussions.

Bleeding: Invasive aspergillosis and aspergilloma cause fatal and severe bleeding in your lungs.

Preventive Measures for Aspergillosis

The following preventive measures can reduce the risk of developing aspergillosis:

• Avoid areas with high mold growth such as construction sites, damp basements or compost piles
• Use high-efficiency particulate air (HEPA) filters in the workplace or home to absorb mould spores from the air
• Wash hands frequently and avoid touching your face with dirty hands
• Avoid smoking to prevent lung damage
• Exercise regularly while consuming a balanced diet and getting adequate sleep
• Adhere to doctor's recommendations for managing and maintaining underlying health conditions and immune system

Myths and Facts Related to Aspergillosis

Some of the myths and facts associated with aspergillosis include:

Myth 1: Aspergillosis is contagious
Fact: It cannot spread from one person to another, it can only affect individuals with weakened immune systems.

Myth 2: Aspergillosis is a rare condition
Fact: It is a common fungal infection, especially in areas with high levels of mould spores.

Myth 3: Aspergillosis is a new disease
Fact: This disease was first described in 1729, affecting humans for centuries.