Aspergillosis: Symptoms, Types, Causes, Risk factors, Treatment and Prevention

A particular type of mold (fungus) can infect people and produce aspergillosis. Although the symptoms and severity of aspergillosis-related infections vary widely, they usually affect the respiratory system.

Aspergillus, the mold that causes the ailments, grows indoors and outdoors. Most of these mold strains are safe to breathe in, but a small number can pose a substantial risk to those with weakened immune systems, underlying lung conditions, or asthma.

The spores can cause an allergic reaction in certain individuals. Some people get lung infections, ranging from minor to major. When the infection spreads to blood vessels and beyond, it results in invasive aspergillosis, the most dangerous type of the disease.

What is Aspergillosis?

An infection brought on by various fungus). Aspergillus fungi is known as aspergillosis (plural of fungus).  Aspergillus is typically found in dead leaves, plants, compost, soil, and other outdoor materials. It can occasionally be seen indoors under damp conditions. The majority of people inhale Aspergillus spores daily without becoming unwell. However, Aspergillus can also result in allergic reactions, long-term lung diseases, and invasive diseases that affect the kidneys, brain, lungs, or other organs.

What types of infections are there with aspergillosis?

 Types of aspergillosis.

•  Allergic bronchopulmonary aspergillosis (APPA).
• Aspergilloma,  "fungus balls."
• Chronic pulmonary Aspergillosis.
• Invasive aspergillosis. One typical sign is fever.

Which symptoms of aspergillosis are present?

Aspergillosis symptoms differ based on the type and location of the infection in your body. The most typical signs and symptoms in the lungs are allergies or infections. Among them are:

• Coughing, occasionally spitting blood.
• Breathing difficulty (dyspnea).
• Breathing noisily (wheezing).
• Chest pain.
• Fever.
• Chronic pulmonary aspergillosis can cause fatigue and weight loss.

Causes:

Mold with Aspergillus is unavoidable. It can be found outside on plants, trees, grain crops, and decomposing leaves and compost.

For healthy individuals, daily exposure to Aspergillus rarely poses a concern. Inhaled mold spores are surrounded and destroyed by immune system cells. However, those on immunosuppressive medications or with compromised immune systems have fewer cells that fight infection. As a result, aspergillus can spread and infect the lungs and, in the worst situations, other body organs.

 Aspergillusis can't to spread from person to person.

How does one diagnose aspergillosis?

A provider's diagnosis of aspergillosis is based on your medical history and symptoms. The diagnosis of aspergillosis in its different manifestations is aided by imaging tests such as CT or X-ray scans, tissue or fluid tests, and allergy testing. Since many other illnesses seem similar to their symptoms, your physician might need to do further tests to rule out other conditions.

Which tests will be done for aspergillosis?

A physician may request the following tests to identify aspergillosis:

• Testing for allergies. For the diagnosis of allergic or chronic forms of aspergillosis, your physician may prescribe blood or skin testing.

• Biopsy. Your healthcare provider might collect tissue or fluid samples to look for indications of an Aspergillus infection.

• Blood tests. In patients with significantly weakened immune systems, invasive aspergillosis can be identified early with the use of a blood test.

• Culture. Your healthcare provider may attempt to cultivate Aspergillus from samples of your bodily fluids, including blood, mucus (sputum), or fluid from the area around your brain, spinal cord, or lungs.

• Imagining. To check for Aspergillus in the area of your body they believe may be sick, your provider may utilize CT or X-rays.

Also Read: Shigella Infection (shigellosis): Symptoms, Causes, Treatment & Prevention

 Risk factors:

The degree of mold exposure you've had and your general health will determine how likely you are to acquire aspergillosis. These elements generally increase your vulnerability to infection:

• Weakened immune system. The greatest risk of invasive aspergillosis is in patients receiving immune-suppressive medications following transplant surgery, particularly bone marrow or stem cell transplants, or in those with certain blood malignancies. Individuals with advanced stages of AIDS may also be more vulnerable.

• Low levels of white blood cells. Individuals with leukemia, organ transplants, or chemotherapy have reduced white cell counts, which increases their vulnerability to invasive aspergillosis. Chronic granulomatous disease, a genetic illness that impairs immune system cells also has this effect.

• Lung spaces. Aspergillomas are more common in people with air spaces (cavities) in their lungs.

• Both cystic fibrosis and asthma. Asthma and cystic fibrosis sufferers are more prone to react allergicly to aspergillus mold, particularly if their lung conditions are chronic or difficult to manage.

• Prolonged use of corticosteroids. The likelihood of opportunistic infections may rise with prolonged use of corticosteroids, contingent on the underlying ailment being managed and the medications being used.

Complications:

Aspergillosis can result in several serious complications, depending on the type of infection:

• Sickened. Severe, and occasionally fatal, bleeding in the lungs can be caused by both invasive aspergillosis and aspergillomas.

• Infection throughout the system. The most serious outcome of invasive aspergillosis is when the infection spreads to other body organs, including the kidneys, heart, and brain. Aspergillosis is invasive spreads quickly and can be deadly.

How does one treat aspergillosis?

The type of aspergillosis you have and any underlying illnesses you may have will determine how your physician treats it. The most popular forms of treatment are corticosteroids, antifungal drugs, and surgery.

Surgery for Aspergillosis

When a single fungus ball causes aspergillosis, surgery is frequently the solution. In select cases, providers also utilize it to treat allergic and invasive aspergillosis. Surgery is typically not advised by healthcare professionals to treat persistent pulmonary aspergillosis.

Treatments for aspergillosis with antifungals

Antifungal medications are used to treat various forms of aspergillosis. If one kind of antifungal isn't doing the trick, your doctor can recommend trying a new kind. Among the potential antifungal therapies are:

• Itraconazole, posaconazole, isavuconazole, and voriconazole.
• Amphotericin B liposomes.
• Micafungin or capsofungin.

 Oral corticostroids. 

The aim of treating allergic bronchopulmonary aspergillosis is to stop the progression of pre-existing cystic fibrosis or asthma. Using oral corticosteroids is the most effective approach to do this. For allergic bronchopulmonary aspergillosis, antifungal drugs by themselves are ineffective; however, when taken with corticosteroids, they can lower the dosage of steroids and improve lung function.

Prevention:

Avoiding Aspergillus molds is difficult. Consult your healthcare physician about the best ways to protect yourself if you have a high risk of infection. Your supplier may:

• To prevent infection, provide an antifungal medication.

• Check for infection symptoms so that you can receive treatment as soon as possible.

There are a few ways you could lessen your exposure to fungi:

• Avoid areas such as construction sites and compost piles where there is a lot of mold or dust.

• Avoiding activities like lawn care and gardening. Put on an N95 face mask if you could be exposed to mold or dust in the air.

References:

• Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis (https://pubmed.ncbi.nlm.nih.gov/25354514/). Thorax. 2015 Mar;70(3):270-7. Accessed 01/16/2023.

• Centers for Disease Control and Prevention. About Aspergillosis. (https://www.cdc.gov/fungal/diseases/aspergillosis/definition.html) Accessed 01/16/2023.

• American Academy of Allergy, Asthma & Immunology. Allergic Bronchopulmonary Aspergillosis (ABPA). (https://www.aaaai.org/conditions-treatments/related-conditions/allergic-bronchopulmonary-aspergillosis) Accessed 01/16/2023.

• Allergic bronchopulmonary aspergillosis (ABPA). American Academy of Allergy, Asthma & Immunology. https://www.aaaai.org/conditions-and-treatments/related-conditions/allergic-bronchopulmonary-aspergillosis. Accessed Jan. 8, 2020.

• Patterson TF, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Infectious Diseases. 2016; doi:10.1093/cid/ciw326.

• Denning DW. Aspergillosis. In: Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J. eds. Harrison’s Principles of Internal Medicine. 21st ed. McGraw Hill; 2022.

• Kauffman CA. Diagnosis of invasive aspergillosis. https://www.uptodate.com/contents/search. Accessed Jan. 8, 2020.

• Ziaee A, Zia M, Goli M. Identification of saprophytic and allergenic fungi in indoor and outdoor environments. (https://pubmed.ncbi.nlm.nih.gov/30191326/) Environ Monit Assess. 2018 Sep 6;190(10):574. Accessed 01/16/2023.