Aspergillosis

Description

Aspergillosis is an infection caused by a type of mold (fungus). The diseases caused by the infection aspergillosis usually affect the respiratory system, but their signs and severity vary greatly.

The mold that triggers the disease, aspergillus, is everywhere — indoors and outdoors. Most strains of this mold are harmless, but some can cause serious illnesses when people with weakened immune systems, underlying lung disease or asthma inhale their spores of fungi.

In some people, the spores trigger an allergic reaction. Other people develop mild to severe lung infections. The most severe form of invasive aspergillosis aspergillosis occurs when the infection spreads to the blood vessels and beyond.

Depending on the type of aspergillosis, treatment may include observation, antifungal medications, or, in rare cases, surgery.

Symptoms

The signs and symptoms of aspergillosis varies with the type of illness you have:

Allergic reaction

Some people with asthma, cystic fibrosis, or have an allergic reaction to mold aspergillus. The signs and symptoms of this condition, known as allergic bronchopulmonary aspergillosis, which include:

  • Fever
  • A cough that may bring up blood or mucus plugs
  • Worsening of asthma

Aspergilloma

Chronicle of the lungs (lung) conditions, such as emphysema, tuberculosis, or sarcoidosis advanced, it can cause air spaces (cavities) to form in the lungs. When people with lung cavities are also infected with aspergillus, fungal fibers may find its way into the cavities and growing in tangled masses (fungus ball), known as aspergillomas.

Aspergillomas may produce no symptoms, or only cause a mild cough at first. Over time and without treatment, however, aspergillomas may worsen the underlying chronic condition of the lungs and potentially cause:

  • A cough that often brings up blood (hemoptysis)
  • Wheezing
  • Shortness of breath
  • Unintentional weight loss
  • Fatigue

Invasive aspergillosis

This is the most severe form of aspergillosis. Occurs when the infection spreads rapidly from the lungs to the brain, heart, kidneys, or skin. Invasive aspergillosis occurs only in people whose immune system is weakened as a result of cancer chemotherapy, bone marrow transplant, or a disease of the immune system. This is not, this form of aspergillosis can be fatal.

The signs and symptoms depend on what organs are affected, but in general, invasive aspergillosis can cause:

  • Fever and chills
  • A cough that brings up blood (hemoptysis)
  • Shortness of breath
  • In the chest or pain in the joints
  • Headaches or eye symptoms
  • The skin lesions

Other types of aspergillosis

Aspergillus can invade areas of your body other than the lungs, such as the sinuses. In the sinus, the fungus can cause a congestion of the nose, sometimes accompanied by the drainage that may contain blood. Fever, facial pain and headache may also occur.

When to see a doctor

If you have asthma or cystic fibrosis, consult your doctor whenever you notice a change in your breathing. Although aspergillosis may not be the cause, it is important to have breathing problems evaluated.

If you have a weakened immune system and develop a fever, shortness of breath or a cough that brings up blood, seek medical attention immediately. In the case of invasive aspergillosis, early treatment is crucial. In some cases, treatment with antifungal medication starts as soon as aspergillosis is suspected, even before the tests have confirmed the diagnosis.

Causes

The mold Aspergillus is inevitable. Outdoor, is found on decaying leaves and compost and the plants, the trees and the crops of cereals.

Journal of exposure to aspergillus is rarely a problem for people with healthy immune systems. When the spores are inhaled, the cells of the immune system to encircle and destroy. But people who have a weakened immune system due to illness or immunosuppressive drugs have fewer infection-fighting cells. This allows the aspergillus taking possession, the invasion of the lungs and, in more severe cases, other parts of the body.

Aspergillosis is not contagious from person to person.

Risk factors

Your risk of developing aspergillosis depends on the general health and the extent of your exposure to mold. In general, these factors make them more vulnerable to the infection:

  • Weakened immune system. People who take immunosuppressive drugs after undergoing transplant surgery — particularly of the bone marrow or stem cell transplant, or people who have certain types of blood cancer are at increased risk for invasive aspergillosis. People in the later stages of AIDS may also be at greater risk.
  • Low white blood cell level. People who have had chemotherapy, organ transplantation or leukemia have lower white cell levels, making them more susceptible to invasive aspergillosis. To not have a chronic granulomatous disease — a hereditary disorder that affects the cells of the immune system.
  • Lung cavities. People who have air spaces (cavities) in your lungs are at greater risk of developing aspergillomas.
  • Asthma or cystic fibrosis. People with asthma and cystic fibrosis, especially those whose lung problems are long-standing or difficult to control, are more likely to have an allergic reaction to mold aspergillus.
  • Long-term therapy with corticosteroids. Prolonged use of corticosteroids may increase the risk of opportunistic infections, depending on the underlying disease that is being treated and what other drugs are being used.

Complications

Depending on the type of infection, aspergillosis can cause a variety of serious complications:

  • The bleeding. Both aspergillomas and invasive aspergillosis can cause serious and sometimes fatal, bleeding in the lungs.
  • The systemic infection. The most serious complication of invasive aspergillosis is the spread of the infection to other parts of your body, especially the brain, heart and kidneys. Invasive aspergillosis spreads rapidly and can be fatal.

Prevention

It is almost impossible to avoid exposure to aspergillus, but if you have had a transplant or undergoing chemotherapy, try to stay away from the places where you can find mold, such as construction sites, compost piles, and buildings store the grain. If you have a weakened immune system, your doctor may recommend that you wear a mask to prevent exposure to aspergillus and other airborne infectious agents.

Aspergillosis

Diagnosis

The diagnosis of aspergilloma or invasive aspergillosis may be difficult. Aspergillus is common in all environments, but are difficult to distinguish from other types of mold under the microscope. The symptoms of aspergillosis are also similar to those of other lung diseases, such as tuberculosis.

Your doctor is likely that the use of one or more of the following tests to identify the cause of your symptoms:

  • The test image. A chest x-ray or computerized tomography (CT) scan — a type of X-ray produced in more detail the X-ray images of conventional make — you can usually reveal a mass of fungi (aspergilloma), as well as the characteristic signs of invasive aspergillosis and allergic bronchopulmonary aspergillosis.
  • Respiratory secretion (sputum) of the test. In this test, a sample of sputum is stained with a dye and checks for the presence of aspergillus filaments. The sample is placed in a culture that fosters the appearance of mold to help confirm the diagnosis.
  • Tissue and blood tests. Skin testing, as well as sputum and blood tests, may be useful in the confirmation of allergic bronchopulmonary aspergillosis. For the skin test, a small amount of antigen of aspergillus is injected into the skin of his forearm. If your blood has antibodies against the mold, that will develop a hard, red bump at the site of the injection. Blood tests to look for high levels of certain antibodies, which indicates an allergic response.
  • The biopsy. In some cases, the examination of a sample of tissue from the lungs or sinuses under a microscope may be necessary to confirm a diagnosis of invasive aspergillosis.

Treatment

The aspergillosis treatment vary with the type of disease. Possible treatments include:

  • Of the observation. Simple, just aspergillomas usually do not need treatment, and the drugs are not effective in the treatment of these fungi in the masses. In its place, aspergillomas do not cause symptoms may simply be monitored closely by chest X-ray. If the disease progresses, then the antifungal medications may be recommended.
  • Oral corticosteroids. The goal in the treatment of allergic bronchopulmonary aspergillosis is to avoid existing asthma or cystic fibrosis worsening. The best way to do this is with oral corticosteroids. Antifungal medications by themselves are not useful for allergic bronchopulmonary aspergillosis, but these can be combined with corticosteroids to reduce the dose of steroid and improve lung function.
  • Antifungal medications.These drugs are the standard treatment for invasive pulmonary aspergillosis. The most effective treatment is a new antifungal drug, voriconazole (Vfend). Amphotericin B is another option. All the antifungal drugs can have serious side effects, including kidney and liver damage. The interactions between antifungal drugs and other medications are also common.
  • Surgery. Due to the antifungal drugs do not penetrate in a aspergilloma very well, the surgery to remove the mushrooms from the mass is the first choice of treatment when a aspergilloma causes of bleeding in the lungs.
  • The embolization. This procedure leaves of lung bleeding caused by an aspergilloma. A radiologist injects a material through a catheter that has been guided in an artery that feeds a lung cavity where an aspergilloma is causing the loss of blood. The injected material hardens, blocking the supply of blood to the area and stop the bleeding. This treatment works temporarily, but the bleeding is likely to start again.

Antifungal medications. These drugs are the standard treatment for invasive pulmonary aspergillosis. The most effective treatment is a new antifungal drug, voriconazole (Vfend). Amphotericin B is another option.

All the antifungal drugs can have serious side effects, including kidney and liver damage. The interactions between antifungal drugs and other medications are also common.

Preparing for your appointment

People who develop aspergillosis usually have an underlying condition, such as asthma or cystic fibrosis, or have a weakened immune system due to disease or to the immunosuppressive drugs. If you have symptoms of aspergillosis and are already receiving treatment for a medical condition, call the doctor who provides your care for this condition. In some cases, when you call to schedule an appointment, your doctor may recommend emergency medical care.

If you have a weakened immune system and develop a fever, shortness of breath or a cough that brings up blood, seek medical attention immediately.

If you have time to prepare before you see the doctor, here's some information to help you prepare for your appointment.

What you can do

  • Be aware of the pre - or post-appointment restrictions. When you call to make the appointment, ask if there is something that you need to do beforehand.
  • Write down your key medical information. If you are going to see a new doctor, bring a summary of the other conditions to which you are being treated, as well as recent medical appointments or hospitalizations.
  • Bring all your medications with you, preferably in their original packaging. If the doctor you are looking at does not have access to your medical records or previous imaging tests, such as X-rays or computed tomography (CT), try to get copies to take with you.
  • Take along a family member or friend. Aspergillosis can be a medical emergency. Take someone who can understand and remember all the information your doctor gives you, and that can stay with you if you need treatment immediately.
  • Write questions to ask their doctor.

Prepare a list of questions so that you can make the most of your time with your doctor. For aspergillosis, some basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • Other that the most likely cause, what are other possible causes of the symptoms?
  • What tests do I need?
  • Do I have to be hospitalized?
  • What treatment do you recommend it?
  • What are the possible side effects of the medications that you are recommending?
  • How will you control my response to treatment?
  • Am I at risk of long-term complications of this condition?
  • I have another health condition. How can I best manage these conditions?

Do not hesitate to ask other questions.

What to expect from your doctor

Your doctor may ask you some questions, including:

  • What are your symptoms?
  • Have you seen other doctors for this?
  • When did you begin experiencing symptoms?
  • How severe are the symptoms? That seems to be getting worse?
  • Have you had a fever?
  • Are you having difficulty breathing?
  • Are you coughing up blood?
  • What you worry about most?
Symptoms and treatment of Aspergillosis