Aspergillosis is a group of diseases affecting the lungs and sinuses. It is caused by Aspergillus, a common fungus that lives both indoors and outdoors. For most people, Aspergillus is harmless. However, if a person already has a weakened immune system, has had an organ transplant or has an exisiting lung condition (such as asthma, COPD, or cystic fibrosis) they have a greater risk of developing aspergillosis. It should be noted that aspergillosis is not contagious.
There are three main types of aspergillosis:
1. Allergic bronchopulmonary aspergillosis (ABPA)
Allergic forms of aspergillosis are the least dangerous type as they generally don’t result in infection. In ABPA, Aspergillus causes lung inflammation and allergy symptoms.
2. Chronic pulmonary aspergillosis (CPA)
This form occurs when Aspergillus destroys lung tissue and causes cavities to develop in the lungs, or where it infects cavities caused by other conditions.
3. Invasive pulmonary aspergillosis (IPA)
IPA is the most severe form of aspergillosis. It is most likely to affect immunocompromised patients or patients recovering from organ transplant. IPA mostly affects the lungs but can also spread to other parts of the body.
In both chronic and invasive pulmonary aspergillosis (CPA and IPA), aspergillosis can develop as a ball, called an aspergilloma. The aspergilloma can increase in size and destroy lung tissue. An aspergilloma can be seen by chest x-rays and can sometimes be removed via surgery.
In IPA, the aspergilloma spreads through the lungs to other areas of the body, including blood, heart, liver and kidneys.
The symptoms of aspergillosis vary depending on the type of infection:
ABPA symptoms are similar to asthma and include wheezing, coughing and shortness of breath.
CPA symptoms include coughing up blood, weight loss, fatigue and shortness of breath.
IPA commonly occurs with other respiratory conditions, so it is hard to determine which symptoms are IPA-driven. However, observed symptoms in IPA patients include: fever, chest pain, coughing up blood and shortness of breath.
Around 5-10% of people with IPA will develop lesions on the skin on their head and limbs as aspergillosis develops. The lesions may be red or violet hardened plaques and can be painful to touch. They may darken and become ulcers or scabs. A health practitioner can advise as to what medicine is appropriate if lesions form.
Aspergillus most commonly enters the body via inhalation. If someone is generally healthy, with no respiratory conditions, they are at a very low risk of aspergillosis. If they have a weakened immune system, an existing respiratory condition or have had an organ transplant, they are at a higher risk of becoming sick from Aspergillus infection. Risk of infection can be lowered by keeping homes warm, dry and mould free, wearing a mask in dusty places, and avoiding places where aspergillus mould is often found, such as compost heaps.
Aspergillosis is often undiagnosed, or diagnosed incorrectly as the symptoms of the condition are relatively broad and non-specific (coughing, wheezing, shortness of breath etc.).
Late diagnosis can result in further damage to your lungs, so it is especially important for people in the high-risk category to visit their healthcare practitioner routinely and inform them if they develop aspergillosis symptoms.
Diagnosis normally involves referral to a specialist who can perform chest x-rays to detect aspergillomas and blood tests to detect invasive aspergillosis. Treatment of aspergillosis can include antifungal medication and steroids.
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