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Aspergillosis of Lung

Overview

Aspergillosis is a group of illnesses caused by a certain type of mold called aspergillus and usually affect the respiratory system. Aspergillus occurs inside and outside and most strains of this mold are harmless with a few exceptions that cause serious illnesses when their spores are inhaled by people who have a weak immune system, asthma or any underlying lung disease. These spores trigger an allergic reaction in some people while others develop mild to serious lung infections. The most serious form of aspergillosis is invasive aspergillosis which occurs when the infection spreads to the blood vessels. Based on the type of aspergillosis, treatment may involve observation, antifungal medications and in some rare cases, surgery.

Symptoms

The signs and symptoms of aspergillosis depend on the type of illness that is developed.

Allergic reaction : People with asthma or cystic fibrosis have an allergic reaction to aspergillus mold. This condition is known as allergic bronchopulmonary aspergillosis. The symptoms include:

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

Fungal mass : A growth of fungus ball may develop if there are cavities in the lungs. This kind of aspergillosis is referred to as aspergilloma. Aspergilloma is a benign condition that does not produce symptoms initially, but over time it can cause:

  • A cough that often brings up blood, sometimes large amounts
  • Wheezing and shortness of breath
  • Unintentional weight loss
  • Fatigue

Infection : The most severe form of aspergillosis is invasive pulmonary aspergillosis and occurs when the infection spreads rapidly from the lungs through the bloodstream to other parts of the body. This occurs only in people who have a weak immune system. Signs and symptoms depend on the organs that are affected. In general, invasive aspergillosis can cause:

  • Fever and chills
  • Cough that brings up blood-streaked sputum (hemoptysis)
  • Severe bleeding from your lungs
  • Shortness of breath
  • Chest or joint pain
  • Nosebleed
  • Facial swelling on one side
  • Skin lesions

Causes

Aspergillus mold is virtually unavoidable. It is found in decaying leaves, compost, on plants, trees and grain crops. Other places where this mold thrives are air conditioning and heating ducts, insulation, and some food and spices. Aspergillus is very common in old buildings and have caused small epidemics among people with weakened immune systems when nearby buildings have been torn down.

Daily exposure to aspergillus is hardly a problem for people with healthy immune systems. When mold spores are inhaled, immune system cells destroy them. In the case of people with weakened immune system from illness or immunosuppressant medications, the aspergillus to take hold, invading the lungs and other parts of the body. Aspergillosis is noncontagious.

Risk factors

The risk of developing aspergillosis depends on an individual's overall health and the extent mold exposure. In general, the factors that make an individual more vulnerable to infection are:

  • Weakened immune system : A weak immune system is the greatest risk factor for invasive aspergillosis. Patients taking immune-suppressing drugs or patients having certain cancers of the blood are the most severely affected. Patients with an advanced stage of AIDS are also at increased risk.
  • Low white blood cell level : White blood cells known as neutrophils play an important role in fighting fungal infections. Patients having a very low level of these cells (neutropenia) due to chemotherapy, leukemia, or an organ transplant are much more susceptible to invasive aspergillosis.
  • Lung cavities : Aspergilloma can develop when mold spores germinate in a healed cavity in the lungs.
  • Asthma or cystic fibrosis : Patients with asthma and cystic fibrosis are more prone to allergic response to aspergillus mold.
  • Ankylosing spondylitis : This is a very rare rheumatologic lung disease that affects primarily the spine. People with this disorder who are male smokers are more likely to develop aspergillomas.
  • A hospital stay : Aspergillus mold is found in many hospitals on bedrails, plants, surgical instruments, air conditioning ducts and insulation. Healthy people are unlikely to be affected, but people with a weakened immune system or serious illness are highly susceptible to infection.
  • Genetic makeup : Genetic constitution makes certain people more prone to infection.

Complications

Aspergillosis can cause a spectrum of serious complications based on the type of infection:

Bone destruction and spread of infection: An aspergillus infection in the sinuses can destroy the facial bones. It can spread beyond the sinuses and become life-threatening if the patient has a weakened immune system.

  • Bleeding : Severe and sometimes fatal bleeding in the lungs can be caused by both aspergillomas and invasive aspergillosis.
  • Systemic infection : The most severe complication of invasive aspergillosis is the spread of the infection to the brain, heart and kidneys. Invasive aspergillosis spreads rapidly and is fatal irrespective of early treatment.