Aspergillosis Explained: Symptoms, Causes, Treatment Options - Dr Naveen A S

What is Aspergillosis?

Aspergillosis is a fungal infection caused by Aspergillus, a common mould found in soil, decaying vegetation, and indoor environments. While most people inhale Aspergillus spores without harm, individuals with weakened immune systems or lung conditions are at higher risk of developing serious infections.

Aspergillosis can manifest in different forms, ranging from mild allergic reactions to severe invasive infections that can be life-threatening. Understanding the symptoms, causes, and treatment options is crucial for early diagnosis and effective management.

Symptoms of Aspergillosis

The symptoms of aspergillosis vary depending on the type of infection:

• Allergic Bronchopulmonary Aspergillosis (ABPA): This condition primarily affects individuals with asthma or cystic fibrosis. It can cause wheezing, coughing, shortness of breath, and worsening asthma symptoms. If left untreated, ABPA can lead to lung damage over time.
• Aspergilloma (Fungal Ball): In some cases, Aspergillus can form a fungal ball inside lung cavities left by previous lung diseases such as tuberculosis or sarcoidosis. This can cause chronic coughing, sometimes with blood (hemoptysis), chest discomfort, and fatigue. In severe cases, aspergillomas may cause life-threatening bleeding.
• Invasive Aspergillosis: This is the most severe form and occurs when Aspergillus spreads from the lungs into other parts of the body, such as the brain, heart, or kidneys. It is particularly dangerous for immunocompromised individuals, such as cancer patients, organ transplant recipients, and those undergoing chemotherapy. Symptoms include fever, chest pain, breathlessness, coughing with blood, and in severe cases, organ failure.

Causes and Risk Factors of Aspergillosis

Aspergillosis is primarily caused by inhaling Aspergillus spores, which are present in the environment. However, not everyone exposed to these spores develops the infection. Certain risk factors increase susceptibility, including:

• Weakened Immune System: Individuals with weakened immune defences, such as those with HIV/AIDS, cancer, or undergoing immunosuppressive treatments (e.g., chemotherapy or organ transplants), are at higher risk.
• Lung Diseases: Pre-existing lung conditions such as asthma, cystic fibrosis, chronic obstructive pulmonary disease (COPD), and tuberculosis create an environment conducive to Aspergillus growth and infection.
• Exposure to Mold: High exposure to Aspergillus in damp or contaminated environments, such as hospitals, construction sites, and agricultural settings, can significantly increase infection risk.
• Use of Corticosteroids: Long-term use of corticosteroids can suppress immune responses, making individuals more susceptible to infections like aspergillosis.

Diagnosis of Aspergillosis

Diagnosing aspergillosis can be challenging because its symptoms often overlap with other respiratory diseases. Doctors use a combination of methods, including:

• Imaging Tests: CT scans and X-rays help detect lung abnormalities associated with aspergillosis, such as fungal balls or invasive infections.
• Blood Tests: Specific blood markers, such as Aspergillus antibodies and galactomannan antigen, can indicate an infection.
• Fungal Cultures and Biopsy: In some cases, doctors collect respiratory samples (sputum or bronchoalveolar lavage) or perform a tissue biopsy to confirm the presence of Aspergillus.

Treatment Options for Aspergillosis

The treatment of aspergillosis depends on the type and severity of the infection. Antifungal medications like voriconazole and amphotericin B are the primary treatment for invasive aspergillosis, helping to inhibit fungal growth and prevent its spread. Itraconazole, posaconazole, and isavuconazole are considered alternate treatment options.

Corticosteroids such as prednisone are prescribed for allergic bronchopulmonary aspergillosis (ABPA) to reduce lung inflammation and control symptoms. In cases where aspergilloma (fungal balls) causes significant bleeding or respiratory distress, surgical removal may be necessary.

Additionally, some patients may require adjunct therapies such as supplemental oxygen or physical therapy to improve lung function and overall recovery.

Prevention Tips

Although aspergillosis cannot always be prevented, certain precautions can lower the risk of infection:

• Avoid Exposure to Mould: Keeping indoor environments dry and well-ventilated can help reduce mould growth. Using air purifiers with HEPA filters can also minimize airborne spores.
• Use Protective Masks: People with weakened immune systems or chronic lung conditions should wear N95 masks when working in high-risk environments, such as construction sites or dusty areas.
• Maintain Good Hygiene: Washing hands regularly, avoiding damp or dusty environments, and properly storing food to prevent mould growth are essential preventive measures.
• Boost Immunity: A healthy lifestyle, including a balanced diet rich in vitamins and minerals, regular exercise, and proper rest, can help strengthen the immune system and reduce vulnerability to infections.
• Early Medical Consultation: Individuals experiencing persistent respiratory symptoms, such as chronic cough, wheezing, or unexplained fever, should seek medical attention promptly to rule out aspergillosis and other respiratory conditions.

Aspergillosis is a serious fungal infection affecting those with weakened immunity and lung diseases. Early detection and treatment are key to preventing complications. Preventive measures and timely medical care can reduce risks, while ongoing research enhances treatment outcomes.