Aspergillosis

The infection occurs when the mould enters the lungs. Over time, aspergillosis can damage the lungs. This can cause breathlessness, coughing, and a decline in lung function. In more serious cases, it can cause infections or long-term lung damage. If untreated, it can become life-threatening.

How aspergillosis affects the lungs and progresses depends on the type of condition, the person’s immune system and any existing lung problems. While it mainly affects the lungs, in rare cases it can spread to other parts of the body. For people with conditions like asthma or tuberculosis, it can make symptoms worse or lead to more severe infections.

Early diagnosis and treatment are important to prevent serious complications.

The main types include allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA), invasive aspergillosis, and aspergilloma (a fungal ball in the lungs).

Symptoms vary depending on the type of aspergillosis but often include coughing, breathlessness, extreme tiredness and chest pain or discomfort. In more severe cases, complications such as coughing up blood can occur. Because these symptoms are common in other lung conditions, diagnosis can sometimes be delayed.

Coughing up mucus is typical and coughing up blood is a warning sign that needs medical attention.

Certain factors increase the risk of developing aspergillosis, particularly for people with weakened immune systems or existing lung conditions.

Who is most at risk?

• Weakened immune system: People undergoing chemotherapy, organ transplant recipients, those with HIV/AIDS, or those on long-term steroid treatments are at higher risk, especially for invasive aspergillosis.
• Long-term lung conditions: Conditions such as asthma, COPD, bronchiectasis, sarcoidosis and cystic fibrosis can make individuals more vulnerable, increasing the risk of ABPA and CPA.
• Previous lung infections: People with tuberculosis (TB) or lung cavities are at risk of aspergilloma and CPA.
• Hospitalised patients: Those on long-term antibiotics or steroids may have a higher risk of developing aspergillosis.
• Environmental exposure: Frequent exposure to mould, damp environments, or decaying plant material may increase the risk of infection in vulnerable individuals.
• Genetic factors: Conditions like cystic fibrosis may increase susceptibility.

Completely preventing aspergillosis may not always be possible, as Aspergillus mould is common in the environment. However, certain steps can help reduce the risk, particularly for those who are more vulnerable.

Reducing exposure to mould

• Improve indoor air quality by controlling humidity and preventing mould growth.
• Avoid damp, dusty or mouldy environments, especially if immunocompromised.
• Use air filters (like HEPA filters) to reduce airborne spores.
• Wear masks in high-risk areas like construction sites or composting areas.

Managing health and lifestyle

• Manage lung conditions like asthma or COPD.
• Avoid smoking and excessive alcohol use.
• Maintain a healthy weight and stay active.

Medical prevention for high-risk individuals

• Those undergoing chemotherapy or transplants may need antifungal medications during high-risk periods.
• Hospitals can reduce risk by using air filtration systems and giving antifungal medication to some vulnerable patients.
• Keeping immunosuppression levels as low as possible may reduce risk.

Aspergillosis can be difficult to diagnose because its symptoms are similar to other lung conditions. Doctors use a combination of medical history, scans and lab tests to confirm the condition.

• Medical history and symptoms: Doctors check for risk factors like asthma, previous lung infections or a weakened immune system.
• Scans: A chest X-ray or CT scan can show signs of infection, allergy or other lung damage.
• Blood tests: These look for signs of an over-reacting immune response/allergy or specific markers of fungal infection.
• Sputum or lung fluid tests: A sample of mucus, sputum or lung fluid may be tested for Aspergillus.
• Bronchoscopy or biopsy: If needed, doctors may pass a small camera into the lungs to collect fluid for more detailed testing.

Please note that the specific tests used will depend on the type of aspergillosis suspected. Not all of the tests mentioned will be relevant for every individual.

Challenges:

Aspergillosis can be difficult to diagnose for several reasons. Its symptoms are similar to those of other lung conditions, which can lead to delays in identifying it. Additionally, tests to check for the infection may not always be readily available outside of specialist centres, or the fungus can sometimes be present in the lungs without causing noticeable illness. This makes confirming an infection harder.

People with weaker immune systems may not show strong signs of infection, which can make blood tests less reliable.

Despite these difficulties, untreated aspergillosis can become serious making early diagnosis especially important for those at higher risk.

The treatment for aspergillosis depends on the type of aspergillosis and the person’s overall health. Most people will need antifungal medications, while others may also require steroids or surgery in severe cases. Managing underlying lung conditions like asthma or COPD is also an important part of treatment.

Medications

• Antifungal drugs are commonly used to fight the fungal infection. These may need to be taken for weeks or even months.
• Steroids are used to reduce inflammation in the lungs in some cases, such as those with allergic bronchopulmonary aspergillosis (ABPA)
• For severe cases, such as invasive aspergillosis, stronger antifungal medications may be given through a vein in the hospital known as Intravenous or IV treatment.

Surgery

A fungus ball (aspergilloma) may need to be surgically removed if it is causing serious symptoms like coughing up blood. However, surgery is usually only considered when medications alone are not enough and the patient is fit for surgery.

Lifestyle changes

• Avoiding mould exposure: Aspergillus is common in damp areas, so reducing exposure by keeping indoor spaces dry and well-ventilated can help. Using air purifiers and avoiding activities like gardening or construction work in dusty environments may also be beneficial.
• Quitting smoking: Smoking damages the lungs and makes it harder for the body to fight off infections like aspergillosis.
• Managing lung conditions: Keeping asthma or COPD under control with the right medications and lifestyle changes can help prevent complications.

New advances in treatment

Researchers are working on new ways to diagnose and treat aspergillosis. These include faster and more accurate diagnostic tools to detect the infection earlier, as well as improved antifungal medications that are being tested to be more effective and have fewer side effects. Studies are also exploring combination treatments, where multiple antifungal drugs are used together to improve outcomes.

There is ongoing research to tackle the issue of drug resistance, as some Aspergillus strains are becoming resistant to current medications.

The importance of early treatment

Since aspergillosis can be difficult to diagnose, it is important to seek medical help if symptoms persist, especially for those with weakened immune systems or existing lung conditions. With the right treatment and lifestyle adjustments, most people can manage the condition and improve their quality of life.

• www.aspergillus.org.uk Provides evidence-based information on Aspergillus infections and their management. A resource provided by the National Aspergillosis Centre in Manchester, offering detailed information and support to patients and carers, including weekly patient meetings and shared experiences. 

• Support groups and organisations: the Aspergillosis Trust and Fungal Infection Trust, along with online forums and patient education resources, are available. Specialist respiratory and infectious disease clinics provide long-term care.