Aspergillosis (Lungs)

Aspergillosis (Lungs)

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It is an infection caused by a type of fungus (aspergillus). The condition usually affects the respiratory system but as the disease progresses, it can spread to various parts of the body.

What is Aspergillosis?

Aspergillus is common both indoors and outdoors. Tiny bits of the fungus float in the air and we breath them without any harm because most of the strains are harmless. But if you are already sick, have certain respiratory disorders (such as asthma, COPD etc.) or have a weak/compromised immune system, you are more prone to get infected and develop aspergillosis.

The disease is not contagious so neither you can get it from someone nor you can pass it to somebody else.

What are the symptoms of Aspergillosis?

In some people, aspergillus may trigger an allergic reaction, while others may develop mild to serious lung infections. The most common symptoms include-

  • Cough
  • Coughing up blood or brownish mucus plugs
  • Chest pain
  • Wheezing (whistling sound while breathing)
  • Fever
  • General body weakness (malaise)
  • Weight loss

What are the types of Aspergillosis?

There are 3 main types of aspergillosis and the symptoms vary depending on each type.

  • Allergic bronchopulmonary aspergillosis (ABPA): individuals who are already suffering from asthma or cystic fibrosis, are more likely to develop this type of aspergillosis. The condition usually starts with an allergic reaction and shows common allergic symptoms. However, these symptoms do not respond to standard anti allergic or anti asthmatic medications. If not treated promptly the infection can spread to other parts of the body as well.
  • Chronic pulmonary aspergillosis: if the infection is not resolved even after 3 months it can be termed as chronic infection. Individuals with chronic lung conditions such as emphysema or tuberculosis (TB) are more likely to develop this condition. Fungus balls which are made up of fungus, mucus, white blood cells and blood clots grow slowly and occupy cavities in the lungs. The condition is also termed as aspergilloma and causes chronic cough, haemoptysis (cough with blood), severe fatigue and unintentional weight loss.
  • Invasive aspergillosis: it is the most severe form of aspergillosis and commonly affects individuals whose immune system is weak or compromised. This can occur in patients suffering from AIDS (HIV positive), cancer, blood cancer (leukaemia) or those who have undergone chemotherapy, organ or bone marrow transplant. The infection initially affects the lungs and may later spread through blood to other organs of the body such as heart, brain, kidneys, or skin. Symptoms vary depending on the organ affected, however in severe cases nosebleed, haemoptysis (cough with blood), headache, joint pain, vision problems and skin lesions may occur.

How is Aspergillosis diagnosed ?

You doctor may advise you to undergo any of the following diagnostic tests to determine the type of aspergillosis

  • Chest X ray: in this test small amounts of radiation are used to create an image of the airways and the lungs. A chest x-ray is helpful in identifying any structural abnormalities of the airways.
  • Chest CT scan: in this test series of x-rays are used to create a cross sectional detailed image of the lungs. CT scan is helpful in identifying any soft tissue abnormalities of the airways. It is very easy to diagnose chest infections on a CT scan especially lung cavities as in case of aspergilloma.
  • Sputum test: the sputum sample is tested for presence of aspergillus filaments.
  • Skin test: in this test a small amount of aspergillus antigen is injected into skin. If you are infected and your body is already carrying antibodies against the fungi, a hard red bump will be formed at the site of injection.
  • Biopsy: tissue sample is taken from lung or any other organ where there is suspicion of infection and studied under microscope to look for aspergillus. It is a confirmatory test for diagnosing invasive aspergillosis.

How is Aspergillosis treated?

There are various treatment options available to treat aspergillosis, however the choice depends on the type of infection and severity of symptoms. Possible options include-

  • Observation: simple aspergillosis is usually asymptomatic and often does not require any treatment. These can be simply observed on chest x rays and in case there is any disease progression, antifungal medicines can be prescribed.
  • Antifungal medicines: this is the standard and most effective treatment of invasive aspergillosis. However, these medicines have serious side effects and often interact with other medicines causing unpleasant side effects such as fever, chills, shortness of breath etc. It is therefore important to inform your doctor about all the medications that you are currently taking, e.g., herbal medicines, nutritional supplements, pain relieving medicines, over the counter (OTC) medicines and any medicines for systemic illness such as diabetes, thyroid, blood pressure etc.
  • Corticosteroids: oral corticosteroids are used in combination with anti-fungal medicines to treat allergic bronchopulmonary aspergillosis. Corticosteroids will prevent worsening of existing asthma or cystic fibrosis, while antifungal medicines will help in treating aspergillus infection.
  • Surgery: it is the treatment of choice to remove the fungal mass from the lungs, which is typically seen in chronic pulmonary aspergillosis. The mass may cause bleeding into the lungs which is a serious complication and requires immediate medical management.

What are complications of Aspergillosis?

  • Certain antifungal medicines may cause kidney or liver damage.
  • Permanent scarring and enlargement of the air sacs in the lungs (bronchiectasis)
  • Invasive aspergillosis may cause massive bleeding in the lung
  • Mucus plugs causing airway blockage
  • Permanent airway blockage
  • Respiratory failure

Tips for prevention

  • Long term use of medicines that suppress the immune system should be avoided.
  • Avoid going to construction sites or areas with a lot of dust.
  • Wear an N95 mask when outdoors
  • Wear hand gloves, shoes and long pants when doing gardening or any activity that involves soil or dust.
  • Clean the exposed skin thoroughly with soap and water
  • Frequent testing of high-risk individuals (patients who have undergone organ or stem cell transplant)

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