Aspergillosis is the name of a range of infections caused by a fungal mould called aspergillus. It usually affects the lungs, but it can spread to almost anywhere in the body.
Aspergillosis can range from mild to life threatening.
Aspergillosis usually only affects people with existing health conditions. Most healthy people have natural immunity to the aspergillus mould. If someone with damaged lungs or a weakened immune system breathes in aspergillus spores, the infection is more likely to stay.
Symptoms of aspergillosis can range from mild wheezing to coughing up blood, depending on the type of aspergillosis and where in the body the infection is (see below).
If you are at risk of aspergillosis, you should avoid areas where the aspergillus mould is likely to be, such as marshlands, compost heaps and piles of dead leaves.
You may also be advised to take extra precautions, such as wearing a face mask and taking antifungal medicines, if you have a weakened immune system. This may be the case if you’re having chemotherapy, you’ve recently had an organ transplant or you’re taking high doses of corticosteroid medication.
Read more information about the causes of aspergillosis and preventing aspergillosis.
When should I contact my GP?
Contact your GP or transplant team immediately if you develop symptoms that suggest you may have an infection, such as a fever or persistent coughing, and:
- you’re taking medication to suppress your immune system (immunosuppressants) after an organ or bone marrow transplant
- you have a condition known to weaken the immune system, such as cancer
Types of aspergillosis
There are four main types of aspergillosis:
- allergic bronchopulmonary aspergillosis
- aspergilloma
- chronic necrotizing aspergillosis
- invasive pulmonary aspergillosis
These are briefly described below.
Allergic bronchopulmonary aspergillosis (ABPA)
Allergic bronchopulmonary aspergillosis (ABPA) is caused by an allergic reaction to spores of fungus mould. It is the mildest form of aspergillosis.
ABPA usually affects people with asthma or cystic fibrosis. It is estimated to affect 0.25–0.8% of people with mild to moderate asthma, and 7% of people with cystic fibrosis.
ABPA affects an estimated 7–10% of people with more severe asthma that can only be controlled with steroid medication.
Aspergilloma
Aspergilloma is common in people who have cystic fibrosis or cavities (spaces) in their lungs. Coughing up blood is one of the most common symptoms of aspergilloma.
Aspergillus fungi enter the lungs and group together to form a dense knot of fungi, called a fungal ball.
Aspergilloma usually only affects people who have an existing lung condition, such as tuberculosis (TB), which means that they have cavities or damage in their lungs.
Chronic necrotizing aspergillosis (CNA)
Chronic necrotizing aspergillosis (CNA) is a slow-spreading, long-lasting infection of the lungs caused by the aspergillus fungus.
CNA usually only affects people with an existing lung condition, or people who have a weakened immune system. A weakened immune system may be caused by conditions such as diabetes, liver disease or long-term alcohol abuse.
CNA is thought to be rare, but little information is available to estimate exactly how many people develop CNA. If the symptoms of CNA are mild, it can go undiagnosed.
Invasive pulmonary aspergillosis (IPA)
Invasive pulmonary aspergillosis (IPA) is a common infection in people with severely weakened immune systems caused by illness or taking immunosuppressants. IPA is the most serious form of aspergillosis.
IPA is a fungal infection in the lungs that spreads rapidly through the body. The infection can spread to the blood, brain, heart and kidneys.
IPA usually only affects people with a severely weakened immune system, such as:
- people with end-stage HIV
- people undergoing high-dose chemotherapy
- people taking immunosuppressants because they have had an organ or bone marrow transplant
IPA is a medical emergency that requires hospitalisation and prompt treatment with injections of antifungal medication.
IPA is estimated to occur in:
- 5–13% of people who have had a bone marrow transplant
- 5–25% of people who have had a heart or lung transplant
- 10–20% of people who have high-dose radiotherapy for leukaemia (cancer of the blood cells)
How is aspergillosis treated?
Allergic bronchopulmonary aspergillosis (ABPA) is usually treated with steroid medications to prevent an allergic response. However, if ABPA reoccurs, a long-term course of steroids may be required.
Both aspergilloma and chronic necrotizing aspergillosis (CAN) can be treated with antifungal medications. In some cases, surgery may be required to remove the infection from the lungs.
Invasive pulmonary aspergillosis (IPA) can be treated with antifungal medication, although it is difficult to treat. The infection can spread very quickly, and someone who develops IPA is usually already very ill. An estimated 50% of people do not respond to treatment and die from the condition.
Read more information about how aspergillosis is treated.