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Aspergillosis

Aspergillus infection

Aspergillosis is an infection or allergic response due to the aspergillus fungus.

Causes

Aspergillosis is caused by a fungus called aspergillus. The fungus is often found growing on dead leaves, stored grain, compost piles, or in other decaying vegetation. It can also be found on marijuana leaves.

Although most people are often exposed to aspergillus, infections caused by the fungus rarely occur in people who have a healthy immune system.

There are several forms of aspergillosis:

  • Allergic bronchopulmonary aspergillosis is an allergic reaction to the fungus. This infection usually develops in people who already have lung problems such as asthma or cystic fibrosis.
  • Aspergilloma is a growth (fungus ball) that develops in an area of past lung disease or lung scarring such as tuberculosis or lung abscess.
  • Invasive pulmonary aspergillosis is a serious infection with pneumonia. It can spread to other parts of the body. This infection occurs most often in people with a weakened immune system. This can be from cancer, AIDS, leukemia, an organ transplant, chemotherapy, or other conditions or medicines that lower the number or function of white blood cells or weaken the immune system.

Symptoms

Symptoms depend on the type of infection.

Symptoms of allergic bronchopulmonary aspergillosis may include:

  • Cough
  • Coughing up blood or brownish mucus plugs
  • Fever
  • General ill feeling (malaise)
  • Wheezing
  • Weight loss

Other symptoms depend on the part of the body affected, and may include:

  • Bone pain
  • Chest pain
  • Chills
  • Decreased urine output
  • Headaches
  • Increased phlegm production, which may be bloody
  • Shortness of breath
  • Skin sores (lesions)
  • Vision problems

Exams and Tests

Your health care provider will perform a physical examination and ask about the symptoms.

Tests to diagnose aspergillus infection include:

Treatment

A fungus ball is usually not treated with antifungal medicines unless there is bleeding into the lung tissue. In such a case, surgery and medicines are needed.

Invasive aspergillosis is treated with several weeks of an antifungal medicine. It can be given by mouth or IV (into a vein). Endocarditis caused by aspergillus is treated by surgically replacing the infected heart valves. Long-term antifungal medicines are also needed.

Allergic bronchopulmonary aspergillosis is treated with medicines that suppress the immune system (immunosuppressive medicines), such as prednisone, typically in conjunction with antifungals.

Outlook (Prognosis)

With treatment, people with allergic bronchopulmonary aspergillosis usually get better over time. It is common for the disease to come back (relapse) and need repeat treatment.

If invasive aspergillosis does not get better with treatment using medicine, it eventually leads to death. The outlook for invasive aspergillosis also depends on the person's underlying disease and immune system health.

Possible Complications

Health problems from the disease or treatment include:

  • Amphotericin B can cause kidney damage and unpleasant side effects such as fever and chills
  • Bronchiectasis (permanent scarring and enlargement of the small sacs in the lungs)
  • Invasive lung disease can cause massive bleeding from the lung
  • Mucus plugs in the airways
  • Permanent airway blockage
  • Respiratory failure

When to Contact a Medical Professional

Contact your provider if you develop symptoms of aspergillosis or if you have a weakened immune system and develop a fever.

Prevention

Precautions should be taken when using medicines that suppress the immune system.

Open References

References

Thompson GR, Patterson TF. Aspergillus species. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 257.

Walsh TJ, Patterson TF. Aspergillosis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 311.

  • Aspergilloma

    Aspergilloma - illustration

    Aspergillosis is an acute pulmonary infection caused by the aspergillus fungus. Aspergillus can cause illness three ways an allergic reaction in asthmatics, a colonization in scarred lung tissue, and an invasive infection with pneumonia, which can affect the heart, lungs, brain and kidneys.

    Aspergilloma

    illustration

  • Pulmonary aspergillosis

    Pulmonary aspergillosis - illustration

    Aspergillosis is an acute pulmonary infection caused by the aspergillus fungus. Aspergillus can cause illness three ways an allergic reaction in asthmatics; a colonization in scarred lung tissue; and an invasive infection with pneumonia which can affect the heart, lungs, brain and kidneys.

    Pulmonary aspergillosis

    illustration

  • Aspergillosis - chest X-ray

    Aspergillosis - chest X-ray - illustration

    Aspergillosis is a fungal infection. The fungus invades and destroys tissue. This type of infection usually occurs in immunocompromised individuals. Here, a chest x-ray shows that the fungus has invaded the lung tissue. The lungs are usually seen as black areas on an x-ray. The cloudiness on the left side of this x-ray is caused by the fungus.

    Aspergillosis - chest X-ray

    illustration

  • Aspergillus antigen skin test

    Aspergillus antigen skin test - illustration

    The aspergillus antigen skin test determines whether or not a person has been exposed to the mold aspergillus. It is performed by injecting an aspergillus antigen under the skin with a needle. After 48 to 72 hours the site of injection is evaluated by a physician. If a positive reaction occurs (the test site is inflamed), the person has been exposed to the aspergillus mold and is at risk for developing aspergillosis.

    Aspergillus antigen skin test

    illustration

  • Aspergilloma

    Aspergilloma - illustration

    Aspergillosis is an acute pulmonary infection caused by the aspergillus fungus. Aspergillus can cause illness three ways an allergic reaction in asthmatics, a colonization in scarred lung tissue, and an invasive infection with pneumonia, which can affect the heart, lungs, brain and kidneys.

    Aspergilloma

    illustration

  • Pulmonary aspergillosis

    Pulmonary aspergillosis - illustration

    Aspergillosis is an acute pulmonary infection caused by the aspergillus fungus. Aspergillus can cause illness three ways an allergic reaction in asthmatics; a colonization in scarred lung tissue; and an invasive infection with pneumonia which can affect the heart, lungs, brain and kidneys.

    Pulmonary aspergillosis

    illustration

  • Aspergillosis - chest X-ray

    Aspergillosis - chest X-ray - illustration

    Aspergillosis is a fungal infection. The fungus invades and destroys tissue. This type of infection usually occurs in immunocompromised individuals. Here, a chest x-ray shows that the fungus has invaded the lung tissue. The lungs are usually seen as black areas on an x-ray. The cloudiness on the left side of this x-ray is caused by the fungus.

    Aspergillosis - chest X-ray

    illustration

  • Aspergillus antigen skin test

    Aspergillus antigen skin test - illustration

    The aspergillus antigen skin test determines whether or not a person has been exposed to the mold aspergillus. It is performed by injecting an aspergillus antigen under the skin with a needle. After 48 to 72 hours the site of injection is evaluated by a physician. If a positive reaction occurs (the test site is inflamed), the person has been exposed to the aspergillus mold and is at risk for developing aspergillosis.

    Aspergillus antigen skin test

    illustration

Tests for Aspergillosis

 
 

Review Date: 5/19/2023

Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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