Aspergillosis describes a mold infection caused by Aspergillus species. The infection often affects the sinuses and lungs. However, other organ systems such as the skin, gastrointestinal tract, or nervous system can also be affected.
What is aspergillosis?
In the infectious disease aspergillosis, the body is affected by the mold Aspergillus, which is one of the most widespread life forms in the world. It belongs to the genus of watering can and tube fungi. The name is derived from the fact that the reproductive structures of the fungus are characteristic elongated tubes and the overall shape of the cells is reminiscent of a watering can that just pours out the contents. Various clinical pictures can be caused by aspergillosis. This depends on which organ system is affected by the mold. There are several forms of aspergillosis that are known:
- Allergic bronchopulmonary aspergillosis (ABPA): this involves an allergic reaction of the immune system, which is triggered by the fungal spores in the respiratory tract.
- Mycotoxicosis: In this disease, there is poisoning by mycotoxins (mold toxins).
- Superficial Aspergillus infection: the infection can affect, for example, the sinuses, the skin of the external auditory canals and the bronchi and trachea.
- Invasive aspergillosis: In this case, the fungi penetrate deeper into the tissue, so that there is an infestation of one or more organs.
In some cases, aspergillosis is also associated with aspergilloma (fungal ball), a larger, spherical colony of the mold that develops within a body cavity such as the nasal sinus or lungs. A fungal plexus forms, which usually also contains mucus and dead cells.
Causes
Aspergillosis develops due to infection with molds of the genus Aspergillus, more than 90 percent of which are Aspergillus fumigatus. The molds thrive primarily on plant material, in potting soil, and on old fruits and vegetables. Infection occurs through inhalation of the mold spores. They settle in the respiratory tract, from where other organs can be infected. Transmission of aspergillosis from person to person is not possible. Aspergillus fungi are widespread, but not every contact leads to the disease. The main risk factors include diseases associated with a weakened immune system, such as HIV, AIDS, autoimmune diseases, and chronic lung disease. White blood cells play a very important role in fighting infections such as aspergillosis. A low number of the cells, for example due to chemotherapy, leukemia or organ transplantation, makes the body equally more susceptible to aspergillosis. Taking certain medications such as immunosuppressants and cytostatics, as well as prolonged administration of cortisone, can also increase the risk. Healthy people who have an intact immune system are extremely unlikely to develop aspergillosis.
Symptoms, complaints, and signs
Symptoms of aspergillosis vary depending on the type of disease. People with asthma and cystic fibrosis may have an allergic reaction to Aspergillus. Signs include fever, cough, sometimes with mucus and/or blood, and shortness of breath. However, worsening asthma, a fungal ball (aspergilloma) and fatigue may also occur. Invasive pulmonary aspergillosis, the most severe form, occurs when the infection spreads rapidly from the lungs to the brain, heart, kidneys or skin. This usually occurs in people with a weakened immune system, such as after chemotherapy. Symptoms include fever, chills, shortness of breath, coughing with expectoration of blood, and bleeding from the lungs. Nosebleeds, chest or joint pain, and unilateral swelling of the face and skin lesions are also part of the clinical picture. If aspergillosis occurs in the sinuses, it is noticeable by a stuffy nose, fever, inflammation, pain in the face, and headache.
Diagnosis and course
Diagnosis of aspergillosis can be difficult. Aspergillus is sometimes found in saliva and sputum. However, it is not as easy to distinguish Aspergillus from other forms under the microscope.In addition, the symptoms of the infection are similar to those of other diseases such as tuberculosis. The sputum (respiratory secretion) test is used to stain a sample of sputum with a dye to test for Aspergillus. An x-ray or computed tomography scan provides detailed images to detect a fungal mass (aspergilloma) and characteristic signs of aspergillosis. A skin test is also suitable for diagnosing aspergillosis. For this, a small amount of Aspergillus antigen is injected into the skin. If the blood has antibodies to the mold, a hard, red bump will develop at the injection site. The blood test will look for high levels of certain antibodies that are indicative of an allergic reaction. Biopsy involves taking a tissue sample from the sinuses or lungs and examining it under a microscope. How aspergillosis progresses depends primarily on the underlying disease and its severity. The immune system also plays an important role in how it is able to fight the pathogen. This can vary greatly from individual to individual. Since people with a weak immune system often contract aspergillosis, a severe course often occurs despite therapy, which can also be fatal.
When should you go to the doctor?
If aspergillosis is suspected, a doctor should be consulted. Typical warning signs include cough with sputum, fever and chills, shortness of breath, chest pain, and nosebleeds. Bleeding in the lungs, facial swelling on one side and facial sores also indicate a serious illness that needs to be treated. So, an immediate visit to the doctor is recommended in any case. During the examination, the doctor can determine whether it is aspergillosis and, if necessary, initiate treatment directly. In this way, further complications can almost always be avoided. Patients with asthma, cystic fibrosis, or respiratory disease should see a doctor if unusual symptoms occur or if the known symptoms increase in intensity. People with weakened immune systems should seek medical advice if they experience sudden attacks of fever, cough with sputum, or shortness of breath. Because a diagnosis of aspergillosis can lead to emergency room admission, people should always go to the doctor with an escort. In addition, necessary information about pre-existing conditions and medications taken should be taken to the doctor.
Complications
Aspergillosis can affect different parts of the body and consequently lead to various complications. The disease often occurs as a concomitant of severe underlying diseases. Because of this fact, many of them end fatally. If the lungs are affected by aspergillosis, special caution is required. A problem with lung involvement is the possible spread to other organs. Therefore, treatment should be given as early as possible. In the case of mold infestation of the lungs, the pathogens can spread to the brain, kidneys or blood vessels. Here there is a risk of thrombosis. Depending on which coronary vessel is affected, a stroke or heart attack can be further complications of aspergillosis. The mold spores can also infect the sinuses. In severe cases, the infection spreads to the bones in the face and destroys them to the point of severe deformities. Resulting psychological problems such as inferiority complexes and isolation cannot be ruled out. It is also possible for the infection to spread behind the facial bones. This can be fatal. If the body is affected by Aspergillos, this can lead to bleeding within the lung tissue. These can lead to further serious complications such as shortness of breath, inflammation of the lung tissue, destruction of lung tissue and, in the worst case, cessation of breathing.
Treatment and therapy
When the symptoms described are noticed, it is important to consult a doctor in order to quickly initiate therapy. This depends on the nature of the disease. In the case of invasive aspergillosis, immediate treatment is very crucial, so it is often started even before the infection has been diagnosed. The goal of treatment for allergic aspergillosis is to prevent existing conditions such as asthma or cystic fibrosis from worsening. In this case, cortisone can be administered in addition to antifungal drugs, which are the standard treatment for invasive aspergillosis.In other cases, however, aspergillosis does not require treatment. This is the case when no symptoms are present or they are mild. Instead, the patient is examined regularly to intervene in case of stagnation or worsening. In severe cases, surgery is necessary for aspergillosis, especially if there is bleeding in the lungs.
Outlook and prognosis
The course of aspergillosis depends on the severity of the disease. This is related to the time of diagnosis and the patient’s own health. The state of the patient’s immune system has a significant and decisive influence on the course of the disease. If the immune system is weakened, not enough defense forces can be mobilized to prevent the spread of the mold. There is an increase in fungal spores and consequent deterioration of health. A strong immune system can contain the spread, but still requires adequate medical support to minimize the existing symptoms. However, because aspergillosis often occurs only in people with a weakened immune system, the prospect of freedom from symptoms is likely to be minimal. In addition, any underlying disease must be taken into account. If the immune system is weakened because of an infection or inflammatory disease, the fungus has the opportunity to spread almost unhindered in a short time. This is also true if chronic diseases are present or the lungs are already damaged. In severe cases, aspergillosis can take a fatal course despite medical treatment. This happens when the fungal spores can spread faster than defenses are built up and irreparable damage to the lungs or respiratory tract is present.
Prevention
As a rule, healthy people with an intact immune system do not contract aspergillosis. Therefore, it is important to strengthen the immune system and stay away from possible sources of infection from the environment. This is equally true for people with chronic lung diseases. Contact with soil, compost and organic waste should be avoided.
Aftercare
The extent to which follow-up care is necessary after aspergillosis has been detected depends on the extent of the immune system. Individuals with intact immune systems usually manage to clear the disease without problems. However, no immunity develops afterwards. Affected persons can become infected again at any time. As part of the diagnosis, a detailed discussion of the symptoms takes place. This is followed by a physical examination. A blood sample and an X-ray usually follow. Complications regularly arise for people with weakened immune systems. The older generation is particularly affected. For them, long-term treatment and support in everyday life become necessary. The medical aftercare uses an antifungal agent. However, this does not always have the desired effect because the body has built up resistance. If the fungus spreads to the lungs or sinuses, surgery is usually necessary. Aftercare also includes avoiding sources of infection. Affected persons should avoid contact with potting soil. For this reason, it is generally forbidden to take potted plants into a hospital. If outpatient treatment is unsuccessful, inpatient treatment is usually indicated. In a severe form, aspergillosis leads to coughing and shortness of breath; death may even be the end result.
What you can do yourself
The symptoms of aspergillosis are very diverse and range from not noticeable to severe. This means that mildly symptomless aspergillosis – even if it has become chronic – often goes unnoticed, and there is no adjustment of behavior in everyday life. Likewise, self-help measures remain absent. If the aspergillosis develops into a so-called systemic mycosis affecting one or more internal organs, the most important self-help measure is to strengthen the immune system, provided there is no artificial immunosuppression, for example after an organ transplant. It goes without saying that in these cases environmental toxins such as tobacco smoke and alcohol or other drugs should be avoided as far as possible as a self-help measure. A balanced diet rich in vitamins and minerals and containing as many natural foods as possible is a great help to the immune system in overcoming the fungal infection.Psychological components in the form of permanent stress can also weaken the immune system to such an extent that the opportunistic fungus of the genus Aspergillus becomes pathogenic and appears as a trigger of aspergillosis. In most cases, several organs are then affected because the pathogen can spread through the bloodstream after overcoming the immune system. More severe aspergillosis that is not contained even by a reinvigorated immune system can be treated with a systemic antifungal agent under medical supervision.
