Aspergillosis is an infection caused by a mold called aspergillus. Aspergillus mold is a type of fungus. The illnesses resulting from aspergillosis infection usually affect the respiratory system. However, the illnesses can have very different symptoms, and some are more serious than others.

Aspergillus can be found indoors and outdoors. Most strains of this mold are harmless. However, a few strains can cause serious illnesses when certain people inhale the fungal spores. These strains are most dangerous for people with weakened immune systems, underlying lung disease or asthma.

In some people, the spores trigger an allergic reaction. Other people develop mild to serious lung infections. The most serious form of aspergillosis is called invasive aspergillosis. This occurs when the infection spreads to blood vessels and beyond.

Depending on the type of aspergillosis, treatment may involve observation, antifungal medicines or, in rare cases, surgery.

The symptoms of aspergillosis depend on the type of illness you develop:

Allergic reaction

Some people with asthma or cystic fibrosis have an allergic reaction to aspergillus mold. This allergic reaction is called bronchopulmonary aspergillosis. Symptoms of this condition include:

• Fever.
• Wheezing.
• A cough that may bring up blood or mucus.
• Worsening asthma.

Aspergilloma

Certain ongoing lung conditions can cause air spaces to form in the lungs, called cavities. These conditions may include emphysema, tuberculosis or advanced sarcoidosis. When people with lung cavities also are infected with aspergillus, fungus fibers may find their way into the cavities. These fibers can grow into tangled masses known as fungus balls or aspergillomas.

Aspergillomas may produce no symptoms or cause only a mild cough at first. Over time and without treatment, however, aspergillomas can worsen the underlying lung condition and possibly cause:

• A cough that often brings up blood, called hemoptysis.
• Fatigue.
• Shortness of breath.
• Unintentional weight loss.
• Wheezing.

Invasive aspergillosis

Invasive aspergillosis is the most severe form of aspergillosis. It occurs when the infection spreads rapidly from the lungs to the brain, heart, kidneys or skin. Invasive aspergillosis occurs only in people whose immune systems are weakened. The immune system may be weakened because of cancer chemotherapy, bone marrow transplantation or a disease of the immune system. Untreated, this form of aspergillosis may be fatal.

Symptoms depend on which organs are affected. In general, invasive aspergillosis can cause:

• A cough that brings up blood, called hemoptysis.
• Chest or joint pain.
• Fever and chills.
• Headaches or eye symptoms.
• Shortness of breath.
• Skin lesions.

Other types of aspergillosis

Aspergillus can invade areas of your body other than your lungs, such as your sinuses. In your sinuses, the fungus can cause a stuffy nose and drainage that may contain blood. Fever, facial pain and headache also may occur.

If you have asthma or cystic fibrosis, see your healthcare professional whenever you notice a change in your breathing. Although aspergillosis may not be the cause, it's important to have breathing problems checked out.

Get immediate medical care if you have a weakened immune system and develop an unexplained fever, shortness of breath or a cough that brings up blood. In the case of invasive aspergillosis, it is important to get treated right away. In some cases, treatment with antifungal medicine begins as soon as aspergillosis is suspected, even before testing has confirmed the diagnosis.

Aspergillus mold is unavoidable. Outdoors, it's found in soil, decaying leaves and compost. It's also found on plants, trees and grain crops.

Everyday exposure to aspergillus is rarely a problem for people with healthy immune systems. When mold spores are inhaled, immune system cells surround and destroy them. But people who have a weakened immune system have fewer infection-fighting cells. This allows aspergillus to take hold, invading the lungs and, in the most serious cases, other parts of the body.

Aspergillosis is not contagious from person to person.

Your risk of developing aspergillosis depends on your overall health and the extent of your exposure to mold. In general, these factors make you more vulnerable to infection:

• Weakened immune system. People taking medicines that suppress the immune system after having a transplant surgery have the highest risk of invasive aspergillosis. The risk is highest after bone marrow or stem cell transplants. People who have certain cancers of the blood also are at highest risk of invasive aspergillosis. People in the later stages of AIDS may be at increased risk.
• Low white blood cell level. People who have had chemotherapy, an organ transplant or leukemia have lower white cell levels. This makes them more vulnerable to invasive aspergillosis. Having an inherited disorder that affects immune system cells, called chronic granulomatous disease, also increases the risk.
• Lung cavities. People who have air spaces, called cavities, in their lungs are at higher risk of developing aspergillomas.
• Asthma or cystic fibrosis. People with asthma and cystic fibrosis are more likely to have an allergic response to aspergillus mold. The risk is higher in those whose lung problems are long-standing or hard to control.
• Long-term corticosteroid therapy. Long-term use of corticosteroids may increase the risk of infections. The risk depends on the underlying disease being treated and what other medicines are being used.

Depending on the type of infection, aspergillosis can cause a variety of serious complications:

• Bleeding. Both aspergillomas and invasive aspergillosis can cause severe, and sometimes fatal, bleeding in your lungs.
• Systemic infection. The most serious complication of invasive aspergillosis is the spread of the infection to other parts of your body. It may spread to your brain, heart and kidneys. Invasive aspergillosis spreads quickly and may be fatal.

It's nearly impossible to avoid exposure to aspergillus. If you have had a transplant or are undergoing chemotherapy, try to stay away from places where you're likely to encounter mold. Places may include construction sites, compost piles and buildings that store grain. If you have a weakened immune system, your healthcare professional may advise you to wear a face mask to avoid being exposed to aspergillus and other airborne infectious agents.

Diagnosing an aspergilloma or invasive aspergillosis can be difficult. Aspergillus is common in all environments. However, it is difficult to tell it apart from certain other molds under the microscope. The symptoms of aspergillosis also are similar to those of other lung conditions such as tuberculosis.

Your healthcare professional is likely to use one or more of the following tests to pinpoint the cause of your symptoms:

• Imaging test. A chest X-ray or CT scan can usually reveal a fungal mass, called an aspergilloma. Imaging tests also may show signs of invasive aspergillosis and allergic bronchopulmonary aspergillosis.
• Respiratory secretion test. This test uses a sample of mucus that has been coughed up, also called sputum. The sputum is stained with a dye and checked for the presence of aspergillus fibers. The sample is then placed in a culture that encourages the mold to grow to help confirm the diagnosis.
• Tissue and blood tests. Skin testing, as well as sputum and blood tests, may be helpful in confirming allergic bronchopulmonary aspergillosis. For the skin test, a small amount of aspergillus antigen is injected into the skin of your forearm. If your blood has antibodies to the mold, you'll develop a hard, red bump at the injection site. Blood tests look for high levels of certain antibodies. High levels can indicate an allergic response.
• Biopsy. In some cases, examining a sample of tissue from your lungs or sinuses under a microscope may be necessary to confirm a diagnosis of invasive aspergillosis.

Aspergillosis treatments vary with the type of disease. Possible treatments include:

• Observation. Simple, single aspergillomas often don't need treatment. Medicines aren't usually effective in treating these fungal masses. Instead, aspergillomas that don't cause symptoms may simply be closely monitored by chest X-ray. If the condition progresses, then antifungal medicines may be recommended.
• Oral corticosteroids. The goal in treating allergic bronchopulmonary aspergillosis is to prevent existing asthma or cystic fibrosis from getting worse. The best way to do this is with medicines called oral corticosteroids. Antifungal medicines by themselves aren't helpful for allergic bronchopulmonary aspergillosis. However, they may be combined with corticosteroids to reduce the dose of steroids and improve lung function.
• Antifungal medicines. These medicines are the standard treatment for invasive pulmonary aspergillosis. The most effective treatment is a newer antifungal medicine, voriconazole (Vfend). Amphotericin B is another option.

  All antifungal medicines can have serious side effects. These may include kidney and liver damage. Interactions between antifungal medicines and other medicines also are common.

• Surgery. Because antifungal medicines don't treat an aspergilloma very well, surgery to remove the fungal mass is the first-choice treatment when an aspergilloma causes bleeding in the lungs.
• Embolization. This procedure stops lung bleeding caused by an aspergilloma. An injected material hardens, blocking the blood supply to the area and stopping the bleeding. This treatment works temporarily, but the bleeding is likely to start again.

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

People who develop aspergillosis usually have an underlying condition. Conditions may include asthma, cystic fibrosis, or a weakened immune system due to illness or to immune-suppressing medicines. If you have symptoms of aspergillosis and are already being treated for a medical condition, call the healthcare professional who provides your care for that condition. In some cases, when you call to set up an appointment, your health professional may recommend urgent medical care.

Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down symptoms you're experiencing, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down key personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements you're taking and the doses.
• Take a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

Your time with your healthcare team is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For aspergillosis, some basic questions to ask include:

• What is likely causing my symptoms?
• What are other possible causes for my symptoms?
• What tests do I need?
• Do I need to be hospitalized?
• What treatment do you recommend?
• What are the possible side effects from the medicines you're recommending?
• How will you monitor my response to treatment?
• Am I at risk of long-term complications from this condition?
• I have another health condition. How can I best manage these conditions together?

Don't hesitate to ask other questions.

What to expect from your doctor

Be prepared to answer questions, such as:

• When did you begin experiencing symptoms?
• How severe are your symptoms? Do they seem to be getting worse?
• Have you had a fever?
• Are you having difficulty breathing?
• Are you coughing up blood?
• What else concerns you?