What is Aspergillosis?

- Fungal Infections & Symptoms

Human fungal diseases are rare and usually don't cause symptoms in healthy people. In this lesson, we'll discuss
Aspergillus, a disease-causing mold, and the di erent infections and symptoms it can cause in susceptible hosts.

Airborne Parasitic Fungus

With every breath you take, you are inhaling a potentially deadly pathogen. You can't see this
parasite oating into your nostrils and weaving its way down into your lungs. You probably breathe
many of them right back out again, but some stick with every breath. If you're a healthy non-
smoker, have no fear, your immune system has an excellent chance of destroying the invaders
before they can make you sick. If your lungs or immune system are compromised, you still have an
excellent chance of escaping these frequent attacks unscathed. But, for the unlucky few among us,
the fungal pathogen Aspergillus might just win. Let's take a closer look and see what we could be in
for.

Aspergillus
Aspergillus is a genus made up of several species of molds that have the potential to cause serious
fungal illnesses in humans and animals. This mold can literally be found everywhere, both inside
buildings and outside in nature. The organism prefers to grow in decaying plant material but can
also be found in high concentrations on stored grains, building materials, and common household
dust. Aspergillus releases reproductive spores, which become airborne.

The only way to contract Aspergillus is to inhale those oating spores. You cannot get sick from
person-to-person or person-to-animal contact, and you do inhale these spores every day of your
life. The overwhelming majority of inhaled spores get eliminated by your immune system without
issue. So, how does Aspergillus ever cause disease?

There are two major ways Aspergillus can shift from a common environmental contaminant to a
potentially deadly pathogen. The rst is if the spores are inhaled by a person that is susceptible to
infection. This includes anyone with a compromised immune system or a chronic lung disease.
People that have recently had an organ transplant, those on high doses of corticosteroids or cancer
patients undergoing chemotherapy are often unable to mount a strong enough defense and
Aspergillus can take hold. People with chronic lung disruptions like those with asthma, cystic brosis
or smokers, also have a higher chance of getting sick from Aspergillus due to the increased irritation
and in ammation present in the lung tissue.
The second way people can get Aspergillus is if they inhale a very large number of spores, too many
for the normal immune response to handle. This usually occurs in people that are disturbing
compost piles or cleaning up large areas of decaying plant matter, like what occurs after winter
snow melt reveals wet autumn leaves. Construction workers are also at risk because building and
renovations can stir up dust and high numbers of spores.

Aspergillosis
So, it's nally spring and you need to do your annual yard cleanup. Unfortunately, it was a great
winter for Aspergillus, and you breathed in a signi cant number of spores. What can you expect?

Aspergillosis is any disease caused by the fungus Aspergillus. This sounds like a pretty worthless
de nition, but as you will see, Aspergillus can cause a wide variety of illnesses depending on where
it ends up in the body. Most commonly, Aspergillus causes an allergic reaction, similar to the
seasonal allergies that make the spring and fall unpleasant for millions of people. The infected host
experiences wheezing and coughing, but the fungus does not actually do any damage to the lung
tissues. If the Aspergillus settles in the sinuses, it can cause fevers and headaches as well.

Aspergillus in the lungs can become more severe if the fungus is able to grow unchecked by the
immune system. Initially, the fungus can turn into a pulmonary aspergilloma, which is a round,
tumor-like ball of lamentous fungal growth in the lungs. This mass can lead to shortness of breath
and chest pains and always requires surgical removal. If Aspergillus is allowed to continue growing
in the lungs unchecked, it can become invasive aspergillosis.

This is the most deadly type of infection in which the fungus spreads throughout the body. The
parasite can invade other organs, interfering with normal function. Fungal masses can block blood
vessels, cause in ammation in the heart lining and change mental function if it invades the brain.
Symptoms can be variable depending on the organs invaded, but usually include bloody coughs,
chills, fever, chest pains, headaches and shortness of breath. When invasive aspergillosis develops,
treatment is required quickly, or it can be fatal.

There are a couple additional points of infection that don't involve the lungs, but they are more
rare. The fungus grows very well in earwax causing painful swelling, itchiness and discharge.
Broken skin is also a portal of entry. If Aspergillus invades the skin around burns, surgical openings
or broken skin, it can cause blisters, swelling, tenderness and fevers.

Diagnosis and Treatment

Aspergillosis can be diagnosed in several ways depending on where the fungus is growing. The rst
step is to question the patient and obtain an accurate history to determine a probable source of
the fungus. If the patient was working construction or disturbing decaying plants, that can be
enough evidence to begin treatment. Surfaces can be sampled and put on growth media in a lab to
look for fungal growth. Sometimes chest X-rays or CT scans are used to look for masses in the
lungs or on organs, which can later be biopsied to determine if Aspergillus is the cause.
Treatment involves the antifungal medication voriconazole, which has shown to be more e ective
at eliminating Aspergillus with fewer side e ects than other antifungals. Other common antifungals
can also be used in place of or in addition to voriconazole in the event of a resistant strain of the
disease.

Because of the potential for serious illness and death, people with compromised immune systems
should avoid damp areas, compost piles and construction dust. If simple avoidance is impossible,
prophylactic antifungal medication can be given to prevent the infection before it can establish.
Despite the widespread abundance of the airborne spores, actual cases of Aspergillosis are rare,
only impacting one or two in 100,000 people in the United States yearly.

Lesson Summary
Let's review. Aspergillus is a lamentous fungal pathogen that can cause disease in humans. The
parasite grows on decaying plant material and is commonly found in compost bins, grain,
construction materials and dust. The fungus releases spores, which, when breathed in can cause
respiratory disease in humans and animals. People inhale the spores every day, and the vast
majority never gets sick. People that inhale large numbers of spores or those with chronic lung
disease or compromised immune function are more likely to develop symptoms.

Aspergillosis is any illness caused by the fungus when it colonizes a host. The disease can be as
minor as the coughing and wheezing associated with seasonal allergies or as severe as a potentially
fatal full body infection. In the case of widespread infections, prompt diagnosis and treatment are
required. Diagnosis is usually made on the basis of case history and symptoms, but X-rays, fungal
growth and biopsies can be used to make a more accurate diagnosis. Treatment usually only
requires the antifungal medication voriconazole, but resistant strains can be eliminated by any
number of common antifungal medicines.

Learning Outcomes
Following this lesson, you'll be able to:

Identify Aspergillus and describe how it enters a body

Summarize why Aspergillus is usually harmless but other times causes infection

Explain the symptoms of aspergillosis

Describe how aspergillosis is diagnosed and treated