Aspergillosis

Aspergillosis is a group of infections caused by a common mould called Aspergillus. Small amounts of the mould are in the air everywhere — most people breathe it in daily without any problem. Illness occurs in people with weakened immunity, chronic lung disease, or allergies to the fungus.

Main types

• Allergic bronchopulmonary aspergillosis (ABPA) — an allergic reaction in the lungs, mostly in people with asthma or cystic fibrosis. Symptoms: worsening asthma, coughing up brown mucus plugs, recurrent chest infections.
• Aspergilloma ("fungus ball") — ball of fungus grows in an existing lung cavity (often a cavity left by previous TB — very relevant in India). May cause coughing up blood (sometimes large amounts — a medical emergency).
• Chronic pulmonary aspergillosis — slow-progressing infection of the lungs in people with prior lung disease. Chronic cough, breathlessness, weight loss, fatigue.
• Invasive aspergillosis — a severe, rapidly-progressive infection in people with severely weakened immunity (bone-marrow or organ transplant, chemotherapy, steroids, HIV). Affects lungs and can spread throughout the body. Life-threatening.
• Cutaneous, sinus, or other localised forms — less common

Who is at risk?

• Asthma (ABPA)
• Prior tuberculosis — particularly for aspergilloma in old TB cavities (India context)
• COPD, bronchiectasis
• Weakened immune system — transplant, chemotherapy, long-term steroids, advanced HIV
• Cystic fibrosis
• Hospitalised patients, especially in intensive care

Symptoms

Vary by type:

• Cough, sometimes coughing up mucus plugs
• Coughing up blood (haemoptysis)
• Breathlessness
• Wheezing
• Chest pain
• Fever, weight loss, fatigue
• Invasive forms — high fever, severe breathlessness, rapid deterioration

Diagnosis

• Chest imaging (X-ray or CT) — often distinctive findings
• Blood tests — specific antibodies, fungal markers
• Sputum or bronchoscopy samples — to grow the fungus or detect its DNA
• Biopsy in some cases

Treatment

• Antifungal medicines — oral or IV, depending on severity
• Steroids — for ABPA
• Surgery — for aspergilloma causing severe bleeding, sometimes for localised disease
• Treat the underlying condition — manage asthma, reduce immunosuppression where possible
• Invasive aspergillosis is an emergency — urgent antifungal treatment, often in intensive care

People with prior TB who develop new haemoptysis (coughing up blood) or worsening lung symptoms should be evaluated promptly — aspergilloma is a recognised late complication.