ConditionInfections
Aspergillosis
Aspergillosis is a group of conditions caused by Aspergillus, a mold found in soil, compost, dust and air everywhere. Most people breathe in its spores daily without harm. In people with asthma or cystic fibrosis it can cause an allergic lung reaction (ABPA). In damaged lungs it can form a fungal ball (aspergilloma) or slowly destroy lung tissue. In people with severely weakened immune systems it can cause invasive aspergillosis, a life-threatening infection treated urgently with antifungal medicine.
Also called: Aspergillus infection, ABPA, aspergilloma, invasive aspergillosis, chronic pulmonary aspergillosis
At a glance
- What causes it
- Inhaled spores of Aspergillus mold, most often A. fumigatus.
- Main types
- Allergic (ABPA, fungal sinusitis), aspergilloma, chronic pulmonary, and invasive aspergillosis.
- Who is at risk
- People with asthma, cystic fibrosis, lung cavities from TB or COPD, and those with weak immunity.
- Symptoms
- Wheeze and cough with brown plugs, coughing blood, weight loss, or fever not responding to antibiotics.
- Diagnosis
- CT scan, blood tests (IgE, Aspergillus antibodies, galactomannan), sputum and sometimes biopsy.
- Treatment
- Steroids for allergic forms. Antifungals such as voriconazole or itraconazole for infection.
When to get help
Call 911 or go to the ER
- Coughing up more than a few tablespoons of blood, or blood with breathlessness
- Fever, chest pain and breathlessness in someone having chemotherapy, a stem cell or organ transplant, or high-dose steroids
- Fever, facial swelling or blackened tissue in the nose with a weakened immune system (possible invasive fungal sinusitis)
See a doctor within a day or two
- Fever above 38 °C (100.4 °F) that persists despite antibiotics in someone with low white blood cells
- Coughing up streaks of blood
- Asthma that is suddenly much harder to control, with brown mucus plugs
Book a routine appointment
- Long-standing cough, tiredness and weight loss in someone with previous TB or COPD
- Asthma or cystic fibrosis that keeps flaring despite treatment
- Chronic blocked nose and thick mucus with nasal polyps
What Aspergillus is
Aspergillus species grow on decaying vegetation, compost, stored grain, damp buildings and in air conditioning systems. Their tiny spores are small enough to reach deep into the lungs. A healthy immune system clears them quickly. Disease depends on how the body reacts: an exaggerated allergic response, colonization of damaged lung, or invasion when immunity is weak.
Types of aspergillosis
| Type | Who gets it | What happens |
|---|---|---|
| Allergic bronchopulmonary aspergillosis (ABPA) | People with asthma or cystic fibrosis | Allergic reaction to mold in the airways causes wheeze, mucus plugs and airway damage |
| Allergic fungal sinusitis | People with nasal polyps or allergies | Thick fungal mucus blocks the sinuses |
| Aspergilloma (fungal ball) | People with old lung cavities from tuberculosis, sarcoidosis or emphysema | A ball of fungus grows inside a cavity, often causing coughing up blood |
| Chronic pulmonary aspergillosis | People with COPD, previous TB, or other lung damage | Slowly progressive lung destruction over months to years |
| Invasive aspergillosis | People with neutropenia, stem cell or organ transplants, high-dose steroids, or severe flu or COVID-19 in intensive care | Fungus invades lung tissue and blood vessels and can spread to the brain, skin and other organs |
Symptoms
ABPA
- Worsening asthma or cystic fibrosis that is hard to control
- Wheezing and cough
- Coughing up brown or black mucus plugs
- Occasional fever and feeling unwell
Aspergilloma
- Often no symptoms
- Coughing up blood (hemoptysis), which can rarely be severe
Chronic pulmonary aspergillosis
- Cough lasting months
- Weight loss and tiredness
- Breathlessness
- Coughing up blood
Invasive aspergillosis
- Fever that persists despite antibiotics
- Chest pain, cough and breathlessness
- Coughing up blood
- Headache, facial pain, nose bleeding or black crusts in the nose with sinus involvement
- Skin lesions, confusion or seizures if it spreads
Diagnosis
Tests depend on the suspected type:
- CT scan of the chest: shows mucus plugs and widened airways (ABPA), a fungal ball in a cavity, or nodules with a surrounding "halo" in invasive disease.
- Blood tests: total IgE and Aspergillus-specific IgE (very high in ABPA), Aspergillus IgG antibodies (chronic forms), eosinophil count.
- Galactomannan and beta-D-glucan: fungal markers in blood or lung fluid that help diagnose invasive aspergillosis.
- Sputum culture and PCR.
- Bronchoscopy with lavage, and sometimes a biopsy.
- Skin prick testing for Aspergillus allergy.
Treatment
Allergic forms
- Oral steroids to calm the allergic reaction in ABPA, tapered over months.
- Antifungal tablets (itraconazole) reduce the fungal load and steroid needs.
- Biologic asthma medicines (such as omalizumab) may help some people.
- Allergic fungal sinusitis is treated with sinus surgery and steroid nasal sprays or rinses.
Aspergilloma
No treatment may be needed if there are no symptoms. Repeated or heavy bleeding is treated with bronchial artery embolization or surgical removal.
Chronic pulmonary aspergillosis
Long-term oral antifungals, typically itraconazole or voriconazole, for at least 6 months and often longer. Surgery is occasionally used.
Invasive aspergillosis
This needs urgent hospital treatment:
- Voriconazole or isavuconazole are first-line antifungals.
- Liposomal amphotericin B or other agents are alternatives.
- Reducing immune suppression where possible.
- Surgery for some localized or sinus disease.
Antifungal medicines interact with many other drugs, so blood levels and liver tests are monitored.
Prevention
- People at high risk, such as stem cell transplant recipients and some leukemia patients, may be given preventive antifungal medicine.
- Avoid compost heaps, gardening with soil or mulch, construction sites and dusty environments if your immune system is weak.
- Hospitals use HEPA-filtered rooms for high-risk patients.
- Fix damp and mold at home, especially if you have asthma.
Outlook
ABPA can usually be controlled with treatment, though flares are common and long-term damage (bronchiectasis) can occur if it is not recognized. Aspergilloma is often stable for years. Chronic pulmonary aspergillosis needs long-term treatment. Invasive aspergillosis remains serious, with significant mortality, but early diagnosis and modern antifungals have improved survival.
Frequently asked questions
What is aspergillosis?
Aspergillosis is an illness caused by Aspergillus, a common mold. It ranges from allergic reactions in people with asthma or cystic fibrosis, to fungal balls in damaged lungs, to life-threatening invasive infection in people with weak immune systems.
Is aspergillosis contagious?
No. Aspergillosis does not spread from person to person or from animals to people. It is caught by breathing in mold spores from the environment.
What are the symptoms of aspergillosis?
Symptoms depend on the type. ABPA causes worsening asthma and brown mucus plugs. Aspergilloma may cause coughing up blood. Chronic forms cause long-lasting cough, weight loss and tiredness. Invasive disease causes fever, chest pain, cough and breathlessness in people with weak immunity.
How is aspergillosis treated?
Allergic forms are treated with steroids and sometimes antifungal tablets. Chronic lung infection needs months of antifungal tablets. Invasive aspergillosis needs urgent antifungal treatment such as voriconazole in hospital. Aspergillomas may be observed or removed if they bleed.
Who is most at risk of invasive aspergillosis?
People with very low white blood cell counts from chemotherapy, stem cell or organ transplant recipients, people on high-dose steroids or other strong immune-suppressing drugs, and critically ill patients with severe flu or COVID-19 are at highest risk.
Sources
This guide was written from current patient and clinical guidance, including:
- CDC: About Aspergillosis
- Infectious Diseases Society of America: Practice Guidelines for the Diagnosis and Management of Aspergillosis
- European Respiratory Society/ESCMID: Chronic pulmonary aspergillosis guidelines
- NHS: Aspergillosis
- MedlinePlus: Aspergillosis
- International Society for Human and Animal Mycology: ABPA working group criteria