Aspergillosis

Overview

Aspergillosis is a group of conditions caused by breathing in a common mould called Aspergillus. This mould is found almost everywhere — in soil, dust, compost, air and damp buildings. Most people breathe in its tiny spores every day without getting ill. But in some people, it can cause an allergic reaction or an infection, usually in the lungs.

Aspergillosis is uncommon. Many people have antibodies to Aspergillus mould, but only a small number develop an illness from it.

It mainly affects people with weakened immune systems, such as those who have had organ or stem cell transplants, or people with long-term lung conditions like asthma, cystic fibrosis, or COPD. It can also affect people taking medicines that suppress the immune system.

Symptoms

Common symptoms

• Coughing, sometimes with mucus
• Wheezing or shortness of breath
• Chest pain or discomfort
• Fever or night sweats
• Feeling very tired
• Coughing up blood

Symptoms in children

• Persistent cough or wheeze
• Difficulty breathing, especially at night or with activity
• Poor weight gain or slow growth
• Fever that does not go away
• Feeling unusually tired or irritable

Symptoms in older adults

• Breathlessness with everyday activities
• Worsening cough or chest congestion
• Confusion or drowsiness, especially if infection is severe
• Loss of appetite and unintentional weight loss
• Fever or chills

Causes

Main causes

• Breathing in Aspergillus mould spores from the air
• The immune system overreacting to the mould, causing allergy and inflammation
• The mould growing inside the lungs or sinuses, usually in people with damaged lungs or weak immune systems

Risk factors

• Long-term lung conditions such as asthma, cystic fibrosis, or COPD
• A weakened immune system due to cancer treatment, organ or stem cell transplant, or immune-suppressing medicines
• Low levels of white blood cells
• Conditions such as diabetes or severe liver or kidney disease
• Being around building sites, compost, or damp, mouldy buildings for long periods

When to see a doctor

See a doctor urgently if:

• You cough up blood, even a small amount
• Your breathing becomes much harder
• You have chest pain that comes and goes or gets worse
• You have a high fever that will not settle

Book a routine appointment if:

• You have a cough that lasts longer than three weeks
• You have had wheezing or breathlessness that is not getting better
• You keep getting chest infections
• You feel very tired or lose weight without meaning to

Diagnosis

A doctor will ask about your symptoms, medical history, and possible exposure to mould. They may listen to your chest and then arrange tests. If aspergillosis is suspected, you may be referred to a lung specialist.

Tests that may be done

• Chest X-ray or CT scan to look at your lungs
• Blood tests to check for antibodies or signs of infection
• A sputum sample, where you cough up mucus for testing
• Breathing tests to measure how well your lungs work
• A bronchoscopy, where a thin tube with a camera is passed into your airway, sometimes taking a small sample

What to expect at your appointment

Most tests are quick and painless. Blood tests and breathing tests are done in clinic. A CT scan takes only a few minutes. If you need a bronchoscopy, you will be given medicine to help you relax, and the doctor will pass a narrow tube through your mouth into your airways. Most people go home the same day.

Treatment

Treatment depends on the type of aspergillosis and how severe it is. Your healthcare team will explain your options and create a plan that fits your situation. Some people need no treatment and are monitored closely, while others may need medicines for a long time.

Self-care at home

• Take your medicines exactly as prescribed, and do not stop without speaking to your doctor
• Keep all follow-up appointments so your condition can be reviewed
• Avoid places with a lot of dust, mould, or soil disturbance
• Tell your doctor quickly if symptoms get worse or you have side effects from treatment

Medical treatments

For allergic forms of aspergillosis, treatment may include steroid medicines to reduce inflammation and antifungal medicines to lower the amount of fungus in the body. For chronic or invasive aspergillosis, the main treatment is a long course of antifungal medicine, usually taken by mouth, or through a drip in hospital for severe infection. Some people may also need treatments to control blood sugar or support their immune system.

When is surgery considered?

Surgery is sometimes used to remove a clump of fungus and scar tissue in the lung (called an aspergilloma) if it keeps causing bleeding or does not respond to medicine. It is not needed for everyone.

Living with this condition

Living with aspergillosis can mean managing a long-term lung condition. You may need regular check-ups, blood tests, and scans. Work with your healthcare team to recognise early warning signs of a flare-up, and make sure you know what to do if your symptoms change.

Lifestyle tips

• Avoid indoor damp and visible mould
• Wear a mask when doing dusty tasks like gardening, sweeping, or building work
• Stay away from compost heaps, hay, and stored grains if you are at high risk
• Keep your home well aired, but avoid humidifiers that might spread mould spores

Diet and exercise

There is no special diet to cure aspergillosis, but eating a balanced diet can help keep your body strong. If you have chronic lung disease, staying as active as you can is helpful. Your doctor or physiotherapist may suggest a pulmonary rehabilitation programme, which combines supervised exercise and education to make everyday activities easier.

Mental health and emotional wellbeing

Living with a long-term lung condition can be stressful. It is normal to feel anxious, frustrated, or low at times. Talk to your healthcare team about how you are feeling. They can offer support, and, if needed, refer you to a counsellor or psychologist. If you are having difficult thoughts, please reach out for help right away.

Prevention

You cannot completely prevent aspergillosis because the mould is common in the environment. But you can lower your risk by avoiding places with high mould exposure, especially if you have a weak immune system or a chronic lung condition.

Vaccines

There is currently no vaccine to prevent aspergillosis.

Screening programmes

There is no routine screening test for the general public. If you are at high risk, your specialist may monitor you with regular check-ups, blood tests, and scans to catch problems early.

Complications

If left untreated

• Allergic forms can lead to permanent damage of the airways, called bronchiectasis, causing long-term breathing problems
• Chronic aspergillosis can cause cavities to form in the lungs, which may bleed and lead to coughing up blood
• Invasive aspergillosis can spread from the lungs to other organs, such as the brain, kidneys, or heart, and become life-threatening

Long-term outlook

Most people with aspergillosis can be treated successfully. Allergic and chronic forms are often managed well over many years. Invasive aspergillosis is serious, but with early hospital treatment many people recover. Your own outlook depends on your overall health, the type of aspergillosis, and how quickly treatment starts. Even with a long-term condition, many people continue to live active and meaningful lives.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.