Aspergillosis

Other Names:Brooder Pneumonia; Mycotic Pneumonia: Pneumomycosis

Definition:Aspergillosis is the name given to a wide variety of diseases caused by fungi of the genus Aspergillus. The most common forms are allergic bronchopulmonary aspergillosis, pulmonary aspergilloma and invasive aspergillosis. Most humans inhale Aspergillus spores every day; aspergillosis develops mainly in immunocompromised individuals. The most common cause is Aspergillus fumigatus.
The aspergillus species includes more than 150 types of mold that occur widely in the indoor and outdoor environment. Although most of the molds are harmless, a few can cause serious illnesses in people with a weakened immune system, underlying lung disease or asthma. These illnesses, collectively called aspergillosis, range from allergic responses to severe and sometimes fatal infections.

Aspergillosis begins when susceptible people inhale mold spores into their lungs. In some people, the spores trigger an allergic reaction. Other people develop mild to serious lung infections. The most deadly form of aspergillosis — invasive aspergillosis — occurs when the infection spreads beyond the lungs to other organs. Even when discovered and treated early, invasive aspergillosis is often fatal.

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Aspergillosis infections are treated with antifungal agents, though not always successfully and often with serious side effects. In 2005, British researchers cracked the genetic code of aspergillus molds. The hope is that this knowledge will lead to better ways of diagnosing and treating aspergillosis.

Symptoms:A fungus ball in the lungs may cause no symptoms and may be discovered only with a chest x-ray. Or it may cause repeated coughing up of blood and occasionally severe, even fatal, bleeding. A rapidly invasive Aspergillus infection in the lungs often causes cough, fever, chest pain, and difficulty breathing.
The signs and symptoms of aspergillosis vary with the type of infection.

Allergic bronchopulmonary aspergillosis
Some people with asthma or cystic fibrosis have an allergic reaction to aspergillus mold. Signs and symptoms of this condition, known as allergic bronchopulmonary aspergillosis, include:

*Fever
*A general feeling of being unwell (malaise)
*A cough that may bring up blood or plugs of mucus
*Wheezing
*Worsening asthma

Aspergilloma
People whose lungs have been damaged by emphysema, tuberculosis or other diseases that leave air spaces (cavities) in the lungs may develop a pulmonary aspergilloma — a tangled ball of fungus fibers that forms in these spaces. Initially, an aspergilloma may not produce symptoms, but over time, it can cause:

*A cough that often brings up blood
*Chest pain
*Wheezing
*Shortness of breath
*Unintentional weight loss

Invasive pulmonary aspergillosis
The most severe form of aspergillosis, invasive pulmonary aspergillosis, occurs when the infection spreads rapidly through your bloodstream to your brain, heart, kidneys or skin. Signs and symptoms depend on which organs are affected, but in general, invasive aspergillosis can cause:

*Fever and chills
*Headaches
*Bloody cough
*Shortness of breath
*Chest or joint pain
*Massive bleeding from your lungs

Other aspergillus infections
Aspergillus can invade your sinuses and ear canals as well as your lungs. In your sinuses, it can cause a stuffy nose, drainage, inflammation, fever, facial pain and headache. Ear canal infections can cause itching, drainage and pain.

Causes:-
Aspergillus plays an indispensable role in the ecosystem by breaking down organic matter. It’s also virtually unavoidable. Outdoors, it’s found in decaying leaves and compost and on plants, trees and grain crops. Inside, the spores — the reproductive parts of mold — thrive in air conditioning and heating ducts, insulation, carpeting, ornamental plants, tap water, dust and food — especially ground pepper and other spices.

Everyday exposure to aspergillus is rarely a problem for people with healthy immune systems. When mold spores are inhaled, immune system cells simply surround and destroy them. But people who have a weakened immune system from illness or medications 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.

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

*Weakened immune system. This is the greatest risk factor for invasive aspergillosis. People taking immune-suppressing drugs after undergoing transplant surgery, especially bone marrow or stem cell transplants, are the most severely affected. In fact, aspergillosis is the leading cause of death among people who have received a transplant. People with later-stage AIDS also may be at increased risk.

*Low white blood cell level. White blood cells called neutrophils play a key role in fighting fungal infections. Having a very low level of these cells (neutropenia) due to chemotherapy, an organ transplant or leukemia makes you much more susceptible to invasive aspergillosis. So does having chronic granulomatous disease — an inherited disorder that affects immune system cells.

*Lung cavities. An aspergilloma develops when mold spores germinate in a healed air space (cavity) in your lungs. Cavities are areas that have been damaged by serious lung diseases such as tuberculosis or sarcoidosis — an illness that causes inflammation in your lungs and other organs. The larger the cavity, the greater your chance of developing an aspergilloma. Most often, aspergillomas don’t spread beyond the cavity, but when they do, they can cause a cough that brings up blood, and the bleeding may be severe.

*Asthma or cystic fibrosis. About 7 percent of people with asthma and cystic fibrosis have an allergic response to aspergillus mold. This is more likely to occur in people whose lung problems are long-standing or hard to control.

*Long-term corticosteroid therapy. Because corticosteroids suppress your immune system, they increase the risk of aspergillosis. Infections that result from corticosteroid use tend to be severe and to progress rapidly.

*A hospital stay. Aspergillus mold is found on many hospital surfaces — bedrails, plants, surgical instruments, air conditioning ducts, insulation and in tap water. Though healthy people aren’t likely to be affected, people with a weakened immune system or serious illness are highly susceptible to infection. Most major hospital outbreaks have been traced to hospital construction and renovation projects, and to contaminated air filters and carpeting.

*Genetics. Some researchers speculate that genetic factors may make certain people more prone to aspergillosis infection.

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Diagnosis:
Diagnosing aspergillosis can be difficult. Aspergillus is common in the environment and is sometimes found in the saliva and sputum of healthy people. What’s more, it’s hard to distinguish aspergillus from other molds under the microscope, and symptoms of the infection are similar to those of conditions such as tuberculosis.

To arrive at an accurate diagnosis, your doctor is likely to use one or more of the following tests:

*Imaging tests. A chest X-ray or computerized tomography (CT) scan — a type of X-ray that produces more detailed images than conventional X-rays do — can usually reveal an aspergilloma as well as characteristic signs of invasive and allergic aspergillosis.

*Sputum stain and culture. In this test, a sample of your sputum is stained with a dye and checked for the presence of aspergillus filaments. The specimen is then placed on a medium that encourages the mold to grow.

*Skin and blood tests. Diagnosing allergic bronchopulmonary aspergillosis usually requires skin and blood tests. For the skin test, a small amount of aspergillus antigen is injected into your forearm. If you have antibodies to the mold in your bloodstream, you’ll develop a hard, red bump at the injection site. Blood tests look for elevated levels of certain antibodies, indicating an allergic response.

*Biopsy. Examining a sample of tissue from your lungs or sinuses under a microscope is usually necessary to confirm a diagnosis of invasive aspergillosis.

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

*Bone loss and spread of infection. An aspergillus infection in your sinuses can destroy facial bones. It can also spread beyond your sinuses, and may be life-threatening if you have a severely impaired immune system.

*Bleeding. Both aspergillomas and invasive aspergillosis can cause massive, and sometimes fatal, bleeding in your lungs.

*Systemic infection. The most devastating complication of aspergillosis is the spread of the infection to other parts of your body, especially your brain, heart and kidneys. Invasive aspergillosis spreads rapidly and is often fatal in spite of early treatment.

Modern Treatments :-
There’s no universally effective therapy for aspergillosis. Available treatments vary with the type of disease:

The drugs amphotericin B, caspofungin, flucytosine, itraconazole, voriconazole [2] are used to treat this fungal infection. For severe cases of invasive aspergillosis a combination therapy of voriconazole and caspofungin is suggested as a first line treatment.

*Oral corticosteroids. The goal in treating allergic bronchopulmonary aspergillosis is to prevent existing asthma or cystic fibrosis from becoming worse. The best way to do this is with oral corticosteroids. Antifungal medications by themselves aren’t helpful for allergic aspergillosis, but they may be used in combination with corticosteroids to reduce the dose of steroids and improve lung function.

*Antifungal medications. These drugs are the standard treatment for invasive pulmonary aspergillosis. Historically, the drug of choice has been amphotericin B, but the newer medication voriconazole is now preferred because it appears more effective and may have fewer side effects. All antifungals can cause serious problems, however, including kidney and liver damage, and they frequently interact with other medications given to people who have weakened immune systems.

*Watchful waiting. Aspergillomas often don’t need treatment, and may simply be closely monitored. When they cause life-threatening bleeding, the options are limited. Because antifungal medications aren’t effective against aspergillomas, surgery is the first choice. The surgery is risky, however, and your doctor may suggest another option, which involves threading a small catheter into the artery that supplies blood to the cavity containing the fungus ball. Though this procedure can stop massive bleeding, it doesn’t prevent it from recurring.

Click for Alternative Treatment of Aspergillosis..(1).…...(2)…….(3)

Outbreaks:-
Albeit relatively rare in humans, aspergillosis is a common and dangerous infection in birds, particularly in pet parrots. Mallards and other ducks are particularly susceptible as they will often resort to poor food sources during bad weather.

Aspergillosis has been the culprit in several recent rapid die-offs among waterfowl. From 8 December until 14 December 2006 over 2,000 Mallards died in the Burley, Idaho area, an agricultural community approximately 150 miles southeast of Boise. Moldy waste grain from the farmland and feedlots in the area is the suspected source. A similar aspergillosis outbreak caused by moldy grain killed 500 Mallards in Iowa in 2005.

While there is no connection between aspergillosis and the H5N1 strain of Avian Influenza (commonly called “bird flu”), rapid die-offs caused by aspergillosis can spark fears of bird flu outbreaks. Laboratory analysis is the only way to distinguish bird flu and aspergillosis.

Prevention:-
It’s nearly impossible to avoid aspergillus entirely, but if you’ve had a transplant or are undergoing chemotherapy, try to stay away from the most obvious sources of mold such as construction sites, compost piles and stored grain.

Hospitals, for their part, are taking increasingly aggressive measure to protect patients, including using barriers around areas under construction, monitoring air and air filters for spores, minimizing exposure to carpet cleaning and vacuuming, and carefully maintaining ventilation systems.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.mayoclinic.com/health/aspergillosis/DS00950
http://cal.vet.upenn.edu/projects/poultry/Syllabus/page30_31.htm
http://en.wikipedia.org/wiki/Aspergillosis

3 thoughts on “Aspergillosis”

  1. Pingback: Jack
  2. I have been diagnosed with Aspergills by the Asthma professor. A few years. Ago I took part in the hospital research to help find a treatment and I was put on Voriconozole for a year. After been on the treatment for 10mths. I started to feel weakness in my legs, so they changed my Statin as it was interacting with the Voriconozole.for the 10mths I was on this treatment I felt better and felt I was given a new lease of life.After 5 years of not been admitted for an asthma attach I had a severe asthma attach and had a stay in hospital. 8 mths later I had another attack and admitted to hospital,only then it occurred to me that the fungus was growing in my lungs so I told the doctors . Tests confirmed this .A course of Itreconozle was given for 5 weeks. I still feel the fungus is still I my lungs. In May this year my consultant said a short course of Voriconozole may be given to me. I am A gardener and love the out door. Now I have learned to wear masks when I do planting eat.

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