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Aspergillosis

The symptoms of aspergillosis vary depending on the condition's type and the affected area of the body affected.

The symptoms of aspergillosis vary depending on the type of condition and the area of the body that's affected.

Allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS)

The symptoms of allergic bronchopulmonary aspergillosis (ABPA) include:

  • shortness of breath 
  • wheezing
  • fatigue (extreme tiredness)
  • cough that brings up mucus or plugs (solid lumps of mucus)
  • generally feeling unwell

If you have asthma, your usual symptoms may become more difficult to control with medication.

Symptoms of severe asthma with fungal sensitisation (SAFS) include:

  • persistent wheezing 
  • severe breathlessness
  • persistent nasal symptoms

Unlike ABPA, someone with SAFS doesn't produce thick mucus, but there may be some mucus present in their airways. Persistent long-term asthma symptoms that can't be controlled with medication are also a common characteristic of SAFS.

Chronic pulmonary aspergillosis (CPA), including aspergilloma

In the initial stages, someone with chronic pulmonary aspergillosis (CPA) may not have any symptoms. However, they may later experience the following symptoms:

  • weight loss
  • breathlessness
  • a persistent cough
  • coughing up blood
  • fatigue (extreme tiredness)

Coughing up blood is the most common symptom of aspergilloma. Other likely symptoms include a cough and a mild fever.

Invasive pulmonary aspergillosis (IPA)

The symptoms of invasive pulmonary aspergillosis (IPA) can vary depending on where in the body the infection spreads. Symptoms include:

  • a raised temperature (increased but not necessarily to the level of a fever) despite taking antibiotics
  • coughing up blood
  • breathlessness
  • chest pain or discomfort
  • fatigue

Aspergillus bronchitis and tracheobronchitis

Aspergillus bronchitis and tracheobronchitis can sometimes affect people with bronchiectasis.

Bronchiectasis is a long-term condition where the lung's airways become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection.

Common symptoms of bronchiectasis include a persistent cough that usually brings up phlegm, and breathlessness.

People with cystic fibrosis are also at risk of developing aspergillus bronchitis and tracheobronchitis, as they have reduced lung function. Recurrent chest infections and the production of very thick mucus that causes breathing difficulties are common.

When to seek medical advice

Contact your GP, care team or transplant team immediately if you develop symptoms that suggest you may have aspergillosis, such as persistent coughing or a fever, and:

  • you're taking immunosuppressants after an organ or bone marrow transplant
  • you have a condition known to weaken the immune system, such as cancer

You should always contact your GP if you:

  • cough up blood
  • have unexplained weight loss
  • have a persistent cough and high temperature
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Aspergillosis

You will have a physical examination and your symptoms will be checked. If aspergillosis is suspected, you'll have further tests to confirm a diagnosis.

Your GP or specialist will check your symptoms and carry out a physical examination.

If they think you may have aspergillosis, you'll need further tests to confirm a diagnosis.

Allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS)

If allergic bronchopulmonary aspergillosis (ABPA) is suspected, you'll have a skin prick test. You may be referred to a specialist at an allergy clinic for the test.

Your skin will be pricked with a needle that contains a small amount of aspergillus mould. If you're allergic, the area of skin where the needle was inserted will come up in a hard red bump.

Blood tests are also used to check for immunoglobulin E (IgE) antibodies, which will be produced by your immune system if you're allergic to the aspergillus mould. Antibodies are special proteins that help fight infections and are markers of allergy.

You may also have a computerised tomography (CT) scan to check whether there's a build-up of mucus in your lungs or bronchiectasis, which is common in ABPA.

As well as having severe asthma, someone with severe asthma with fungal sensitisation (SAFS) will also be sensitised (allergic) to one or more types of fungi. As with ABPA, this can be diagnosed using a skin prick test, where your skin is pricked with a tiny amount of the suspected allergen to see if there's a reaction. Most people with SAFS will be sensitised to one or more types of fungi.

Chronic pulmonary aspergillosis (CPA), including aspergilloma

If chronic pulmonary aspergillosis (CPA) is suspected, you'll have a chest X-ray. A diagnosis will also be based on symptoms such as weight loss, fatigue, a persistent cough and breathlessness that have lasted for more than three months.

If aspergilloma (a fungal ball) is suspected, you'll probably be referred for a CT scan as well as a chest X-ray. The scan will be used to check for an aspergilloma, which can show up as a dark mass.

A blood test may also be used to check for aspergillus (IgG) antibodies and a sample of your mucus may be tested for fungal growth. Occasionally, a biopsy (small tissue sample) may also be taken if a mass is found in a lung cavity.

Invasive pulmonary aspergillosis (IPA)

Invasive pulmonary aspergillosis (IPA) is diagnosed in the same way as CPA, using a combination of CT scans, blood tests, mucus tests, and possibly a bronchoscopy or biopsy.

It's important that all of the tests are carried out within 72 hours and treatment is started as soon as possible.

Aspergillus bronchitis and tracheobronchitis

A bronchoscopy with bronchial biopsy is recommended to help diagnose aspergillus bronchitis and tracheobronchitis.

Aspergillus or mucus must be present in the airways for a diagnosis of aspergillus bronchitis to be made. Sometimes a sensitive molecular test is needed to confirm this.

A bronchoscopy is a procedure where a bronchoscope (a long, flexible tube with a camera at the end) is inserted into the airways, usually through the nose or mouth. During the examination a small piece of affected tissue is removed (biopsy) for testing in a laboratory.

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