Aspergillosis is the name of a range of infections caused by a fungal mould called aspergillus. It usually affects the lungs, but it can spread to almost anywhere in the body.

Aspergillosis can range from mild to life threatening.

Aspergillosis usually only affects people with existing health conditions. Most healthy people have natural immunity to the aspergillus mould. If someone with damaged lungs or a weakened immune system breathes in aspergillus spores, the infection is more likely to stay.

Symptoms of aspergillosis can range from mild wheezing to coughing up blood, depending on the type of aspergillosis and where in the body the infection is (see below).

If you are at risk of aspergillosis, you should avoid areas where the aspergillus mould is likely to be, such as marshlands, compost heaps and piles of dead leaves.

You may also be advised to take extra precautions, such as wearing a face mask and taking antifungal medicines, if you have a weakened immune system. This may be the case if you're having chemotherapy, you've recently had an organ transplant or you're taking high doses of corticosteroid medication.

Read more information about the causes of aspergillosis and preventing aspergillosis.

When should I contact my GP?

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

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

Types of aspergillosis

There are four main types of aspergillosis:

• allergic bronchopulmonary aspergillosis
• aspergilloma
• chronic necrotizing aspergillosis
• invasive pulmonary aspergillosis

These are briefly described below.

Allergic bronchopulmonary aspergillosis (ABPA)

Allergic bronchopulmonary aspergillosis (ABPA) is caused by an allergic reaction to spores of fungus mould. It is the mildest form of aspergillosis.

ABPA usually affects people with asthma or cystic fibrosis. It is estimated to affect 0.25–0.8% of people with mild to moderate asthma, and 7% of people with cystic fibrosis.

ABPA affects an estimated 7–10% of people with more severe asthma that can only be controlled with steroid medication.

Aspergilloma

Aspergilloma is common in people who have cystic fibrosis or cavities (spaces) in their lungs. Coughing up blood is one of the most common symptoms of aspergilloma.

Aspergillus fungi enter the lungs and group together to form a dense knot of fungi, called a fungal ball.

Aspergilloma usually only affects people who have an existing lung condition, such as tuberculosis (TB), which means that they have cavities or damage in their lungs.

Chronic necrotizing aspergillosis (CNA)

Chronic necrotizing aspergillosis (CNA) is a slow-spreading, long-lasting infection of the lungs caused by the aspergillus fungus.

CNA usually only affects people with an existing lung condition, or people who have a weakened immune system. A weakened immune system may be caused by conditions such as diabetes, liver disease or long-term alcohol abuse.

CNA is thought to be rare, but little information is available to estimate exactly how many people develop CNA. If the symptoms of CNA are mild, it can go undiagnosed.

Invasive pulmonary aspergillosis (IPA)

Invasive pulmonary aspergillosis (IPA) is a common infection in people with severely weakened immune systems caused by illness or taking immunosuppressants. IPA is the most serious form of aspergillosis.

IPA is a fungal infection in the lungs that spreads rapidly through the body. The infection can spread to the blood, brain, heart and kidneys.

IPA usually only affects people with a severely weakened immune system, such as:

• people with end-stage HIV
• people undergoing high-dose chemotherapy
• people taking immunosuppressants because they have had an organ or bone marrow transplant

IPA is a medical emergency that requires hospitalisation and prompt treatment with injections of antifungal medication.

IPA is estimated to occur in:

• 5–13% of people who have had a bone marrow transplant
• 5–25% of people who have had a heart or lung transplant
• 10–20% of people who have high-dose radiotherapy for leukaemia (cancer of the blood cells)

How is aspergillosis treated?

Allergic bronchopulmonary aspergillosis (ABPA) is usually treated with steroid medications to prevent an allergic response. However, if ABPA reoccurs, a long-term course of steroids may be required.

Both aspergilloma and chronic necrotizing aspergillosis (CAN) can be treated with antifungal medications. In some cases, surgery may be required to remove the infection from the lungs.

Invasive pulmonary aspergillosis (IPA) can be treated with antifungal medication, although it is difficult to treat. The infection can spread very quickly, and someone who develops IPA is usually already very ill. An estimated 50% of people do not respond to treatment and die from the condition.

Read more information about how aspergillosis is treated.

Symptoms of aspergillosis vary depending on the type of infection and where it is in the body. Common symptoms include coughing up blood or mucus and a high temperature.

Allergic bronchopulmonary aspergillosis (ABPA)

The symptoms of allergic bronchopulmonary aspergillosis (ABPA) include:

• a high temperature of 38C (100.4F) or above
• shortness of breath
• wheezing
• fatigue
• a cough that brings up mucus
• coughing up blood
• a general sense of feeling unwell

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

Aspergilloma

Coughing up blood is the most common symptom of aspergilloma. Other symptoms are:

• a high temperature of 38C (100.4F) or above
• a cough

Chronic necrotizing aspergillosis (CNA)

Symptoms of chronic necrotizing aspergillosis (CNA) include:

• a persistent cough that brings up mucus
• coughing up blood
• a high temperature of 38C (100.4F) or above
• unexplained weight loss
• night sweats
• a general sense of feeling unwell

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 high temperature of 38C (100.4F) or above
• a cough that brings up mucus
• coughing up blood
• breathlessness
• chest pain
• headaches
• fatigue

When to seek medical advice

Contact your GP or transplant team immediately if you develop symptoms that suggest you may have an infection, such as a high temperature or persistent coughing, and:

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

Always contact your GP if you:

• cough up blood
• have unexplained weight loss
• have a persistent cough and fever

Aspergillosis is caught by breathing in small spores of aspergillus mould.

Most people’s immune systems will quickly isolate and destroy the mould before it has a chance to spread into their lungs. However, if a person has a weakened immune system or damaged lungs, the infection is more likely to stay.

Aspergillosis is not contagious so it cannot be passed between people or animals.

Aspergillus mould

The aspergillus mould that causes aspergillosis is found in all countries and many different environments. Therefore, it can be difficult to avoid.

Aspergillus mould can be found in:

• rotting leaves
• compost
• plants
• trees
• crops

The mould can also grow inside buildings and is found in:

• air conditioning systems
• heating systems
• insulation material
• carpets
• dust
• household plants
• ground pepper and spices

There have been cases of aspergillus mould growing inside computers.

You may be advised to take extra precautions, such as using a face mask or taking antifungal medication, if you have damaged lungs or a weakened immune system. This might be because you are having chemotherapy, or taking immunosuppressant medication or high doses of corticosteroids

Read more information about how to prevent aspergillosis.

Your GP will check your symptoms and carry out a physical examination. If they think you may have aspergillosis, you will need further tests to confirm a diagnosis.

Allergic bronchopulmonary aspergillosis (ABPA)

If allergic bronchopulmonary aspergillosis (ABPA) is suspected, your GP may carry out or refer you for an allergic skin test.

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

Read more about how an allergy is diagnosed.

Blood tests are also used to check for antibodies, which are created by your immune system if you are allergic to the aspergillus mould.

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

Aspergilloma

If aspergilloma is suspected, you will probably be referred for chest X-rays and a CT scan. These are both used to check for a fungal ball, which can show up as a dark mass.

A sample of your mucus may also be taken to check for fungal spores.

Chronic necrotizing aspergillosis (CNA)

Chronic necrotizing aspergillosis (CNA) is usually diagnosed by asking you about your symptoms and using X-rays and CT scans to look at your lungs. Samples of your blood and mucus may also be checked for antibodies and fungal spores.

In some cases of CNA, you may need to have a biopsy to confirm the diagnosis. This involves taking a small sample of tissue from your lungs and checking it for fungal spores using a microscope.

A biopsy is usually carried out using a thin tube, called a bronchoscope, which is passed down your throat and into your lungs. The bronchoscope is used to remove a sample of lung tissue. The procedure is performed under a local anaesthetic (the area is numbed), so it is not painful, and only takes around five minutes to complete.

Invasive pulmonary aspergillosis (IPA)

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

Treatment for aspergillosis varies depending on the type of infection. Treatment may include steroid or antifungal medication. In some cases, surgery is necessary.

Allergic bronchopulmonary aspergillosis (ABPA)

Allergic bronchopulmonary aspergillosis (ABPA) is treated using corticosteroid tablets (oral corticosteroids).

Corticosteroids suppress the immune system. This helps prevent the allergic reaction that ABPA can cause.

Most people need a three- to six-month course of oral corticosteroids. The dose is gradually reduced over time before treatment is stopped.

The side effects of oral corticosteroids include:

• osteoporosis (thinning of the bones)
• high blood pressure
• diabetes 
• weight gain
• the eye disorders cataracts and glaucoma
• thinning of the skin
• bruising easily
• muscle weakness

You will also need regular appointments to check for high blood pressure, diabetes and osteoporosis when taking corticosteroids.

Aspergilloma

Often, aspergilloma doesn't need to be treated. If your doctor thinks that treatment is needed, you may be given antifungal medications such as itraconazole. This is usually given as tablets.

How long you will need to take itraconazole depends on how well your symptoms react to it. Side effects are rare, but may include:

• headaches
• nausea
• vomiting
• a skin rash
• hair loss

Surgical resection (see below) may also be an option in some cases.

Some people may need injections of an antifungal medication called amphotericin B. An injection is usually given directly into the lungs. The doctor giving the injection will use a CT scanner to guide the needle to the site of the fungal ball.

Chronic necrotizing aspergillosis (CNA) and invasive pulmonary aspergillosis (IPA)

Because of the similarities between the causes of chronic necrotizing aspergillosis (CNA) and invasive pulmonary aspergillosis (IPA), these conditions are treated in the same way.

If you are diagnosed with CNA or IPA, you may be admitted to hospital so that your health can be carefully monitored. You will also receive assistance with your breathing, if required.

CNA and IPA are usually treated with injections of a powerful antifungal medication called voriconazole.

Common side effects of voriconazole include:

• visual disturbances
• a rash
• nausea
• vomiting
• diarrhoea 
• headaches
• stomach pains

Rarer side effects of voriconazole include:

• flu-like symptoms such as joint and muscle pain
• changes in mental state, such as depression or anxiety
• dizziness
• hallucinations (seeing or hearing things that are not real)
• breathing difficulties
• jaundice (yellowing of the skin and the whites of the eyes)
• swelling of the lips or face

If you also have a weakened immune system, you may be given additional treatment to help strengthen it. This includes a type of medication known as colony-stimulating factors (CSFs). CSFs help encourage your bone marrow to produce more white blood cells, which fight infection.

A medication called interferon gamma can also be used to boost the immune system. Interferon gamma is a genetically engineered version of a protein that the immune system uses to fight off infection.

The most common side effects of interferon gamma and CSFs are flu-like symptoms, such as:

• a high temperature of 38C (100.4F) or above
• chills
• joint and muscle pain
• headaches
• nausea

Surgery

Surgery may be required if CNA, IPA and aspergilloma do not respond to antifungal treatment, or if the coughing up of blood is thought to be life threatening. Extensive coughing up of blood can cause the lung tissue to become filled with blood, leading to suffocation.

Surgical resection

Surgical resection of the lung, to remove the infected piece of lung tissue, is one treatment option in severe CNA, IPA and aspergilloma.

Depending on the extent of the infection, the type of surgical resection used could be:

• a wedge resection, where a small piece of lung is removed
• a lobectomy, where the top or bottom half of the lung (known as a lobe) is removed
• a pneumonectomy, where the entire lung is removed

Many people who have a surgical resection are worried that they will not be able to breathe properly afterwards, but it is possible to breathe with just one lung.

Bronchial artery embolisation

Bronchial artery embolisation (BAE) is a common treatment for coughing up of blood that is life threatening.

Coughing up blood is caused when one of the bronchial arteries (the major blood vessels in the lungs) is weakened by infection. The weakened artery ruptures, releasing blood. BAE is used to block the flow of blood out of the artery.

During a BAE, a small, flexible tube called a catheter is guided into your lungs. A CT scanner is usually used to guide the catheter to the exact site of the rupture.

A jelly-like solution is passed down the catheter. This blocks the site of the rupture and prevents further bleeding.

It is nearly impossible to avoid the aspergillus fungus completely, but you can take precautions to prevent aspergillosis.

Avoiding exposure to the aspergillus fungus

The main way to prevent aspergillosis is to avoid being exposed to the aspergillus fungus.

If you have asthma, a weakened immune system or a history of lung disease, avoid places where the aspergillus fungus is likely to be, such as:

• marshland and bogs
• forests
• compost heaps
• grain stores
• rotting vegetation
• piles of dead leaves

The harmful effects of the fungus in buildings can be reduced by ensuring that there is good ventilation (such as open windows) and dust control. This is particularly important if construction or renovation work is being carried out.

Keeping the room disinfected, maintaining room temperature and ensuring adequate air flow are all useful ways of preventing an aspergillosis infection.

It is also important to clean skin injuries well with soap and water, especially if the injury has been exposed to soil or dust.

Extra precautions

Extra precautions may be recommended by your GP if you have a weakened immune system because:

• you're having chemotherapy
• you're taking immunosuppressant medication
• you've recently had a transplant
• you're taking high doses of corticosteroids

Extra precautions may include:

• wearing a face mask when you're near a dusty environment, such as a construction site
• avoiding activities that involve close contact with soil and dust, such as gardening
• using air purifiers
• taking antifungal medication