Introduction

Aspergillosis is the name of a group offungal conditionscaused by a mould called aspergillus.

It usually affects the respiratory system (windpipe, sinuses and lungs) and causes wheezing and coughing,but it can spread to anywhere in the body.

Aspergillosis can usually be treated with medication, butin a few cases it's very serious and potentially life-threatening.

How do you get aspergillosis?

You can get aspergillosis if you inhaletiny particlesof the aspergillus mould that hang in the air.

The mould is found in many different places, but it's particularly common in:

• rotting leaves and compost
• plants, trees and crops
• air conditioning and heating systems
• insulation material
• dust

In most people,inhaling aspergillusparticles isn't a problem, because your immune system quickly destroys them. However, aspergillosis candevelop if you have a pre-existing lung condition, such as Asthma or cystic fibrosis ,or if youhave a weakened immune system.

Aspergillosis isn't contagious, so it can't be passed from person to person.

There are several tests that can lead to a diagnosis.

It's caused by the immune system reacting to the aspergillus mould.

ABPA usually affects people with asthma or cystic fibrosis . It's estimated that around 1 in every 40 people with asthma may be affected by ABPA.

There's also a very similar condition called severe asthma with fungal sensitisation (SAFS).

Chronic pulmonary aspergillosis

Chronic pulmonary aspergillosis (CPA) is a long-term infection that usually only affects people with an underlying lung condition, such as tuberculosis (TB) , chronic obstructive pulmonary disorder (COPD) or sarcoidosis . Along with a persistent cough, breathlessness, tiredness and weight loss, coughing up blood is a common symptom.

CPA can sometimes cause an aspergilloma (a fungal ball) to grow in the lungs. It can also result in the lungs becoming permanently scarred if it isn't treated.

It's estimated that around 400-750 people in England have CPA.

CPA requires specialist follow up treatment with antifungal medications and is usually long-term. The National Aspergillosis Centre offers specialist follow up of patients with CPA.

Invasive pulmonary aspergillosis

Invasive pulmonary aspergillosis (IPA) usually only affects people witha weak immune system,such aspeople who have received a bone marrow transplant or cancer treatment, or those with HIV or AIDS . It's the most serious type of aspergillosis.

If you have IPA, it's likely you'll have a raised temperature as well as lung symptoms, such as a cough, chest pain or breathlessness.

InIPA, the aspergillus mould can spread through the bloodstream from the lungs to the brain, eyes, heart or kidneys. This is very serious and can be life-threatening if it's not treated quickly.

IPA is estimated toaffect up to one in everyfour people who've had a bone marrow transplant, a heart or lung transplant, or high-dose chemotherapy for leukaemia (cancer of the blood cells).

Treatments foraspergillosis

Treatment for aspergillosis depends on the specific type.

ABPA and SAFS are usually treated with steroid medication to dampen the reaction ofthe immune systemto theaspergillus particles, and antifungal medication to help kill the mould.

CPA and aspergillomacan be treated with long-term antifungal medication. In some cases, surgery may be needed to remove an aspergilloma from the lungs, prevent bleeding in the lungs, or remove infected tissue.

IPA is treated in hospital withpowerful antifungal medications given by a drip into a vein. The infection can spread very quickly, andpeople who develop IPAare usually already very ill. This means that, unfortunately, aroundhalf of those with the condition die from it.

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Preventing aspergillosis

It's almostimpossible to avoid the aspergillusmouldcompletely, but there are precautions you can take toreduceyour exposure if you're at risk ofaspergillosis.

Try to avoid places where the mould is often found, such as:

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

If you have a weakened immune system, you may also be advised to take extra precautions, such as wearing a face mask and taking a long-term course ofantifungal medication.

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