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Aspergillosis States where aspergillus is found in the U.S. from 1865 to 2009.
= reports of severe aspergillosis

Fungal Disease Series #4
Aspergillosis is an infection caused

by a fungus called Aspergillus.
The Aspergillus mold lives in soil,
plants and rotting material. It can
also be found in the dust in your
home, carpeting, heating and air
conditioning ducts, certain foods
including dried fish and in marijuana.
FREQUENCY
Because the number of people with weakened
immune systems has been increasing over the years, LEAST GREATEST
aspergillosis, which occurs more frequently in this
group, is now the leading cause of death due to What are the different forms and
invasive fungal infections in the United States. symptoms of aspergillosis?
Not everyone who gets aspergillosis goes on to develop Everyone reacts to this fungus differently, depending
the severe form (invasive aspergillosis). The starred on your immunity and other factors. Different forms
states on the map show where invasive aspergillosis and their symptoms include:
is most common. The map also shows the states in n Hypersensitivity Pneumonitisan allergic reaction
the U.S. where aspergillosis is most frequently found. to the fungus in the lungs. Symptoms can last for
The darkest shaded states are those with the highest weeks or months and include:
number of people with aspergillosis, and the lighter shortness of breath coughing
shaded states are those with the fewest. n Allergic Bronchopulmonary Aspergillosis
What causes Aspergillosis? (ABRA)an asthma-like illness. Symptoms do not

improve with usual asthma treatment and include:
Aspergillus enters the body when you breathe in the
fungal spores (seeds). This fungus is commonly coughing shortness of breath
found in your lungs and sinuses. If your immunity wheezing
n Invasive Aspergillosisa rapidly spreading and
(the ability to fight off infections) is normal, the
infection can be contained and may never cause an potentially life threatening illness. Symptoms include:
illness. However, a weak immune system or having fever that does not get better with antibiotics
a chronic lung disease allows the Aspergillus to grow, difficulty breathing
invade your lungs and spread throughout your body. chest pain that is worse with deep breathing
This may happen if you: dry cough
have a cancer such as leukemia or aplastic anemia; coughing up blood, which can be caused by a
take chemotherapy or are on corticosteroids for a ball of fungus that forms in the lungs
long time (for any reason); In severe cases, additional symptoms include:
had an organ transplant (for example, kidney or swollen eye on one side
lung); bleeding from the nose
have advanced HIV infection; or difficulty talking
have a chronic lung disease like asthma, paralysis of facial muscles
emphysema, tuberculosis or cystic fibrosis. ulcers inside the mouth or inside the chest wall
Am J Respir Crit Care Med Vol. 186, P1-P2, 2012 Online Version Updated October 2013. www.thoracic.org
ATS Patient EducationSeries 2012 American Thoracic Society
confusion, seizures or stroke-like symptoms, and preventing damage to your lungs and other organs.
which could mean the infection has spread to Treatment for allergic reactions includes steroids and
the brain. an anti-fungal drug like itraconazole, which are often
taken for several months.
How is Aspergillosis diagnosed?
Aspergillosis generally starts out as a spot in your lung Can aspergillosis be prevented?
called a lung nodule. (This nodule can be mistaken It is difficult to avoid being exposed to Aspergillus.
for lung cancer or tuberculosis). When the fungus However, if your immune system is weak, you should
is just a nodule, you likely will not have symptoms. take special precautions. For example, avoid dusty areas
However, over time, the fungus may develop into or at least wear a surgical mask (see also ATS Disposable
pneumonia or a fungus ball. Respirators at http://patients.thoracic.org/information-
Unfortunately, the only way to diagnose aspergillosis series/en/resources/disposable-respirators.pdf) when
with certainty is by a tissue biopsy (sampling a you are around dusty areas, and avoid gardening until
piece of your lung). Other tests that can be done your immune system improves.
include examining your sputum (phlegm) or taking Use of anti-fungal drugs to prevent aspergillosis
cultures from your airways (breathing tubes). Culture is helpful, mainly if you are at high-risk (have a low
specimens can be collected by a bronchoscopy (see white blood cell count, leukemia or a myelodysplastic
Fiberoptic Bronchoscopy at http://patients.thoracic. syndrome, or if you have received a stem cell
org/information-series/en/resources/fiberoptic- transplant).
bronchoscopy.pdf). Unfortunately, these cultures
Author: Hrishikesh S Kulkarni MD
sometimes miss the infection. There is also a test that Reviewers: Suzanne Lareau RN, MS, Bonnie Fahy RN, MN,
identifies parts of the fungus in your blood, called Chadi Hage MD.
the serum galactomannan test. However, this test is
not 100% accurate. It may even miss a few cases, Resources:
but a positive test increases the chance you have Centers for Disease Control and Prevention (CDC)
the infection, especially if you have risk factors for http://www.cdc.gov/nczved/divisions/dfbmd/diseases/
aspergillosis, and have what looks like aspergillosis on a aspergillosis/#what_Aspergillus
chest X-ray or CT scan. Mayo Clinic
http://www.mayoclinic.com/health/aspergillosis/DS00950
How is aspergillosis treated?
National Institute of Health (NIH)
If you develop symptoms of aspergillosis, you may need http://www.ncbi.nlm.nih.gov/pubmedhealth/
treatment with an anti-fungal drug for either a brief or PMH0002302
a long time. The weaker your immunity and the worse
your symptoms are, the more aggressive your health care
provider will be in diagnosing and starting treatment.
Anti-fungal drugs used to treat aspergillosis include:
Action Steps
voriconazole, amphotericin B, caspofungin, itraconazole,
See your health care provider if you notice any of
and posaconazole. Because most of these drugs have side
these symptoms:
effects, they are not usually given unless your health care
provider is sure that you have aspergillosis. If you have A fever that will not go away, especially if you are also
having shortness of breath and/or chest pain, and if
a history of aspergillosis, you may be asked to take anti-
your immunity is weak
fungal drugs to prevent the infection from coming back,
especially when your immune system is weak (such as Chronic cough, especially if your sputum (phlegm) is
blood-stained
if you are receiving a course of cancer chemotherapy).
If you have an aspergilloma, you may need surgery to Sinusitis or frequent asthma flares that do not improve
remove the fungus ball because drugs are not very even when you take your usual asthma medicines
effective in treating it. Surgery may also be recommended Doctors Office Telephone:
if your infection does not improve with drugs.
Treatment of allergic bronchopulmonary aspergillosis
(ABPA) is aimed at preventing and treating flare-ups
The ATS Patient Information Series is a public service of the American Thoracic Society and its journal, the AJRCCM. The information appearing
in this series is for educational purposes only and should not be used as a substitute for the medical advice one ones personal health care
provider. For further information about this series, contact J.Corn at jcorn@thoracic.org.
www.thoracic.org

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Aspergillosis States where aspergillus is found in the U.S. from 1865 to 2009.

= reports of severe aspergillosis

Aspergillosis is an infection caused

What causes Aspergillosis? (ABRA)an asthma-like illness. Symptoms do not

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