aspergillosis

Aspergillosis: description

Aspergillosis is an infection with a special mold of the genus Aspergillus. The name derives from Latin and means translated “the frond”, as the fungal spores under the microscope in appearance to this shape. Aspergillus fungi are found in the environment virtually everywhere, they thrive particularly well on rotting plant parts, for example in the compost pile, biotons or in potting soil. But even indoors, for example behind wallpaper, in old upholstered furniture or insulating materials, the fungus can hide.

People can get aspergillosis if they inhale the fungal spores. The infection more often affects people whose immune system is weakened by certain diseases or medications, for example. For healthy people, however, the fungus is rarely a threat.

Another form of the disease is the so-called allergic bronchopulmonary aspergillosis (ABPA). Here, the fungi colonize the bronchi and lungs and simultaneously cause an allergic reaction. ABPA is occasionally present in people with chronic lung diseases, such as chronic bronchial asthma.

Aspergillosis and her clinical pictures

Aspergillosis can cause various conditions, depending on which organ system is affected by the mold. The following forms of aspergillosis are known:

• Allergic bronchopulmonary aspergillosis (ABPA): It comes to an allergic reaction of the immune system, triggered by fungal spores in the airways.
• mycotoxicosis: By this one understands a poisoning by mold poison (mykotoxins). Certain Aspergillus species can produce so-called aflatoxins, which are considered carcinogenic. Although toxin-producing Aspergillus species are rare in Europe, contaminated foods can be imported from the corresponding regions of the world.
• Superficial Aspergillus infection: This can affect the skin of the external auditory canal, the paranasal sinuses, trachea and bronchi.
• Invasive aspergillosis: The fungi penetrate deeper into the tissue, one or more organs are affected in this form:
• Aspergillosis of the paranasal sinuses
• Aspergillus bronchopneumonia: inflammation of the bronchi and lungs as a result of infection
• Aspergillosis of the central nervous system
• Aspergillosis of the gastrointestinal tract
• Aspergillosis with involvement of blood vessels, heart, liver or kidneys

In some cases, a so-called aspergilloma (“mushroom ball”) is also produced in connection with aspergillosis. It forms a larger, spherical colony of mold, forming a fungus, which usually also contains a mixture of mucus and dead cells. Aspergilloma develops within a prefabricated body cavity, such as the paranasal sinus or lungs.

Aspergillosis: symptoms

The symptoms of aspergillosis depend primarily on which organ system is affected by the mold fungi.

Possible symptoms of aspergillosis are:

• Inflammation of the bronchi or lungs with coughing, shortness of breath, rattles during breathing, painful cough, brownish-purulent, more rarely bloody sputum
• Sinusitis with nasal discharge, sinus pain, headache
• Inflammation of the external ear canal with itching, pain, ear discharge
• Asthma attacks in allergic bronchial asthma
• Weakness of cardiac output (performance kink, shortness of breath)
• Diarrhea and abdominal pain with involvement of the gastrointestinal tract
• Neurological disorders in case of involvement of the central nervous system, meningitis
• fever

Aspergillosis: causes and risk factors

The reason Aspergillosis is an infection with mold fungi of the genus Aspergillus. More than 90 percent of the cases are Aspergillus fumigatus. Other human Aspergillus species are A. terreus, A. flavus, A. niger and A. nidulans. The molds thrive in particular on plant material, old fruits and vegetables and typically in potting soil. Humans infect themselves by inhaling the mold spores; These settle directly in the airways and can infect further organs from here. Aspergillosis can not be transmitted from person to person.

Aspergillus fungi are very common, but not every contact with the pathogen also leads to a disease. The main risk factors for aspergillosis therefore include diseases associated with reduced defenses, such as HIV or AIDS. Even people who take medicines that reduce the immune system, have a higher risk of developing aspergillosis. Such medicines include, in particular, so-called immunosuppressants, which are used, for example, after organ transplants or certain agents from cancer therapy (cytostatics). Various autoimmune diseases as well as chronic lung diseases (such as chronic obstructive pulmonary disease = COPD, bronchial asthma) make those affected more susceptible to the fungal infection. In contrast, healthy people with an intact immune system rarely develop aspergillosis.

Aspergillosis: examinations and diagnosis

So that the doctor can detect an aspergillosis, he inquires in a detailed conversation about the respective complaints. Often, the doctor also asks about existing illnesses and taking medications that can weaken the immune system. This may be an important guide to the diagnosis of aspergillosis for the doctor.

This is followed by a physical examination in which the doctor – depending on the symptoms – the affected organ system examined in more detail. In most cases, several examination methods are required to diagnose aspergillosis. These include blood tests, X-ray examinations as well as laboratory examinations of sample material (ejection, tissue samples, etc.). If the detection of fungal strains of the genus Aspergillus is successful and at the same time a corresponding clinical picture is present, the doctor can set the diagnosis to aspergillosis.

Aspergillosis: treatment

To treat an aspergillosis, the doctor uses an antifungals (antifungal). The active substances voriconazole and itraconazole are the drugs of first choice. Alternatively, amphotericin B and echinocandins are used. However, some Aspergillus species have resistance. In this case, the doctor deviates from other antifungals. Allergic bronchopulmonary aspergilliosis (ABPA) is usually treated with corticosteroids such as cortisone.

If an aspergilloma has formed (in the paranasal sinus or lungs, for example), medication is usually insufficient. In this case, a surgical procedure is required in which the mushroom ball is removed.

Aspergillosis: prevention

Normally, healthy people with intact immune systems do not become ill with aspergillosis, even when exposed to the virus. However, people with chronic lung disease or compromised immune systems should take various precautions. This includes keeping possible sources of infection out of their environment. For this reason, visitors may not bring potted plants with potting soil to the hospital. At home, avoid contact with compost, soil or organic waste as much as possible. A safe protection against infection with the aspergillosis, in the form of a vaccine, does not exist so far.

Aspergillosis: disease course and prognosis

How the aspergillosis proceeds depends primarily on its expression. A key factor here is the ability of the immune system to cope with the pathogen. This can be individually very different and is also dependent on the underlying disease. Since, however, often people with weak defensive infect with the mold, the aspergillosis despite therapy often takes a difficult course and can also be fatal.