Alternative Names: Aspergillosis - acute invasive

Causes, incidence, and risk factors:

Aspergillosis is caused by the fungus aspergillus, which�is commonly found on dead leaves, bird droppings, and compost piles.

It can cause�an allergic reaction in people with asthma, or a�fungus ball (aspergilloma) in an area of�previous disease such as tuberculosis or lung abscess.

Invasive pulmonary aspergillosis occurs when the infection spreads. This is the most serious type of aspergillosis infection, and is the topic of this article. Invasive pulmonary aspergillosis�can affect any organ, particularly the heart, lungs, brain, and kidneys.�As the disease gets worse,�the nervous system and skin may be affected.

Immunosuppression is one of the main risk factors for invasive pulmonary aspergillosis. Another�risk factor is�a very low white blood cell count over a prolonged period. This�type of�problem is sometimes found in patients�who have had�chemotherapy or bone marrow transplantation.

Symptoms:

• Chest pain
• Cough (dry, or producing blood or phlegm)
• Shortness of breath
• Fever
• Joint pain
• Unintentional weight loss

Signs and tests:

Listening to the chest with a stethoscope (auscultation) occasionally reveals crackles or a pleural friction rub -- a sound made by the inflamed lining of the lung rubbing against the lung.

Tests may include:

• Open lung biopsy
• Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy
• Sputum culture and fungal stains
• Chest x-ray
• Chest CT scan
• CBC showing a low neutrophil count

Treatment:

The objective of therapy is to treat any immune problems and to control the�infection with antifungal medications. In the past, antifungal therapy was limited to amphotericin B. However, several less toxic agents have been�shown to work�against aspergillus. These include itraconazole, voriconazole, and capsofungin.

The patient will probably be admitted to the hospital.

If�white blood cell counts are too low, the patient usually must�reduce or stop�immunosuppressive drug therapy�and begin treatment with granulocyte-colony-stimulating factor (GCSF).

Support Groups:

Expectations (prognosis):

Patients with the invasive form of pulmonary aspergillosis are usually critically ill. The disease is difficult to cure. Prognosis is often not good. Patients should talk to their�health care provider about their individual�case.

Complications:

This infection can damage multiple organs, eventually causing multi-organ system failure.

Calling your health care provider:

Call your health care provider if symptoms of this disorder develop. If you know you have a low white blood cell count and have fevers or symptoms of a respiratory infection, you should immediately notify your health care provider. An early diagnosis may improve the chance of a good outcome.

Prevention:

People who are immunosuppressed because of disease or medications should avoid environments where aspergillus fungus can grow.