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Division of Foodborne, Bacterial and Mycotic Diseases (DFBMD)

Aspergillosis (Aspergillus)

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Frequently Asked Questions

What is Aspergillus?

Aspergillus is a fungus (or mold) that is very common in the environment.  It is found in soil, on plants and in decaying plant matter. It is also found in household dust, building materials, and even in spices and some food items. There are lots of different types of Aspergillus, but the most common ones are Aspergillus fumigatus and Aspergillus flavus.  Some others are Aspergillus terreus, Aspergillus nidulans, and Aspergillus niger.

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What is aspergillosis?

Aspergillosis is disease cause by Aspergillus. There are many different kinds of aspergillosis. One kind is allergic bronchopulmonary aspergillosis (also called ABPA), a condition where the fungus causes allergic respiratory symptoms, such as wheezing and coughing, but does not actually invade and destroy tissue. Another kind of aspergillosis is invasive aspergillosis, a disease that usually affects people with immune system problems. In this condition, the fungus invades and damages tissues in the body. Invasive aspergillosis most commonly affects the lungs, but can also cause infection in many other organs and can spread throughout the body.

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Who gets aspergillosis?

ABPA can affect people who are otherwise healthy, but it is most common in people with asthma or cystic fibrosis. Invasive aspergillosis generally affects people who have compromised immune systems, such as people who have had a bone marrow transplant or solid organ transplant, people who are taking high doses of corticosteroids, and people getting chemotherapy for cancers such as leukemia. Rarely, persons with advanced HIV infection can acquire the infection.

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How is Aspergillus spread?

Since Aspergillus is so common in the environment, most people breathe in Aspergillus spores every day. It is probably impossible to completely avoid breathing in some Aspergillus spores. For people with healthy immune systems, this does not cause harm, and the immune system is able to get rid of the spores. But for people with compromised immune systems, breathing in Aspergillus spores, especially breathing in a lot of spores (such as in a very dusty environment) can lead to infection. Studies have shown that invasive aspergillosis can occur during building renovation or construction. Outbreaks of Aspergillus skin infections have been traced to contaminated biomedical devices.

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What are the symptoms of aspergillosis?

There are many different kinds of aspergillosis, causing different symptoms. As mentioned above, ABPA can cause respiratory symptoms like wheezing, coughing and even fever in people with asthma or cystic fibrosis, and occasionally in people who are otherwise healthy. Aspergillus can also cause allergic sinusitis, and it can cause aspergilloma, or a “fungus ball” in the lung or other organs. Lung aspergillomas usually occur in people with other forms of lung disease, like emphysema or a history of tuberculosis. People with an aspergilloma in the lung may have no symptoms at all. Sometimes they may cough up bloody mucus. People who have invasive aspergillosis in the lung may have symptoms such as fever, chest pain, cough, and shortness of breath. Other symptoms may develop if the infection spreads beyond the lungs. When invasive aspergillosis spreads outside of the lungs, it can affect almost any organ in the body, including the brain.

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How soon do symptoms appear?

Incubation time varies depending on host factors and exposure characteristics.

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If I have symptoms, should I see my doctor?

Yes. Invasive aspergillosis is a very serious infection, and early treatment is necessary.

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How is an Aspergillus infection diagnosed?

Your doctor might perform a variety of tests to make the diagnosis. In addition to considering your risk factors, symptoms, and findings on physical examination, your doctor might ask you to have an imaging test performed, such as a chest x-ray or CT scan of the lungs. Also, samples of respiratory secretions or samples from affected tissues may be sent to the laboratory for fungal culture. Biopsies of affected tissue might be taken to look for evidence of the fungus under a microscope. There are other, newer tests that can help monitor for invasive aspergillosis in high-risk persons who are severely immunocompromised.

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How is invasive aspergillosis treated?

Voriconazole is currently first-line treatment for invasive aspergillosis. There are other drugs that can be used to treat invasive aspergillosis in patients who cannot take voriconazole or who have not responded to voriconazole. These include itraconazole, lipid amphotericin formulations, caspofungin, micafungin, and posaconazole.  Whenever possible, immunosuppressive medications should be discontinued or decreased.

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How can Aspergillus infections be prevented?

It is almost impossible to avoid all exposure to this fungus. It is present in the environment. However, for persons who are very immunocompromised, some measures that may be helpful include: avoidance of dusty environments and activities where dust exposure is likely (such as construction zones), wearing N95 masks when traveling near dusty environments, and avoidance of activities such as gardening and lawn work. Other air quality improvement measures such as HEPA filtration may be used in healthcare settings, and prophylactic antifungal medication may in some circumstances be prescribed by your doctor.

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Page last modified: March 27, 2008
Content Source: National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ZVED)

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