after ORGAN TRANSPLANTATION, or are otherwise
IMMUNOCOMPROMISED. Aspergillosis may also occur
as an allergic reaction (called allergic bronchopul-
monary aspergillosis or ABPA) in people who
have ASTHMA or CYSTIC FIBROSIS, causing airway
INFLAMMATIONand fluid accumulation in the LUNGS.
Aspergillus, the infective FUNGUS, is common in the
environment, especially in decaying vegetation
and in the soil, and in air ventilation ducts in
buildings. Hospitals also harbor Aspergillus, so
aspergillosis can develop as a nosocomial infec-
tion. Occasionally aspergillosis takes the form of
an encapsulated ball, called an aspergilloma or a
mycetoma, that forms within a pocket of healed
SCARtissue from previous damage to the lung such
as may remain from TUBERCULOSISorSARCOIDOSIS.
Symptoms and Diagnostic PathSymptoms of aspergillosis vary widely and may
not appear at all unless the fungus establishes
itself within the lungs in a widespread pattern.
When symptoms are present they typically
include
- HEMOPTYSIS (bleeding from the lungs that
appears in the SPUTUMor coughing up BLOOD) - CHEST PAIN
- FEVER
- COUGH
- rapid or difficult BREATHING(DYSPNEA)
The doctor also may suspect aspergillosis in a
person who has been receiving treatment for an
apparent bacterial infection without any improve-
ment in symptoms. The diagnostic path typically
begins with a chest X-RAY, which shows whether
there are infiltrates or obstructions in the lungs.
COMPUTED TOMOGRAPHY(CT) SCANoften can provide
more detailed visualization of lung structures and
anomalies. Though imaging results are not conclu-
sive, they provide leading clues to suggest or rule
out aspergillosis. Because aspergillosis spores are
so common in the environment, sputum cultures
are not usually helpful in making the diagnosis as
nearly everyone’s sputum is likely to contain some
Aspergillus. BRONCHOALVEOLAR LAVAGE, in which the
pulmonologist rinses cell samples from the walls
of the bronchi during BRONCHOSCOPY, or biopsy to
obtain tissue samples, may provide more accurate
culture results. The individual’s health history also
plays a key role in making the diagnosis.Treatment Options and Outlook
Invasive aspergillosis is life-threatening and
requires treatment with intravenous (IV) ANTIFUN-
GAL MEDICATIONSsuch as amphotericin B, itracona-
zole, or voriconazole. Recovery depends on the
IMMUNE SYSTEM’s ability to rally against the infec-
tion. In people who are immunocompromised, the
challenge may be overwhelming. In such situa-
tions aspergillosis can have serious and even fatal
consequences. However, most people fully recover
with appropriate treatment. Aspergillomas may
require surgery to remove them when they cause
bleeding (evident as hemoptysis), pain, or diffi-
culty breathing. CORTICOSTEROID MEDICATIONSsuch
as prednisone are usually effective in relieving the
symptoms of ABPA, which is an immune reaction
to the presence of Aspergillus,common in people
who have asthma, rather than an invasive infec-
tion with the fungus.Risk Factors and Preventive Measures
People who are taking immunosuppressive ther-
apy, such as after organ transplantation, or who
are immunocompromised are vulnerable to inva-
sive aspergillosis because their immune systems
cannot fend off this ordinarily innocuous fungus.
Aspergillosis is also a risk for people who have
HIV/AIDS. Though there are no measures for pre-
venting aspergillosis, those who are susceptible to
this fungal infection can minimize the severity of
disease by seeking medical diagnosis and treat-
ment at the earliest indication of disease.
See also BRONCHIECTASIS; NEUTROPENIA.asphyxia The inability of the LUNGSto take in air
or conduct the OXYGEN–CARBON DIOXIDE EXCHANGE,
depriving the body of oxygen.Asphyxia is a life-threatening emer-
gency that requires immediate medical
treatment.Asphyxia may occur as a consequence of water
or other fluids in the lungs (drowning) that results
in suffocation (inability of air to enter the lungs),
carbon monoxide poisoning, trauma to the TRA-186 The Pulmonary System