Allergic bronchopulmonary aspergillosis is fatal

Aspergillosis

Aspergillosis: description

Aspergillosis is an infection with a specific mold of the Aspergillus genus. The Latin name means "the frond" - under the microscope the fungal spores look like a frond.

Aspergillus mushrooms are found practically everywhere in the environment. They thrive particularly well on rotting parts of plants, for example in compost heaps, organic bins and potting soil. But the fungus can also hide inside, for example behind wallpaper, in old upholstered furniture or insulating materials.

By breathing in the fungal spores, people can develop aspergillosis. It often affects people whose immune system is weakened, for example due to certain diseases or medication. For healthy people, however, the fungus is rarely a threat.

Aspergillosis and its clinical pictures

Aspergillosis can cause various clinical pictures. So there is:

  • Allergic bronchopulmonary aspergillosis (ABPA): Here the fungi colonize the bronchi and lungs and at the same time cause an allergic reaction. ABPA is occasionally found in people with chronic lung diseases such as chronic bronchial asthma.
  • Aspergilloma: Fungal colonization in an existing body cavity (such as paranasal sinuses or lungs) in the form of a larger, spherical structure made of fungal threads, mucous gland secretions and dead cells ("mushroom ball"). Especially when the immune system is weakened, the fungus can penetrate deeper into the tissue starting from the aspergilloma (invasive aspergillosis).
  • Invasive Pulmonary Aspergillosis (IPA): Aspergillus fungi penetrate deeper into the lung tissue. It is usually a complication of severe viral pneumonia, such as that caused by flu, parainfluenza or coronaviruses.
  • other forms of invasive aspergillosis: Starting in the lungs, the fungus can also infect any other organ via the bloodstream, such as the heart, kidneys, liver, eyes, central nervous system (brain and spinal cord) and / or skin. Doctors then speak of a disseminated infestation.
  • Superficial aspergillosis: This rare form of Aspergillus infection can develop on burns, under bandages, after damage to the eye or sinuses, in the mouth, in the nose, or in the external ear canal.

Aspergillosis: symptoms

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

Possible symptoms of aspergillosis are:

  • Inflammation of the bronchi (bronchitis) or the lungs (pneumonia) with shortness of breath, rattle noises when breathing, painful cough and brownish-purulent, rarely bloody expectoration
  • Sinusitis with nasal discharge, tenderness in the area of ​​the sinuses, headache
  • Inflammation of the external ear canal with itching, pain, discharge from the ear
  • Asthma attacks in allergic bronchial asthma
  • Cardiac output weakness (performance kink, shortness of breath)
  • Diarrhea and abdominal pain if the gastrointestinal tract is involved
  • neurological disorders with involvement of the central nervous system, meningitis (meningitis)
  • fever

Aspergillosis: causes and risk factors

The cause of aspergillosis is one Infection with molds of the genus Aspergillus. In over 90 percent of the cases it is Aspergillus fumigatus. Other Aspergillus species occurring in humans are A. terreus, A. flavus, A. niger and A. nidulans. The molds thrive particularly on plant material such as old fruit and vegetables and typically in potting soil. People become infected by breathing in the mold spores; these settle directly in the respiratory tract and can affect other organs from here.

Aspergillosis cannot be transmitted from person to person!

Risk factors for aspergillosis

Aspergillus mushrooms are very common. However, not every contact with the pathogen leads to disease. The main risk factors for aspergillosis are therefore considered to be Diseases associated with reduced immune system, for example HIV or AIDS.

Also treatment with drugs that lower the immune system (Immunosuppressants), increases the risk of developing aspergillosis. Such drugs are given after organ transplants, for example, to prevent rejection of the donor organ. Certain agents from cancer therapy (cytostatics) also have an immunosuppressive effect.

Various Autoimmune diseases as chronic lung disease (like chronic obstructive pulmonary disease = COPD, bronchial asthma) also make those affected more susceptible to the fungal infection. Healthy people with an intact immune system, on the other hand, very rarely develop aspergillosis.

Aspergillosis: examinations and diagnosis

In order to be able to diagnose aspergillosis, the doctor first collects the patient's medical history (anamnesis): In a detailed discussion, he asks about the exact symptoms and asks about any previous illnesses and the use of medication. This information can give the doctor important clues about a possible aspergillosis.

This is followed by various examinations:

  • During the physical examination, the doctor concentrates on the organ system that is causing symptoms (e.g. listening to and tapping the lungs when coughing and shortness of breath).
  • An X-ray examination or computed tomography (CT) of the affected body region can also be informative for the diagnosis.
  • So-called galactomannans can be searched for in a blood sample (possibly also in a sample of the nerve water = liquor). These are starch-like substances that are found in the cell wall of Aspergillus. The evidence of galactomannans suggests aspergillosis.
  • In some cases (e.g. if an Aspergilloma is suspected) it makes sense to test the blood for antibodies against Aspergillus.
  • Sample material from the patient (e.g. sputum, tissue samples - e.g. from the lungs) can be analyzed for the presence of Aspergillus fungal threads.

Aspergillosis: treatment

To treat aspergillosis, the doctor usually prescribes one Antifungal agents (Antifungal agent). The active ingredients voriconazole and itraconazole are the first choice. Alternatively, amphotericin B and echinocandins are used. However, some Aspergillus species are resistant to such active ingredients. In this case, the doctor has to switch to other antifungal drugs.

An allergic bronchopulmonary aspergillosis (ABPA) is usually associated with Corticosteroids ("Cortisone").

If an aspergilloma has formed (for example in the paranasal sinuses or lungs), drug treatment is usually not enough. In this case is a surgical intervention necessary, in which the "mushroom ball" is removed.

Aspergillosis: disease course and prognosis

How aspergillosis proceeds in individual cases depends primarily on its severity. A decisive factor here is the ability of the immune system to deal with the pathogen. This can vary greatly from person to person and is also dependent on existing underlying diseases. Since the mold infection very often affects people who have a weak immune system due to illness or medical treatment, aspergillosis is severe in many cases despite therapy. It can then even be fatal.

Aspergillosis: prevention

Normally, contact with the mold does not cause aspergillosis in healthy people with an intact immune system. However, people with chronic lung disease or compromised immune systems should take several precautionary measures to heart. This includes keeping possible sources of infection away from their surroundings. For this reason, hospital visitors, for example, are not allowed to bring potted plants with potting soil for their patients. At home, too, risk patients should avoid contact with soil, compost and organic waste as much as possible. So far, there is no reliable protection against infection with aspergillosis, for example in the form of a vaccination.

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