Definition

Pulmonary aspergillosis is an allergic reaction to a fungus called aspergillus, which causes inflammation of the airways and air sacs of the lungs.

Alternative Names

Aspergillosis - allergic bronchopulmonary; Allergic bronchopulmonary aspergillosis; ABPA

Causes, incidence, and risk factors

The aspergillus fungus is common. It can grow on dead leaves, stored grain, bird droppings, compost stacks and other decaying vegetation. Although most people are frequently exposed to aspergillus, infections caused by it such as a pneumonia or fungus ball (aspergilloma) are rare.

Some people, however, have an allergic reaction (hypersensitivity) to this fungus, which is called allergic bronchopulmonary aspergillosis (ABPA). It is characterized by inflammation of the airways (bronchi) or air sacs (alveoli). The disease may mimic asthma or pneumonia, and, in fact, most patients with ABPA have asthma as well.

Patients with asthma or cystic fibrosis are at highest risk for allergic aspergillosis.

Symptoms

• Worsening symptoms of asthma
• Wheezing
• Cough may produce brownish plugs or bloody sputum
• Fever

Signs and tests

• CBC
• Serum IgE antibodies
• Aspergillus antigen skin test
• Serum aspergillus antibodies
• Chest x-ray
• CT scan - chest
• Sputum stain and culture for fungus
• Bronchoscopy and transbronchial biopsy
• Lung biopsy (rare)

Treatment

Allergic aspergillosis is treated with prednisone. The anti-fungal antibiotic itraconazole can also be helpful. People with asthma should also continue their usual treatments.

Support Groups

Expectations (prognosis)

The response to therapy is usually good, with improvement over time. Relapses requiring repeat treatment are common.

Complications

• Irreversible airway obstruction
• Bronchiectasis
• Mucous plugs
• Respiratory failure

Calling your health care provider

Call your health care provider if symptoms of this disorder develop.

Call your health care provider if breathing becomes more difficult. Severe breathing difficulty is an emergency.

Prevention

People with predisposing factors (asthma, cystic fibrosis, etc.) should try to avoid environments where this fungus is found if possible.

Images

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