Alternate Names: Acute invasive aspergillosis; Aspergillosis - acute invasive

Causes and Risks:

Aspergillosis is caused by a fungus (aspergillus) that is commonly found in the environment. It grows on dead leaves, stored grain, bird droppings, compost piles, or other decaying vegetation.

It causes illness in three ways: as an allergic reaction in people with asthma; as a colonization in an old healed lung cavity from previous disease such as tuberculosis or lung abscess, in which it produces a fungus ball called aspergilloma; and as an invasive infection with pneumonia that is spread to other parts of the body by the bloodstream (invasive aspergillosis). The invasive infection can affect the eye (causing blindness) or any other organ of the body, but especially the heart, lungs, brain, and kidneys. Late in the course of the disease, the nervous system, skin, and other organs may become affected.

Risk factors in addition to immunosuppression include a very low white blood cell count over a prolonged period. This is especially a problem in patients with prolonged neutropenia (low white blood cell counts) following chemotherapy. The incidence is 5 out of 100,000 people. However, this condition can be common in children with cystic fibrosis.

Prevention:

People who are immunosuppressed because of disease or medications should avoid environments that are conducive to the growth of aspergillus fungus.

Symptoms:

• chest pain
• cough
• shortness of breath
• fever
• joint pain

Signs and Tests:

Listening to the chest with a stethoscope (auscultation) occasionally reveals 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 biopsy
• sputum culture
• chest X-ray
• CBC (shows a low neutrophil count)

Treatment:

The objective of therapy for patients with invasive aspergillosis is to control the infection with antifungal medications, and to reverse any correctable immunosuppression. Surgical removal of foreign or infected tissue (debridement) from the sinuses may be necessary. Hospitalization will probably be necessary. It is usually necessary to stop giving the patient immunosuppressive drugs and begin treatment with granulocyte colony stimulating factor (GCSF).

Prognosis:

The death rate for patients with invasive aspergillosis is almost 50%.

Complications:

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

Call your health care provider if symptoms of this disorder develop. An early diagnosis may improve the chance of a good outcome.