Aspergilloma

The most common sites of infection are the respiratory apparatus (lungs, sinuses) and these infections can be:

• Invasive (e.g. Invasive Pulmonary Aspergillosis - IPA)
• Non-invasive (e.g. Allergic Pulmonary Aspergillosis - ABPA)
• Chronic pulmonary and aspergilloma (e.g chronic cavitary, semi- invasive)
• Severe asthma with fungal sensitisation (SAFS)

Aspergilloma

Occasionally  the fungus invades healthy lung tissue and causes cavities or an abscess.  It is most common in the lungs but can also occur in the brain, kidney, or other organs.
The fungus mass or ball can also be called a mycetoma, although this term is best reserved for subcutaneous infections.

Pre-existing cavities in the lung may have been caused by a previous infection, such as histoplasmosis, tuberculosis, lung abscess, or by cystic fibrosis, sarcoidosis, or lung cancer. Aspergillus is a common fungus. Whose spores are found in the air we breathe . It can grows on dead leaves, stored grains, bird droppings, compost piles, and other decaying vegetation. It does not normally cause a problem for a healthy individual to inhale these spores – but if your immune system is deficient or compromised it can invade human tissues.

Almost all aspergilloma are caused by Aspergillus fumigatus. In diabetic patients it may be caused by Aspergillus niger. It is very rarely caused by Aspergillus flavus, Aspergillus oryzae, Aspergillus terreus, or Aspergillus nidulans.

Some patients with aspergilloma, have chronic cavitary pulmonary aspergillosis, with an aspergilloma. Such patients have subtle immune deficits and require long term antifungal therapy (see below).

Tests used to diagnose an aspergilloma may include:

• Chest x-ray
• Chest CT
• Sputum culture
• Bronchoscopy or bronchoscopy with lavage (BAL)
• Serum precipitins for aspergillus (blood test to detect antibodies to aspergillus)

Treatment
Often, no treatment is necessary. However, if a patient coughs up blood, treatment may be required (usually angiography and embolisation, surgery or tranexamic acid). Angiography (injection of dye into the blood vessels) may be used to locate the site of bleeding which may be stopped by shooting tiny pellets into the bleeding vessel. Surgery is another option to remove the aspergilloma or to control bleeding, and is often the only choice if it is life-threatening.
Occasionally, antifungal medications such as itraconazole, voriconazole, or amphotericin B can be used.

For more information on aspergillus and its diseases and a multilingual translation click here