Aspergillosis – Diagnosis and Treatment

Diagnosis

Doctors use several methods to find out if a person has aspergillosis or a related lung infection. Because Aspergillus is a common fungus in the environment, distinguishing it from other molds with basic tests can be difficult.

Pulmonary aspergillosis often has symptoms that look like those from other lung conditions, including tuberculosis, which can complicate the process.

Tests That Doctors Use

• Imaging Studies:
  • Chest X-rays and computed tomography (CT) scans help doctors spot fungal masses, sometimes called “fungus balls.” These scans can reveal nodules or changes in the lungs that suggest aspergilloma or invasive pulmonary aspergillosis.
• Laboratory Analysis:
  • Sputum Tests: Doctors examine a sample of mucus for Aspergillus filaments and then grow it in a special culture. This process confirms if a species of Aspergillus, such as Aspergillus fumigatus, causes the infection.
  • Blood and Skin Testing: Blood tests check for high antibody levels, which may indicate an allergic reaction like allergic bronchopulmonary aspergillosis. In a skin test, doctors inject a small amount of Aspergillus antigen into the skin and watch for a reaction.
• Tissue Sampling:
  • Sometimes doctors need to perform a biopsy, removing a small tissue piece from the lungs or sinuses to study under a microscope. This procedure helps determine if the infection is invasive.

Common Signs and Lab Findings

Symptom	Possible Indication
Cough, shortness of breath	Pulmonary infection
Wheezing, chest pain	Allergic bronchopulmonary aspergillosis
Fever, fatigue, headache	Invasive infection
Coughing up blood	Aspergilloma (fungus ball)

Further Details

Doctors may use bronchoscopy to look into the lungs with a small camera or perform bronchoalveolar lavage to collect fluid samples for testing.

Markers like galactomannan in blood or lung fluid can also help detect invasive aspergillosis. Accurate diagnosis often requires a combination of these approaches.

Treatment

The steps for managing aspergillosis depend on the type of infection and the patient’s overall health, especially the function of the immune system.

For cases with a single aspergilloma that causes few or no symptoms, doctors may recommend regular monitoring. They often use chest X-rays to watch for changes.

Medication does not usually help with these fungal lumps unless symptoms develop or the problem worsens.

In people with allergic bronchopulmonary aspergillosis, doctors often prescribe oral corticosteroids to help prevent asthma or cystic fibrosis from getting worse.

Sometimes, doctors add an antifungal drug to reduce the amount of steroids needed and to improve breathing.

For serious infections, especially in those with weakened immune systems, doctors prescribe IV or oral antifungal medications. Some cases require more than one drug or combination therapy to control the infection.

In rare cases, if an aspergilloma causes heavy bleeding in the lungs, surgeons may need to remove it. When surgery is not possible, doctors can perform an embolization procedure to stop bleeding, though this may only provide a temporary fix.

Doctors sometimes prescribe prophylaxis (preventive antifungal medicine) to people at high risk to prevent infections. All these treatments require careful medical supervision, as antifungal drugs can cause side effects and interact with other medicines.

Getting Ready for Your Visit

Steps You Can Take Beforehand

Taking time to prepare can help get the most out of the appointment. Follow these steps to help the visit go smoothly:

• Check for instructions. When you call the clinic to schedule, ask if you need to follow any restrictions before or after the visit, such as avoiding food or certain medicines.
• List your medical history. Write down all chronic diseases, recent hospital stays, appointments, and any treatments, especially immune-suppressing drugs.
• Gather your medications. Bring all medication bottles, including over-the-counter pills, supplements, or inhalers. This is important if you have had lung disease or another serious condition.
• Collect key documents. If your doctor does not have access to your recent imaging tests like chest X-rays or CT scans, try to get copies to bring to the appointment.
• Bring someone with you. If possible, have a family member or friend come along. Aspergillosis can require urgent treatment, and having support helps you recall information.
• Prepare your questions. Write a list ahead of time to be sure you remember. Some sample questions:

Sample Questions to Ask
What might be causing my symptoms?
What tests do I need?
Will I need to go to the hospital?
What are the treatment options?
What side effects should I watch for?
How will you check if the treatment is working?
Could I have long-term health effects?
How can I manage my other conditions alongside this one?

Do not hesitate to add your own questions. The discussion may help those with complicated health histories, such as transplant recipients or those with blood cancers.

What Your Health Care Provider Might Ask

Your doctor will likely ask several questions to better understand your situation and to decide what tests or treatments you need:

• What symptoms are you having?
• When did your symptoms start?
• Have the symptoms gotten worse?
• Are you experiencing a fever?
• Do you have trouble breathing?
• Have you coughed up blood?
• Have you seen other doctors about this before?
• What else worries you?

The provider may also ask about other recent illnesses, hospital stays, or treatments you received if you have a condition like neutropenia, leukemia, or a recent organ transplant.

If you prepare to answer these questions, you can help make the evaluation faster and more accurate.