Allergic bronchopulmonary aspergillosis (ABPA)

The symptoms of allergic bronchopulmonary aspergillosis (ABPA) include:

• a high temperature (fever) of 38°C (100°F) or above,
• shortness of breath,
• wheezing,
• fatigue,
• a cough that brings up mucus,
• haemoptysis (coughing up blood), and
• a general sense of feeling unwell.

If you have asthma, your usual symptoms may become more difficult to control with medication.

Aspergilloma

Haemoptysis (coughing up blood) is the most common symptom of aspergilloma. Other symptoms are:

• a high temperature (fever) of 38°C (100°F) or above, and
• a cough.

Chronic necrotizing aspergillosis (CNA)

Symptoms of chronic necrotizing aspergillosis (CNA) include:

• a persistent cough that brings up mucus,
• haemoptysis (coughing up blood),
• a high temperature (fever) of 38°C (100°F) or above,
• unexplained weight loss,
• night sweats, and
• a general sense of feeling unwell.

Invasive pulmonary aspergillosis (IPA)

The symptoms of invasive pulmonary aspergillosis (IPA) can vary depending on whereabouts in the body the infection spreads. Symptoms include:

• a high temperature (fever) of 38°C (100°F) or above,
• a cough that brings up mucus,
• haemoptysis (coughing up blood),
• wheezing,
• chest pain,
• shallow, rapid breathing,
• headache, and
• fatigue.

When to seek medical advice

Contact your doctor and/or your transplant team immediately if you develop symptoms that suggest you may have an infection, such as a fever or persistent coughing, and:

• you are taking immunosuppressants as a result of having an organ or bone marrow transplant, or
• you have a condition that is known to weaken the immune system, such as cancer.

Always contact your doctor if you have:

• haemoptysis (coughing up blood),
• unexplained weight loss, and/or
• symptoms of persistent coughing and fever.

Causes of aspergillosis 

The aspergillus mould that causes aspergillosis is found in all countries and many different environments. It can therefore be difficult to avoid.

Aspergillus mould can be found in:

• decaying leaves,
• compost,
• plants,
• trees, and
• crops.

The mould can also grow inside buildings and is found in:

• air conditioning systems,
• heating systems,
• insulation material,
• carpets,
• dust,
• household plants, and
• ground pepper and spices.

There have been cases of aspergillus mould growing inside computers.

The aspergillosis infection is caught by breathing in small spores of aspergillus mould. Most people’s immune systems will quickly isolate and destroy the mould before it has a chance to spread into their lungs.

But if a person has a weakened immune system or damaged lungs, the infection is more likely to stay.

Diagnosing aspergillosis 

Allergic bronchopulmonary aspergillosis (ABPA)

If allergic bronchopulmonary aspergillosis (ABPA) is suspected, your doctor may perform (or refer you for) an allergic skin test.

Your skin will be pricked with a needle that contains a small amount of the aspergillus mould. If you are allergic, the area of skin where the needle was placed will come up in a hard red bump.

Blood tests are also used to check for antibodies that are created by your immune system if you are allergic to the aspergillus mould.

You may also have a computerised tomography (CT) scan to check whether there is a build-up of mucus in your lungs (bronchiectasis), which is common in ABPA.

Aspergilloma

If aspergilloma is suspected, it is likely that you will be referred for chest X-rays and a CT scan. These are both used to check for the presence of a fungal ball, which can show up as a dark mass.

A sample of your mucus may also be taken to check for antibodies and fungal spores.

Chronic necrotizing aspergillosis (CNA)

Chronic necrotizing aspergillosis (CNA) is usually diagnosed by asking you about your symptoms and using X-rays and CT scans to look at your lungs. Samples of your blood and mucus may also be checked for antibodies and fungal spores.

In some cases of CNA, you may need to have a biopsy to confirm the diagnosis. This involves taking a small sample of tissue from your lungs and checking it for fungal spores using a microscope.

A biopsy is usually carried out using an instrument called a bronchoscope, which is a thin tube that is passed down your throat and into your lungs. The bronchoscope is used to remove a sample of lung tissue. The procedure is performed under a local anaesthetic (the area is numbed), so it is not painful and only takes around five minutes to complete.

Invasive pulmonary aspergillosis (IPA)

Invasive pulmonary aspergillosis (IPA) is diagnosed in the same way as CNA, using a combination of CT scans, blood and mucus tests and biopsy.

Related articles

1. Fungal infec­tions — Asper­gil­losis
2. Treat­ing and pre­vent­ing asper­gil­losis 
3. Chest infec­tion in adults 
4. Cystic fibrosis
5. Asbestosis – Chronic lung dis­ease 
6. Avian influ­enza (or bird flu)
7. Inflamed air­ways — Bron­chitis 
8. Res­pir­at­ory tract infec­tion — Bron­chi­olitis

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