Aspergillosis

Diagnosing an aspergilloma or invasive aspergillosis can be difficult. Aspergillus is common in all environments. However, it is difficult to tell it apart from certain other molds under the microscope. The symptoms of aspergillosis also are similar to those of other lung conditions such as tuberculosis.

Your healthcare professional is likely to use one or more of the following tests to pinpoint the cause of your symptoms:

• Imaging test. A chest X-ray or CT scan can usually reveal a fungal mass, called an aspergilloma. Imaging tests also may show signs of invasive aspergillosis and allergic bronchopulmonary aspergillosis.
• Respiratory secretion test. This test uses a sample of mucus that has been coughed up, also called sputum. The sputum is stained with a dye and checked for the presence of aspergillus fibers. The sample is then placed in a culture that encourages the mold to grow to help confirm the diagnosis.
• Tissue and blood tests. Skin testing, as well as sputum and blood tests, may be helpful in confirming allergic bronchopulmonary aspergillosis. For the skin test, a small amount of aspergillus antigen is injected into the skin of your forearm. If your blood has antibodies to the mold, you’ll develop a hard, red bump at the injection site. Blood tests look for high levels of certain antibodies. High levels can indicate an allergic response.
• Biopsy. In some cases, examining a sample of tissue from your lungs or sinuses under a microscope may be necessary to confirm a diagnosis of invasive aspergillosis.

Aspergillosis treatments vary with the type of disease. Possible treatments include:

• Observation. Simple, single aspergillomas often don’t need treatment. Medicines aren’t usually effective in treating these fungal masses. Instead, aspergillomas that don’t cause symptoms may simply be closely monitored by chest X-ray. If the condition progresses, then antifungal medicines may be recommended.
• Oral corticosteroids. The goal in treating allergic bronchopulmonary aspergillosis is to prevent existing asthma or cystic fibrosis from getting worse. The best way to do this is with medicines called oral corticosteroids. Antifungal medicines by themselves aren’t helpful for allergic bronchopulmonary aspergillosis. However, they may be combined with corticosteroids to reduce the dose of steroids and improve lung function.
• Antifungal medicines. These medicines are the standard treatment for invasive pulmonary aspergillosis. The most effective treatment is a newer antifungal medicine, voriconazole (Vfend). Amphotericin B is another option.All antifungal medicines can have serious side effects. These may include kidney and liver damage. Interactions between antifungal medicines and other medicines also are common.
• Surgery. Because antifungal medicines don’t treat an aspergilloma very well, surgery to remove the fungal mass is the first-choice treatment when an aspergilloma causes bleeding in the lungs.
• Embolization. This procedure stops lung bleeding caused by an aspergilloma. An injected material hardens, blocking the blood supply to the area and stopping the bleeding. This treatment works temporarily, but the bleeding is likely to start again.