Aspergillosis is an infection caused by a fungus of the genus Aspergillus. This type of infection occurs mainly in the lungs, and mainly in fragile and / or immunocompromised people. Several antifungal treatments can be considered depending on the case.

Definition of aspergillosis

Aspergillosis is a medical term that groups together all infections caused by fungi of the genus Aspergillus. They are due to the inhalation of the spores of these fungi (which are in a way the seeds of the fungi). It is for this reason that aspergillosis mainly occurs in the respiratory tract, and in particular in the lungs.

Cause of aspergillosis

Aspergillosis is an infection with a fungus of the genus Aspergillus. In 80% of cases, it is due to the species Aspergillus fumigatus. Other strains, including a. niger, A. nidulans, A. flavus, and A. versicolor, can also be the cause of aspergillosis.

Types d’aspergilloses

We can distinguish different forms of aspergillosis:

• Allergic bronchopulmonary aspergillosis which is a hypersensitivity reaction to Aspergillus species, mainly occurring in asthmatics and people with cystic fibrosis;
• aspergilloma, a pulmonary aspergillosis which results in the formation of a fungal ball in a lung cavity and which follows a previous disease such as tuberculosis or sarcoidosis;
• aspergillary sinusitis which is a rare form of aspergillosis in the sinuses;
• invasive aspergillosis when infection with Aspergillus fumigatus extends from the respiratory tract to other organs (brain, heart, liver, kidneys, etc.) via the bloodstream.

Diagnosis of aspergillosis

It is based on a clinical examination which can be supplemented by in-depth examinations:

• analysis of a biological sample from the infected area to identify the fungal strain;
• an x-ray or CT scan of the infected area.

People affected by aspergillosis

In a large majority of cases, the body is able to fight off strains of Aspergillus and prevent aspergillosis. This infection only occurs if the mucous membranes are altered or if the immune system is weakened.

The risk of developing aspergillosis is especially higher in the following cases:

• asthma;
• cystic fibrosis;
• history of tuberculosis or sarcoidosis;
• organ transplantation, including a bone marrow transplant;
• cancer treatment;
• high dose and prolonged corticosteroid therapy;
• prolonged neutropenia.

Respiratory signs

Aspergillosis is caused by contamination through the respiratory tract. It often develops in the lungs and is manifested by different respiratory signs:

• a cough ;
• whistling;
• breathing difficulties.

Other signs

Depending on the form of aspergillosis and its course, other symptoms may appear:

• fever ;
• sinusitis;
• rhinitis;
• headaches;
• episodes of malaise;
• fatigue;
• weight loss;
• chest pain;
• bloody sputum (hemoptysis).

This Aspergillus infection is mainly treated with antifungal treatments (eg voriconazole, amphotericin B, itraconazole, posaconazole, echinocandins, etc.).

There are exceptions. For example, antifungal treatment is not effective for aspergilloma. In this case, surgical treatment may be necessary in order to remove the fungal ball. Regarding allergic bronchopulmonary aspergillosis, treatment is based on the use of corticosteroids by aerosols or by mouth.

Prevention can consist of supporting the immune defenses of fragile people and limiting their exposure to the spores of fungi of the genus Aspergillus. For high-risk patients, isolation in a sterile room can be implemented to prevent the occurrence of invasive aspergillosis with serious consequences.