Merch and Aspergilliosis

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http://www.merck.com/mmhe/sec17/ch197/ch197b.html

Aspergillosis is infection caused by the fungus Aspergillus that

usually affects the lungs.

Aspergillus is very common and is frequently found in compost heaps,

air vents, and airborne dust. Inhalation of Aspergillus spores is the

primary cause of aspergillosis.

Aspergillosis usually affects open spaces in the body, such as

cavities that have formed in the lungs from preexisting lung

diseases. The infection may also occur in the ear canals and sinuses.

In the sinuses and lungs, aspergillosis shows up as a ball

(aspergilloma) composed of a tangled mass of fungus fibers, blood

clots, and white blood cells. The fungus ball gradually enlarges,

destroying lung tissue in the process, but usually does not spread to

other areas.

Less often, aspergillosis can become very aggressive and rapidly

spread throughout the lungs and often through the bloodstream to the

brain and kidneys. This rapid spread occurs mainly in people with a

weakened immune system.

In addition to causing infection, Aspergillus sometimes produces an

allergic reaction when it is present on a person's skin or mucous

membranes (see Allergic and Autoimmune Diseases of the Lungs:

Allergic Bronchopulmonary Aspergillosis).

Symptoms and Diagnosis

A fungus ball in the lungs may cause no symptoms and may be

discovered only with a chest x-ray. Or it may cause repeated coughing

up of blood and—rarely—severe, even fatal, bleeding. A rapidly

invasive Aspergillus infection in the lungs often causes cough,

fever, chest pain, and difficulty breathing.

Aspergillosis

Aspergillosis affecting the deeper tissues makes a person very ill.

Symptoms include fever, chills, shock, delirium, and blood clots. The

person may develop kidney failure, liver failure (causing jaundice),

and breathing difficulties. Death can occur quickly.

Aspergillosis of the ear canal causes itching and occasionally pain.

Fluid draining overnight from the ear may leave a stain on the

pillow. Aspergillosis of the sinuses causes a feeling of congestion

and sometimes pain or discharge.

In addition to the symptoms, an x-ray or computed tomography (CT)

scan of the infected area provides clues for making the diagnosis.

Whenever possible, a doctor sends a sample of infected material to a

laboratory to confirm identification of the fungus.

Prognosis and Treatment

Aspergillosis that is present only in a sinus or a single spot in the

lung progresses slowly. The infection requires treatment but does not

pose an immediate danger. However, if the infection is widespread or

the person appears seriously ill, treatment is started immediately.

Aspergillosis is treated with antifungal drugs, such as amphotericin

BSome Trade Names

FUNGIZONE

, itraconazoleSome Trade Names

SPORANOX

, or voriconazoleSome Trade Names

VFEND

.. Some forms of Aspergillus are resistant to these drugs, however,

and may need to be treated with a caspofunginSome Trade Names

CANCIDAS

, a newer antifungal drug.

Doctors treat aspergillosis in the ear canal by scraping out the

fungus and applying drops of antifungal drugs. Fungus collections in

the sinuses must usually be removed surgically. If fungus balls in

the lungs grow near large blood vessels, they may also need to be

removed surgically because they may invade the blood vessel and cause

bleeding.

Last full review/revision February 2003

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