Invasive Aspergillosis - Symptoms, Diagnosis, and Treatment

Creator: Dr. Niharika Singh
Published: 2023-05-09T11:41:47

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Invasive aspergillosis is a serious fungal infection that occurs in immunocompromised individuals. To know more, read the article below.

Written by

Dr. Niharika Singh

Medically reviewed by

Dr. Shubadeep Debabrata Sinha

May 9, 2023

June 5, 2023

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Contents

What Is Aspergillosis?
What Is Invasive Aspergillosis?
How Do People Get Invasive Aspergillosis?
What Are the Signs and Symptoms of Invasive Aspergillosis?
How to Diagnose Invasive Aspergillosis?
What Happens if Invasive Aspergillosis Is Left Untreated?
How to Treat Invasive Aspergillosis?

What Is Aspergillosis?

Aspergillosis is an infection that is caused by a fungus called aspergillus. Aspergillus can be found all over the world. There are currently more than 180 kinds of Aspergillus known, and new ones are constantly being discovered. This fungus can develop on dead leaves, grain that has been stored, crop residues, or other decomposing vegetation. Additionally, it is present in marijuana leaves. Almost all of these molds (fungi) do not cause any harm. However, some varieties can cause various diseases in humans, from basic allergic reactions to life-threatening invasive diseases.

What Is Invasive Aspergillosis?

Invasive aspergillosis is a subdivision of aspergillosis and is the most serious form of this fungal infection. For people with impaired immune systems, invasive aspergillosis is a major factor that causes mortality and morbidity. Aspergillosis is categorized into chronic, allergic, and invasive types. The subdivisions of aspergillosis are as follows:

1. Allergic: An allergy to the fungus can cause allergic pulmonary aspergillosis. People with respiratory conditions like cystic fibrosis (a serious inherited condition where organs such as pancreas and lungs accumulate thick, sticky mucus) or asthma (a respiratory disease that causes narrowing and inflammation of airways and affects breathing) are more likely to develop this illness.They have been further categorized into the followings:

Allergic bronchopulmonary (lung) aspergillosis.
Allergic Aspergillus sinusitis.

2. Chronic: Chronic aspergillosis occurs when an Aspergillus infection results in pulmonary (lung) cavities, which can last for three months or longer. The lungs may also include one or more aspergillomas, which are fungus balls. Chronic aspergillosis is further classified as

Chronic pulmonary (lung) aspergillosis.
Cutaneous (skin) aspergillosis.

3. Invasive Aspergillosis: Invasive aspergillosis, the most dangerous type of aspergillosis, appears when this fungal infection spreads to blood vessels and other body areas.

How Do People Get Invasive Aspergillosis?

Most individuals inhale fungal spores every day because the fungus Aspergillus, which causes aspergillosis, is extremely prevalent both indoors and out. The inhalation of some Aspergillus spores is probably hard to avoid totally. Inhaling Aspergillus does not have any negative effects on immune-system-healthy people. Therefore, generally, healthy individuals do not get invasive aspergillosis. Due to any underlying medical condition, individuals with weak immune systems usually catch this serious fungal infection. Invasive aspergillosis typically affects those who have had solid organ or bone marrow transplants. The conditions which make an individual more susceptible to getting this infection are listed below.

Hematopoietic stem cell transplant (HSCT) recipients.
Solid organ transplant recipients.
Intensive care unit (ICU) patients.
Post-operative invasive aspergillosis.
Patients with COPD (chronic obstructive pulmonary disease).
HIV (human immunodeficiency virus)-infected patients.
Patients receiving newer immunosuppressive agents.

What Are the Signs and Symptoms of Invasive Aspergillosis?

Invasive aspergillosis infection begins in the lungs and quickly spreads through the circulation to potentially impact the brain, kidneys, heart, and skin, among other bodily organs. The signs and symptoms of invasive aspergillosis are discussed below.

The most common symptoms include the following:

Blood in cough (hemoptysis).

Shortness of breath (dyspnea).
Chest pain.
Joint pain.
Headache.
Tiredness.

The additional symptoms include the following:

Anorexia (loss of appetite).
Loss of weight.
Sweating.
Skin lesions.

The symptoms of invasive aspergillosis can range from asymptomatic to significant hemoptysis, which can be fatal. The rate at which symptoms appear also varies according to the patient's immune system. In addition, patients with some form of immunosuppression, such as acquired immunodeficiency syndrome (AIDS), corticosteroid usage, diabetes mellitus, or alcoholism, may exhibit a quicker onset of symptoms. For example, they will show symptoms in weeks rather than months.

How to Diagnose Invasive Aspergillosis?

Several different testing methods can diagnose invasive aspergillosis. The current gold standard for the diagnosis of invasive aspergillosis is tissue culture. This approach can detect Aspergillus species in the sample being tested. However, the invasive nature of tissue collection in this test makes it less appealing.

Bronchoalveolar lavage (BAL) fluid taken from the upper and lower respiratory tracts can be used to establish the diagnosis of invasive aspergillosis in the absence of tissue specimens. However, the overall sensitivity of culture employing BAL material is predicted to be 50 percent, even though BAL is a safe treatment.

Additionally, a doctor can do a blood test to check for aspergillosis antibodies. Immunoglobulins commonly referred to as antibodies are specialized proteins that the body produces to fight off harmful microbes, poisons, and other foreign substances. Galactomannan and beta-d-glucan, which are components of the Aspergillus cell wall, can also be detected through blood tests. These tests, sometimes known as assays, may be carried out on some susceptible individuals.

In patients with hematologic malignancies or HSCTs, the serum galactomannan assay is found to be a quick test that is approved to identify probable cases of invasive aspergillosis. In serum and BAL samples, galactomannan, a polysaccharide secreted in biological fluids during Aspergillus growth, can be found several days before the onset of clinical signs and symptoms. Additionally, lung fluid (BAL fluid) can be used for the galactomannan assay test. If either of these tests is positive, invasive aspergillosis is likely the cause.

What Happens if Invasive Aspergillosis Is Left Untreated?

If invasive aspergillosis is not treated at the right time, it can lead to several complications. Shock, delirium, severe lung bleeding, and tracheobronchitis, an infection of the trachea and bronchi that can restrict the airway, are just a few of the severe life-threatening problems that might arise. An organ failure, such as the liver or kidney, can occur. Seizures, intracranial hemorrhage, or infection of the brain's surrounding membranes (meningitis) may result if the infection progresses to the brain. A stroke may occur if the central nervous system is involved in this infectious disease. Additionally, a study revealed that invasive aspergillosis is a complication of COVID-19.

How to Treat Invasive Aspergillosis?

Invasive aspergillosis is mostly treated with antifungal medications. The United States food and drug administration (FDA) has authorized the medications Isavuconazole, Caspofungin, and Voriconazole for the treatment of invasive aspergillosis.

When invasive aspergillosis is detected, treatment should start immediately because the patient's condition can deteriorate rapidly over the course of one to two weeks from when it first appears until death. For a course of treatment lasting six to twelve weeks, the drug regime for critically sick patients includes intravenous (IV) therapy with Voriconazole (four mg/kg, twice daily), Posaconazole (300 mg IV, daily), Micafungin (150 mg IV, daily), or Amphotericin B (one mg/kg, daily). However, the first-line therapy includes Voriconazole. Amphotericin is a second-line treatment as it is effective but has an adverse effect profile. When treating patients with coexisting diseases, care should be given to alleviate their immunocompromised state as much as feasible.

Additionally, surgery may be utilized to treat some invasive aspergillosis consequences, such as significant hemoptysis that does not go away after bronchial artery embolization (a process where the bronchial arteries are evaluated using X-rays) or localized infection that does not improve with antifungal therapy.

Conclusion:

Invasive aspergillosis is a severe and serious fungal disease that can be life-threatening. An antifungal agent is started before or during a time of high risk to prevent an invasive fungal infection; this preventive measure is generally called prophylaxis. Apart from this, early diagnosis and treatment also aid in easy recovery from this infection.

Frequently Asked Questions

1. Is There a Cure for Invasive Aspergillosis?

Invasive aspergillosis poses a formidable challenge in its treatment, constituting a severe fungal infection that is difficult to cure, especially in individuals with compromised immune systems. The prognosis hinges on factors like the infection's severity, prompt diagnosis, and the affected person's overall health. Typically, the primary course of treatment involves the use of voriconazole, recognized as a frontline therapeutic option.

2. What Types of Invasive Aspergillosis Exist?

Various manifestations of aspergillosis encompass distinct types, notably pulmonary aspergillosis, characterized by its primary impact on the lungs. Sinus aspergillosis sees the invasion of aspergillosis into the sinus cavities, while cerebral aspergillosis extends its reach into the central nervous system. Cutaneous aspergillosis uniquely targets the skin, and disseminated aspergillosis involves widespread dissemination of the infection through the skin, wounds, and tissues.

3. How Does Chronic Aspergillosis Differ From Invasive Aspergillosis?

Chronic aspergillosis unfolds as a comparatively subdued variant, advancing gradually over time, mainly afflicting individuals grappling with underlying lung conditions like cystic fibrosis or Chronic Obstructive Pulmonary Disease (COPD). In contrast, invasive aspergillosis presents a more formidable challenge, exhibiting heightened severity. This invasive form is particularly prevalent in individuals with profoundly compromised immune systems. Notably, it does not restrict its impact solely to the lungs but extends its reach to vital areas such as the central nervous system, sinuses, and other organs

4. What Characteristics Define Invasive Aspergillosis?

Individuals with compromised immune systems bear the brunt of invasive aspergillosis, with its primary impact often centered on the lungs, manifesting symptoms like a persistent cough and breathlessness. The insidious invasion extends to the blood vessels, triggering thrombosis and infarction. Not confining its assault to the lungs alone, this fungal menace ventures into other tissues and organs. The cornerstone of treatment lies in antifungal medications, offering a crucial defense against the invasive nature of the infection.

5. Distinguish Between Aspergillosis and Invasive Aspergillosis

Aspergillosis encompasses various diseases attributed to various Aspergillus species, ranging from mild to severe manifestations. In contrast, invasive aspergillosis poses a life-threatening scenario, marked by the difficult infiltration of Aspergillus species into critical tissues and organs such as the brain, lungs, and sinuses. This perilous condition mainly targets individuals with weakened immune systems, intensifying its impact on their health.

6. Where Is the Most Frequent Location for Invasive Aspergillosis?

Invasive aspergillosis predominantly establishes its stronghold in the respiratory system, with the lungs emerging as the primary target. Beyond the pulmonary domain, this formidable infection can extend its reach to various organs throughout the body, including the sinuses, central nervous system, skin, and other tissues.

7. Define Invasive Pulmonary Aspergillus Disease.

Invasive aspergillosis represents a grave and life-threatening malady wherein Aspergillus species launch an invasion, not only targeting the lungs but also penetrating critical organs like the brain and sinuses. The standard approach to managing this serious ailment typically entails the administration of antifungal medications, with Voriconazole taking a prominent role.

8. By What Means Can One Contract Invasive Pulmonary Aspergillosis?

Those with significantly compromised immune systems face an elevated risk of developing invasive pulmonary aspergillosis. Moreover, individuals subject to prolonged or intensive use of corticosteroids, recipients of organ transplants, those who have undergone bone marrow transplantation, individuals grappling with advanced HIV/AIDS, individuals with chronic lung diseases, and those with severe burns all fall into the category of high-risk individuals susceptible to contracting invasive pulmonary aspergillosis.

9. Is There a Cure for Pulmonary Aspergillosis?

Tailoring the treatment approach for pulmonary aspergillosis hinges on the individual's health status and the specific type of the ailment. Allergic bronchopulmonary aspergillosis, for instance, often calls for a combination of corticosteroids and antifungal medications. Chronic pulmonary aspergillosis, on the other hand, relies primarily on antifungal medication as its mainstay. In cases of Invasive pulmonary aspergillosis, Voriconazole takes the lead as the first-line treatment. In instances of localized infections, surgical removal may also be contemplated as part of the therapeutic strategy.

10. What Is the Typical Duration of Treatment for Lung Aspergillosis?

The duration of treatment for pulmonary aspergillosis is contingent upon factors like the severity of the disease and the patient's overall condition. This therapeutic regimen is typically sustained for a period ranging from six to twelve weeks, emphasizing the importance of tailoring the treatment duration to the specific nuances of the individual case.

11. What Constitutes the Optimal Treatment for Invasive Aspergillosis?

Effectively managing invasive aspergillosis entails the use of critical antifungal medications, with Voriconazole standing out as a primary and frontline treatment option. Notably, in localized lesions, a surgical strategy may come into play, involving removing the infected tissue as a targeted intervention to mitigate the impact of the infection.

12. Who Is Particularly Susceptible to Invasive Aspergillosis?

Those with compromised immune systems are very susceptible to invasive aspergillosis, a risk that is particularly heightened in individuals with blood cancer, recipients of organ transplants, and those enduring prolonged neutropenic conditions resulting from chemotherapy. Prolonged use of corticosteroids further contributes to this vulnerability. Additionally, individuals grappling with advanced stages of HIV or AIDS, along with those contending with chronic lung disorders, also find themselves more prone to the insidious threat of invasive aspergillosis.

13. What Is the Primary Approach for Treating Invasive Aspergillosis?

The cornerstone of addressing invasive aspergillosis revolves around administering antifungal medications. Voriconazole takes the lead as the first-line treatment, typically given at 4 mg/kg twice daily. Complementing this, medications like Amphotericin B, administered at 1 mg/kg, are also employed as part of the therapeutic arsenal.

14. Are There Novel Treatments Available for Aspergillus Infections?

Cutting-edge approaches to combat aspergillus infections introduce novel antifungal medications, with Voriconazole emerging as a recent addition to the therapeutic arsenal. Joining the ranks are other innovative medications like Olorofim, Posaconazole, Itraconazole, Isavuconazole, and Micafungin, contributing to the evolving landscape of treatment options.

15. Can Aspergillus Infections Be Managed Through Natural Remedies?

Addressing aspergillus infections necessitates a comprehensive medical and, in some cases, surgical intervention, dismissing the notion that natural remedies alone can manage this severe condition. However, while not a standalone solution, certain natural practices can contribute to overall health. These include maintaining a balanced diet, exercising regularly, effectively managing underlying health conditions, minimizing exposure to environmental sources, and adhering to good hygiene practices.

Sources

Dr. Shubadeep Debabrata Sinha

Infectious Diseases

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