Aspergillosis

Diagnosis

Diagnosing aspergilloma or invasive aspergillosis can pose challenges. Your doctor is likely to utilize one or more of the following tests to accurately determine the underlying cause of your symptoms:

• Allergy tests: Your healthcare provider might request blood tests or skin tests to diagnose allergic or chronic variations of aspergillosis. These tests help determine if your immune system exhibits reactions to aspergillus antigens, aiding in the identification of allergic or prolonged forms of the condition.
• Imaging test: An imaging test such as a chest X-ray or computerized tomography (CT) scan — which is a form of X-ray producing more detailed images than conventional X-rays — can typically uncover a fungal mass (aspergilloma). It can also reveal characteristic indications of invasive aspergillosis and allergic bronchopulmonary aspergillosis.
• Respiratory secretion (sputum) test: In this assessment, a sample of your sputum is stained with a dye and examined for the presence of aspergillus filaments. The sample is subsequently placed in a culture that fosters the mold’s growth, aiding in confirming the diagnosis.
• Tissue and blood tests: Skin testing, in conjunction with sputum and blood tests, can be beneficial in confirming allergic bronchopulmonary aspergillosis. For the skin test, a minor quantity of aspergillus antigen is introduced into the skin of your forearm. If your blood contains antibodies to the mold, you will develop a firm, red bump at the injection site. Blood tests search for elevated levels of specific antibodies, indicative of an allergic response.
• Biopsy: In some cases, the examination of a tissue sample from your lungs or sinuses under a microscope may be necessary to confirm a diagnosis of invasive aspergillosis.

Treatment

Aspergillosis treatment varies by disease type:

• Observation: Simple aspergillomas may not need immediate treatment; monitoring with X-rays suffices. Progression may prompt antifungal medication.
• Oral Corticosteroids: Allergic bronchopulmonary aspergillosis management involves the administration of corticosteroids. Often, a combination with antifungal agents is prescribed to not only mitigate symptoms but also optimize lung function.
• Antifungal Medications: In cases of invasive pulmonary aspergillosis, antifungal medications are the standard treatment. Voriconazole is often the first-line choice due to its effectiveness against Aspergillus species. Amphotericin B serves as an alternative when Voriconazole isn’t suitable. However, these medications carry the risk of adverse effects, such as liver and kidney damage. Furthermore, potential interactions with other medications need to be taken into consideration.
• Surgery: Due to limited penetration of antifungal medications into aspergillomas, surgical removal of the fungal mass becomes the primary treatment option when such growths result in lung bleeding.
• Embolization: To stop lung bleeding from aspergillomas, embolization temporarily blocks arterial blood supply via catheter injection.