Can Aspergillosis Cause Death?

Aspergillosis Mortality Risk: Who’s Most Vulnerable?

Aspergillosis is a fungal infection caused by Aspergillus mould. It can range from mild allergic reactions to life-threatening systemic infections. While most aspergillosis cases are manageable, some forms of the disease may have mortality risks. This happens particularly in immunocompromised individuals.

Read on to learn if aspergillosis causes death, its types, causes, etc.

Can an Individual Die Due to Aspergillosis?

Aspergillosis can lead to death, especially if it is invasive aspergillosis. It primarily affects immunocompromised individuals (e.g., those undergoing chemotherapy, organ transplants, or advanced HIV). Invasive aspergillosis has a mortality rate of 30–90%, depending on how quickly it is diagnosed and treated.

However, if the infection spreads to the central nervous system, mortality rates may reach 100%. Even non-invasive forms like chronic pulmonary aspergillosis can lead to fatal complications such as severe lung bleeding or respiratory failure if untreated.

In most cases, death occurs due to the following reasons:

• Delayed diagnosis
• Widespread organ involvement
• Underlying health conditions like leukaemia or chronic obstructive pulmonary disease (COPD).

Early antifungal therapy and surgical intervention for localised infections (e.g., aspergillomas) improve survival rates.

What Are the Different Types of Aspergillosis?

Aspergilloses are of the following types:

Invasive Pulmonary Aspergillosis (IPA)

IPA occurs in patients with severe immunocompromised conditions when hyphae invade lung tissue while evading immune defences such as alveolar macrophages. Immunosuppression permits progression despite neutrophils' attempts to eradicate hyphae through inflammatory mediators.

According to histopathology, lung tissue invasion frequently results in systemic spread and high mortality if antifungal treatment is delayed.

Chronic Pulmonary Aspergillosis (CPA)

Aspergilloma, chronic cavitary (CCPA), and fibrosing (CFPA) forms are all included in CPA. It develops gradually, leaving scars and lung cavities that frequently overlap on radiographs. Weight loss and a chronic cough are among the symptoms. It causes respiratory decline if left untreated, especially in patients who already have lung diseases like tuberculosis.

Allergic Bronchopulmonary Aspergillosis (ABPA)

A hypersensitivity reaction to Aspergillus spores, ABPA, affects asthma or cystic fibrosis patients. Symptoms mimic severe asthma (wheezing, coughing) due to immune-mediated lung inflammation. Diagnosis involves elevated IgE and eosinophil levels, requiring corticosteroids and antifungals (itraconazole/voriconazole) to prevent bronchiectasis or fibrosis.

Aspergillus Bronchitis

This chronic lower airway infection involves tracheal/bronchial colonisation without tissue invasion. In non-immunocompromised individuals, it arises from impaired mucus clearance or subtle immune defects. Symptoms include chronic cough and sputum, often misdiagnosed as bacterial bronchitis. Antifungal therapy is needed for resolution.

Aspergillus Rhinosinusitis

Non-invasive: Fungal balls (single sinus) or allergic fungal rhinosinusitis (eosinophilic mucin) cause chronic sinusitis and nasal polyps.

Invasive: Acute forms (rapid orbital/brain invasion, high mortality) occur in immunocompromised hosts. Chronic forms progress slowly in mild immunodeficiency, requiring aggressive surgery and antifungals.

How to Identify the Symptoms of Aspergillosis?

The following symptoms indicate that an individual is suffering from aspergillosis:

• Allergic Forms (ABPA, Sinusitis)
• Wheezing, chronic cough, and shortness of breath.
• Sinus congestion, headaches, and nasal discharge.
• Aspergilloma
• Coughing up blood (haemoptysis) in 10–30% of cases.
• Chest pain and fatigue.
• Invasive Aspergillosis
• Fever, chills, and rapid breathing.
• Neurological symptoms (confusion, seizures) if the brain is affected.
• Skin lesions or gastrointestinal issues (abdominal pain, diarrhoea) in disseminated cases.
• Chronic Pulmonary
• Progressive weight loss, night sweats, and persistent cough.

What Are the Possible Causes of Aspergillosis?

The primary cause is exposure to Aspergillus spores, which are ubiquitous in:

• Soil
• Compost
• Decaying vegetation
• Indoor environments (e.g., air conditioning systems, potted plants).

Most people inhale these spores daily without illness, but certain conditions increase susceptibility:

• Individuals with weak immunity due to chemotherapy, long-term corticosteroid use, or HIV/AIDS can be affected by aspergillosis.
• Chronic lung diseases like asthma, COPD, or prior tuberculosis increase the risks of aspergillosis.
• Medical devices like ventilators or intravenous catheters, which can introduce spores, can also increase the risk of this fungal infection.

Preventive measures include avoiding mould-heavy environments (e.g., construction sites) and using antifungal prophylaxis in high-risk patients.

Aspergillosis can indeed be fatal, particularly when invasive or untreated. Early recognition of symptoms, antifungal therapies (e.g., voriconazole), and addressing underlying health conditions can help reduce the mortality rate. Those with compromised immunity or chronic lung diseases should stay aware to minimise exposure and seek prompt medical care if symptoms arise.