What is the First Line Treatment for Aspergillosis?

Treating Aspergillosis: Antifungal Therapy & Support Options

Aspergillus, a common mould found in the environment, is the cause of a group of diseases known as aspergillosis. Most people inhale Aspergillus spores daily without becoming sick. However, people with compromised immune systems, long-term lung conditions, or specific allergies may experience a variety of illnesses collectively referred to as aspergillosis. 

These ailments can range from severe invasive infections that can spread to the lungs and other organs, causing allergic reactions. Read on to learn about its treatment, diagnosis, causes, and symptoms.

What Are the Treatment Procedures for Aspergillosis?

The treatment procedure for aspergillosis is influenced by its type, severity, and the underlying health of the patient. Here are some of the common treatment techniques that you must know:

• Observation : Drugs are frequently ineffective against asymptomatic aspergillomas (fungus balls) until symptoms appear. Therefore, careful observation may be all that is needed.
• Antifungal Drugs : Antifungals may not cure aspergillomas but can alleviate symptoms. Surgery remains definitive for high-risk cases. Antifungal therapy is the most effective treatment for invasive aspergillosis. Voriconazole, a triazole antifungal medication that is safer than traditional medications like amphotericin B, is considered the first-line treatment for aspergillosis. Another suggested first-line medication is isavuconazole. When triazoles are ineffective, liposomal amphotericin B may be used. Other antifungals like itraconazole or caspofungin may be considered for less severe forms or as adjuvant therapy.
• Corticosteroids : Oral corticosteroids effectively reduce inflammation and prevent lung damage in allergic bronchopulmonary aspergillosis. Antifungals such as itraconazole may be added to lower the necessary steroid dosage.
• Surgery : Since antifungal medications frequently fail to penetrate aspergillomas, surgical excision may be required if the mass results in severe bleeding or other complications.
• Embolisation : Although embolisation is usually a short-term solution, it may be used to stop the blood supply and control haemorrhage in cases of aspergilloma-related life-threatening bleeding.
• Special Considerations : To guarantee effectiveness and reduce toxicity, blood levels of triazole antifungals may need to be checked. It is especially needed for patients with variable absorption or interacting medications.
• Prophylaxis : In high-risk patients, such as those undergoing bone marrow transplantation or intensive chemotherapy, antifungal prophylaxis with agents like posaconazole may be recommended to prevent invasive aspergillosis.

How to Diagnose Aspergillosis?

Diagnosing aspergillosis involves several steps to identify the infection and its type accurately. 

• Imaging Tests : Imaging tests like chest X-rays and CT scans can reveal the presence of a fungal mass (aspergilloma) or show signs of invasive or allergic bronchopulmonary aspergillosis. CT scans are particularly valuable because they provide more detailed images than standard X-rays, helping to detect subtle changes in lung tissue.
• Laboratory Tests  : A sputum test involves staining a sample of respiratory secretions to look for Aspergillus filaments under a microscope. The specimen is then cultured to confirm the presence of the mould. 
• Blood and Skin Tests : These are especially useful for allergic forms of aspergillosis. For instance, a skin test can reveal an allergic reaction if a raised, red bump forms after injection of an Aspergillus antigen. Blood tests can detect antibodies that indicate an immune response to the fungus. 
• Biopsy : In some cases, biopsy (removing a small tissue sample from the lungs or sinuses) is necessary. Examining this tissue under a microscope can confirm invasive aspergillosis, especially when other tests are inconclusive.

What Causes Aspergillosis?

Aspergillosis is caused by exposure to the spores of Aspergillus species, most commonly A. fumigatus. These spores are ubiquitous in the environment, found in soil, decaying vegetation, dust, and indoor air. Infection occurs primarily through inhalation of airborne spores. 

In healthy individuals, the immune system typically eliminates these spores without consequence. However, in people with weak immunity, such as those undergoing chemotherapy, organ transplantation, or living with advanced HIV/AIDS, the spores can germinate and cause invasive disease. 

Chronic lung conditions like asthma, cystic fibrosis, or tuberculosis also increase susceptibility to certain forms of aspergillosis.

What Are the Symptoms of Aspergillosis?

The symptoms of aspergillosis vary depending on the form of the disease:

1. Allergic Bronchopulmonary Aspergillosis (ABPA) : Oral corticosteroids are first-line for ABPA, but antifungals (e.g., itraconazole) are added to reduce steroid dependence and prevent recurrence. This primarily affects individuals with asthma or cystic fibrosis and may cause wheezing, coughing, shortness of breath, and sometimes brownish mucus plugs.
2. Aspergilloma (fungus ball) : A mass of fungus may develop in pre-existing lung cavities, often leading to chronic coughing and, in some cases, coughing up blood (haemoptysis). 
3. Chronic Pulmonary Aspergillosis : Symptoms include weight loss, fatigue, cough, and sometimes coughing up blood.
4. Invasive Aspergillosis : This severe form can cause fever, chest pain, cough, and shortness of breath. If the infection spreads, symptoms related to other organs, such as the brain, heart, or kidneys, may occur.

Aspergillosis encompasses a spectrum of diseases caused by Aspergillus mould, ranging from mild allergic reactions to severe, life-threatening infections. The first-line treatment for invasive aspergillosis is the antifungal medication voriconazole, with isavuconazole and liposomal amphotericin B as alternatives. Early diagnosis and prompt initiation of therapy are crucial for improving outcomes, particularly in immunocompromised patients.