Invasive aspergillosis is a serious fungal infection caused by Aspergillus mould. It usually affects people whose immune system is severely weakened by illness or medical treatment.

It is very different from chronic pulmonary aspergillosis (CPA), ABPA and other long-term forms of aspergillosis. Most people with asthma, bronchiectasis, ABPA or CPA are not at risk of invasive aspergillosis unless they also have major immune suppression or are seriously unwell.

Invasive aspergillosis needs prompt specialist assessment and treatment, usually in hospital.

Key points

• Invasive aspergillosis is uncommon but can be life-threatening.
• It mainly affects people with major immune suppression or critical illness.
• It usually starts in the lungs but can sometimes spread to other parts of the body.
• Fever, worsening breathlessness, chest pain or coughing up blood in someone at high risk need urgent medical advice.
• Diagnosis and treatment require a specialist hospital team.

Who is at risk?

Invasive aspergillosis is most likely to occur when the body cannot control fungal spores that are breathed in from the environment.

People at higher risk include those who have:

• Leukaemia, lymphoma or another blood cancer, particularly during intensive chemotherapy
• Very low neutrophil levels (neutropenia)
• A stem-cell or bone-marrow transplant
• A solid-organ transplant, especially a lung transplant
• High-dose steroids or other strong immune-suppressing medicines
• A severe immune deficiency
• A stay in intensive care, especially following severe influenza, COVID-19 or another serious viral pneumonia

Some people with very severe lung disease, particularly when they are acutely unwell or receiving substantial steroid treatment, may also be at increased risk.

What are the symptoms?

Symptoms vary and can be caused by many other illnesses. In someone at higher risk, clinicians may be particularly concerned about:

• Fever that persists or does not improve as expected
• New or worsening cough
• Increasing breathlessness
• Chest pain, especially when breathing in
• Coughing up blood
• Marked tiredness or weakness

If infection has spread beyond the lungs, it can sometimes cause symptoms such as severe headache, confusion, visual changes or unusual skin lesions.

When should I seek urgent help?

If you have a severely weakened immune system, are having chemotherapy, have recently had a transplant, or have been advised that you are at high risk, contact your hospital team urgently if you develop a persistent fever, worsening breathlessness, chest pain or cough up blood.

Seek emergency help if you are severely breathless, confused, faint, coughing up a significant amount of blood, or otherwise rapidly becoming more unwell.

For people who are not in a high-risk group, these symptoms are far more likely to have another cause. However, they should still be discussed with a healthcare professional if they are new, severe or worsening.

How is invasive aspergillosis diagnosed?

There is no single test that proves every case. Doctors combine information about a person’s immune system, symptoms, scans and laboratory results.

Tests may include:

• A CT scan of the chest
• Blood tests, including galactomannan or beta-D-glucan where appropriate
• Sputum testing
• A bronchoscopy sample, sometimes called bronchoalveolar lavage (BAL)
• Fungal culture, microscopy or PCR testing
• Occasionally, a tissue biopsy

Finding Aspergillus in a sample does not always mean it is causing invasive disease. Specialists consider the whole clinical picture before reaching a diagnosis.

How is it treated?

Treatment is usually started in hospital and is guided by infectious-disease, respiratory, haematology, transplant or intensive-care specialists.

Antifungal medicines may include:

• Voriconazole
• Isavuconazole
• Liposomal amphotericin B

The best treatment depends on the person’s condition, other medicines, kidney and liver function, possible resistance and the type of immune suppression involved. Drug levels and side effects often need careful monitoring.

Treatment also involves addressing the underlying reason the immune system is weakened where this can be done safely. This may mean treating neutropenia, reviewing immune-suppressing medicines or managing the illness that led to intensive-care admission.

Treatment often continues for several weeks or longer, depending on the response and recovery of the immune system.

Is invasive aspergillosis contagious?

No. It does not pass from person to person.

People develop invasive aspergillosis when they breathe in common Aspergillus spores at a time when their immune defences are too weak to clear them. Healthy people breathe in these spores every day without becoming ill.

How does it differ from other forms of aspergillosis?

• ABPA is an allergic reaction to Aspergillus, usually in people with asthma or cystic fibrosis.
• CPA is a long-term infection that develops over months in lungs that are already damaged.
• Invasive aspergillosis is a rapidly progressive infection, usually in people with major immune suppression.

Learn about ABPA
Learn about chronic pulmonary aspergillosis (CPA)
Learn about treatment for aspergillosis

More information

The Aspergillosis Knowledge Hub brings together reliable information on the different forms of aspergillosis, tests, treatments, symptoms and living with a long-term lung condition.

References

• Infectious Diseases Society of America: Clinical Practice Guideline for Aspergillosis
• ECMM guidance on invasive fungal infections

More information

Visit the Invasive & Acute Aspergillosis Hub

The Aspergillosis Knowledge Hub brings together reliable information on the different forms of aspergillosis, tests, treatments, symptoms and living with a long-term lung condition.

Last reviewed: September 2026