Understanding Aspergillosis: A Guide for Expert Patients and Clinical Professionals

Aspergillosis is an umbrella term for a group of diseases caused by infection or hypersensitivity to fungi in the Aspergillus genus, most commonly Aspergillus fumigatus. The spectrum of disease ranges from benign colonisation to aggressive, life-threatening invasive infection, depending on the host’s immune status and pre-existing lung condition.

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🔍 Main Forms of Aspergillosis

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👥 Who Is Vulnerable?

Risk varies by form:

1. ABPA

• Adults or children with moderate-to-severe asthma

• Patients with cystic fibrosis

2. CPA / Aspergilloma

• Structural lung disease: TB scarring, COPD, sarcoidosis, bronchiectasis

• Immune dysregulation: diabetes, corticosteroid use

3. Invasive Aspergillosis

• Neutropenic patients (especially haematological malignancies)

• Solid organ or stem cell transplant recipients

• Chronic granulomatous disease

• ICU patients (especially with influenza or COVID-19)

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⚠️ Main Symptoms and Diagnostic Red Flags

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🧪 Diagnosis

📌 ABPA

• Elevated total IgE (>1000 IU/mL)

• Raised Aspergillus-specific IgE/IgG

• Eosinophilia

• Chest CT: central bronchiectasis, mucus impaction (“finger-in-glove”)

• Positive sputum culture or PCR for A. fumigatus

📌 CPA

• Symptoms >3 months

• Chest imaging: cavitary lesions, fungal ball, pleural thickening

• Positive Aspergillus IgG

• Repeated positive cultures/PCR from sputum or BAL

• Exclusion of TB and other mimics

📌 Invasive Aspergillosis

• Imaging: halo sign, air crescent sign on CT

• Serum galactomannan, (1→3)-β-D-glucan, PCR

• BAL galactomannan and culture

• Tissue biopsy (definitive)

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💊 Treatment Approaches

🟦 ABPA

• Oral corticosteroids (mainstay)

• Itraconazole or posaconazole to reduce fungal burden

• Biologics (e.g. omalizumab, mepolizumab, benralizumab) in steroid-dependent or resistant cases

🟧 CPA

• Long-term triazole antifungals (e.g. itraconazole, voriconazole, posaconazole)

• Monitoring of serum drug levels, liver function

• Surgical resection in selected cases (aspergilloma)

• Inhaled amphotericin B in refractory cases

🟥 Invasive Aspergillosis

• Voriconazole (first-line)

• Liposomal amphotericin B (alternative)

• Duration: typically 6–12 weeks

• Manage immunosuppression, treat underlying disease

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🧭 Monitoring and Follow-up

• Serial imaging (CT or X-ray)

• Aspergillus IgG/IgE titers

• Liver function and antifungal serum levels

• Patient-reported symptom scores and quality of life

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📚 Further Information and Resources

• National Aspergillosis Centre (NAC): aspergillosis.org,

• UK Clinical Guidelines: BTS CPA Guidelines (2016), ERS ABPA position paper (2020)

• Support Groups: NAC Patient Support Facebook Group, Aspergillosis Trust

• Referral Pathway: Respiratory teams can refer to NAC via NHS e-Referral system or Advice & Guidance. NAC is a tertiary NHS service so referrals cannot be made by a GP.

• When ‘chest infections’ don’t respond: when to suspect ABPA or CPA (Clinical perspective)
• AntifungalInteractions.org – A Specialist Resource for Safer Antifungal Treatment
• Aspergillosis and Diet: coping with weight loss, poor appetite, food avoidance and stomach symptoms
• Cystic Fibrosis, CFTR Gene Variants, and Aspergillosis
• Weekly Aspergillosis Research Update: 31 March – 7 April 2026
• Voriconazole interactions: what patients need to know
• Itraconazole interactions: what patients need to know
• Amphotericin B interactions: what patients need to know
• Isavuconazole interactions: what patients need to know
• Posaconazole interactions: what patients need to know

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