Allergic bronchopulmonary aspergillosis
This condition presents as a form of asthma that is resistant to conventional treatment. It also affects people with cystic fibrosis.
Treatment is based on the use of corticosteroids, sometimes in combination with an oral antifungal drug.
The fungus can develop in a pre-existing lung cavity resulting from a previous illness such as tuberculosis or sarcoidosis. Spores germinate in the cavity to form a ball known as a mycetoma. The disease can go unnoticed, especially in the early stages. It can lead to weight loss, chronic cough, fatigue and blood-streaked sputum. Treatment depends on the size and location of the lesions. Hemoptysis (coughing up blood) is a warning sign that may lead to surgical resection, where possible.
The fungus can develop in the sinuses. In patients with an effective immune system, infection gives rise to chronic headaches and nasal obstruction, and sinus drainage is generally an effective treatment. If the sphenoid sinuses are affected, surgery and an antifungal treatment are required. Aspergillus sinusitis is much more serious in patients with a weakened immune system caused by leukemia, a bone marrow transplant, etc., who often present with an invasive form requiring immediate antifungal treatment.
This is the third leading cause of invasive fungal infection in France. Mainly caused by the species Aspergillus fumigatus, it affects immunocompromised individuals, especially those who have had a bone marrow transplant, patients undergoing long-term cancer and neutropenia treatment or immunosuppressive therapy following an organ transplant, and patients in hospital intensive care units, in particular for severe influenza or COVID-19 infection. Symptoms are fever, cough, thoracic pain, hemoptysis and breathing difficulties.
The condition is diagnosed by culture, detection of particular fungal antigens or DNA from a blood or deep respiratory sample (using a galactomannan antigen test or Aspergillus PCR), and the appearance of thoracic lesions in a CT scan. Antifungal treatment must be administered at an early stage.
Antifungal treatment with voriconazole or isavuconazole is started immediately. The emergence of Aspergillus resistant to these azole drugs is a growing problem in some countries as a result of widespread azole use in agriculture. Azole resistance in treatment for invasive infections is not currently a major problem in France.