Friday, July 31, 2009


The pulmonary specialist thought Fred might be aspergillosis

He ordered a blood test. I'm at risk because I have asthma. The fevers could be a symptom of aspergillosis. The Bronchoscopy washings were negative for aspergillosis and so was a follow up blood test.

Aspergillosis is a group of illnesses caused by mold. The mold that triggers the illnesses, aspergillus, includes more than 150 types of mold that occur widely in the indoor and outdoor environment. Although most of the molds are harmless, a few can cause serious illnesses in people with a weakened immune system, underlying lung disease or asthma. These illnesses, collectively called aspergillosis, range from allergic responses to severe and sometimes fatal infections.

Aspergillosis begins when susceptible people inhale mold spores into their lungs. In some people, the spores trigger an allergic reaction. Other people develop mild to serious lung infections. The most serious form of aspergillosis — invasive aspergillosis — occurs when the infection spreads to blood vessels and beyond, into the lungs to other organs.

The name of the fungus, Aspergillosis, was coined by a priest botanist, for its resemblance to the aspergillum, a brush used for sprinkling holy water in the Catholic high masses. Over 135 species have been described. A couple dozen are involved in human and animal disease.

Depending on the type of aspergillosis, treatment may involve watchful waiting, antifungal medications, steriods or, in rare cases, surgery.

Diagnosing aspergillosis can be difficult. Aspergillus is common in the environment and is sometimes found in the saliva and sputum of healthy people. What's more, it's hard to distinguish aspergillus from other molds under the microscope, and symptoms of the infection are similar to other conditions.

To arrive at an accurate diagnosis, your doctor is likely to use one or more of the following tests:

  • Imaging tests. A chest X-ray or computerized tomography (CT) scan — a type of X-ray that produces more detailed images than conventional X-rays do — can usually reveal an aspergilloma as well as characteristic signs of invasive and allergic aspergillosis.
  • Sputum stain and culture. In this test, a sample of your sputum is stained with a dye and checked for the presence of aspergillus filaments. The specimen is then placed in something that encourages the mold to grow.
  • Tissue and blood tests. Diagnosing allergic bronchopulmonary aspergillosis usually requires skin and blood tests. For the skin test, a small amount of aspergillus antigen is injected into your forearm. If you have antibodies to the mold in your bloodstream, you'll develop a hard, red bump at the injection site. Blood tests look for high levels of certain antibodies, indicating an allergic response.
  • Biopsy. Examining a sample of tissue from your lungs or sinuses under a microscope is usually necessary to confirm a diagnosis of invasive aspergillosis.
I've had all these tests except Sputum, none of them positive for the fungi, but that's still not conclusive that I don't have it. It might not be aspergillosis -- it might be cancer. Or... something else?

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