Chronic Pulmonary Aspergillosis: Causes and Treatment

Chronic Pulmonary Aspergillosis (CPA) is a long-term fungal infection caused by Aspergillus, a mould commonly found in soil, dust, and decaying plants. It mainly affects people with pre-existing lung conditions or weakened immune systems.

Key points about Chronic Pulmonary Aspergillosis

It develops gradually, often over months or years.
It causes cavities or scarring in the lungs.
It often affects people with tuberculosis, COPD, or asthma.
Diagnosis involves chest scans, blood tests, and fungal cultures.

Difference Between Acute and Chronic Pulmonary Aspergillosis

Acute aspergillosis progresses rapidly and is life-threatening.
Chronic aspergillosis develops slowly and is linked to long-term lung damage.

Chronic Pulmonary Aspergillosis Symptoms

Chronic Pulmonary Aspergillosis symptoms develop gradually and primarily affect the lungs. This condition occurs when Aspergillus spores enter the respiratory system, especially in individuals with existing lung conditions or weakened immunity.

Persistent cough: A long-lasting cough that does not improve over time.
Shortness of breath: Difficulty breathing, especially during physical activity.
Chest pain: Discomfort or pain in the chest, often worsening with coughing.
Fatigue: Ongoing tiredness and low energy levels.
Weight loss: Unexplained loss of weight due to prolonged illness.
Wheezing: A whistling sound while breathing.
Fever: Low-grade fever that persists in some cases.
Coughing up blood: Also known as hemoptysis, which may occur if the infection damages blood vessels in the lungs.

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Chronic Pulmonary Aspergillosis Causes

Chronic Pulmonary Aspergillosis is caused by a fungal infection that develops when a person inhales Aspergillus spores from the environment. However, in people with weakened immune systems or chronic lung diseases, these spores can settle in the lungs, leading to persistent infection.

Weakened immune system: Conditions like HIV/AIDS, cancer, or organ transplantation reduce the body’s ability to fight infections.
Chronic lung diseases: People with tuberculosis, chronic obstructive pulmonary disease (COPD), asthma, or cystic fibrosis have damaged lungs, making them more vulnerable.
Previous lung infections: Individuals with past lung infections, especially bacterial or fungal, have a higher risk.
Prolonged corticosteroid use: Long-term use of steroids can suppress immunity, increasing susceptibility to fungal infections.
Exposure to Aspergillus spores: Regular exposure in construction sites, agricultural work, or gardening raises the risk.

Types of Chronic Pulmonary Aspergillosis

Aspergillosis can manifest in different ways that primarily affect the lungs, with symptoms varying depending on the specific form of the condition.

Chronic cavitary pulmonary aspergillosis: Results in cavities in the lungs due to invasive growth of Aspergillus fungi.
Chronic fibrosing pulmonary aspergillosis: This leads to progressive lung tissue scarring and fibrosis caused by chronic inflammation from Aspergillus infection.
Subacute invasive pulmonary aspergillosis: It is characterised by a less aggressive form of invasive lung infection, often seen in immunocompromised individuals.
Chronic necrotizing pulmonary aspergillosis: Causes localized tissue death and necrosis in the lungs, leading to chronic and potentially severe respiratory symptoms.
Chronic cavitary pulmonary aspergillosis: Involves the formation of cavities or cysts in the lungs, which can harbour Aspergillus fungi and cause persistent respiratory issues.

Risk Factors of Chronic Pulmonary Aspergillosis

Chronic Pulmonary Aspergillosis can develop in people who are exposed to Aspergillus spores, especially if they have existing lung problems or weakened immune systems. The risk factors for Chronic Pulmonary Aspergillosis include:

Weakened immune system
Chronic lung conditions
Asthma
Cystic fibrosis
Tuberculosis
Chronic obstructive pulmonary disease (COPD)
Use of corticosteroids
Organ transplantation
HIV/AIDS

Diagnosis of Chronic Pulmonary Aspergillosis

Diagnosis of Chronic Pulmonary Aspergillosis involves a combination of clinical evaluation, imaging tests, and laboratory investigations.

Chest X-ray or CT Scan: These imaging tests reveal lung cavities, scarring, or fungal masses linked to Chronic Pulmonary Aspergillosis.
Blood Tests: Special blood tests detect Aspergillus antibodies, indicating exposure to the fungus responsible for Chronic Pulmonary Aspergillosis.
Sputum Culture: Examining lung secretions under a microscope helps identify Aspergillus fungi, confirming Chronic Pulmonary Aspergillosis.
Bronchoscopy: In some cases, doctors use a small camera to examine the airways and collect tissue samples for analysis.

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Treatment for Chronic Pulmonary Aspergillosis

Chronic Pulmonary Aspergillosis requires long-term treatment to manage symptoms, slow disease progression, and prevent complications. The treatment plan usually combines medications, procedures, and supportive care to improve lung function and quality of life.

Antifungal medications: Doctors often prescribe antifungal drugs such as voriconazole or itraconazole to control Chronic Pulmonary Aspergillosis by stopping fungal growth and reducing lung inflammation.
Posaconazole therapy: If the infection resists first-line drugs, posaconazole may be recommended to target Chronic Pulmonary Aspergillosis more effectively.
Surgery: In severe cases where lung cavities are extensive or bleeding occurs, surgical removal of the affected lung areas may be necessary.
Bronchial artery embolization: This procedure helps control severe bleeding caused by chronic pulmonary aspergillosis by blocking the blood vessels that feed the infected tissue.
Pulmonary rehabilitation: Breathing exercises, oxygen therapy, and physiotherapy can help improve lung function and quality of life.
Nutritional support: A balanced diet strengthens immunity, helping the body respond better to Chronic Pulmonary Aspergillosis treatment.
Regular follow-ups: Continuous imaging and blood test monitoring ensure timely treatment plan adjustments.