Aspergillus bronchitis (AB) is a chronic illness in which the Aspergillus fungus causes a superficial infection in the large airways (bronchi). People with abnormal airways (e.g. in cystic fibrosis or bronchiectasis) have a higher risk of getting Aspergillus bronchitis after breathing in the fungus. It also affects people who have a slightly weakened immune system. Patients with chronic pulmonary symptoms and evidence of Aspergillus in the airways, but who do not fulfil the diagnostic criteria for chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA) or invasive aspergillosis (IA), may have AB.
Presentation
Patients often have a long-lasting chest infection that does not improve with antibiotics. To be diagnosed with Aspergillus bronchitis patients must have:
● Symptoms of a lower airway disease for over one month
● Positive sputum sample
● A slightly weakened immune system
The following are also suggestive of Aspergillus bronchitis:
● High IgG levels
● Fungus growing in airways, or plugs of mucus seen with a bronchoscopy
● Good response to antifungal medication after eight weeks of treatment
Treatment
The antifungal drug itraconazole is usually prescribed; voriconazole may also be used. It is important to monitor the blood levels of antifungals to ensure optimal dosing, as individuals vary in their absorption levels of these drugs. Many patients get dramatic benefit with near resolution of respiratory symptoms and reduction or even cessation of chest infections. Typical treatment duration is 4 months, however relapse on discontinuation of therapy is common.