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Treatments and drugs
By Mayo Clinic staffAspergillosis treatments vary with the type of disease. Possible treatments include:
- Observation. Aspergillomas often don't need treatment, and medications aren't usually effective in treating these fungal masses. Instead, aspergillomas that don't cause symptoms may simply be closely monitored by chest X-ray.
- Oral corticosteroids. The goal in treating allergic bronchopulmonary aspergillosis is to prevent existing asthma or cystic fibrosis from becoming worse. The best way to do this is with oral corticosteroids. Antifungal medications by themselves aren't helpful for allergic bronchopulmonary aspergillosis, but they may be used in combination with corticosteroids to reduce the dose of steroids and improve lung function.
- Antifungal medications. These drugs are the standard treatment for invasive pulmonary aspergillosis. Historically, the drug of choice has been amphotericin B, but the newer medication voriconazole (Vfend) is now preferred because it appears more effective and may have fewer side effects. All antifungals can cause serious problems, however, including kidney and liver damage, and they frequently interact with other medications given to people who have weakened immune systems.
- Surgery. Because antifungal medications don't penetrate aspergillomas very well, surgery to remove the fungal mass is the first-choice treatment when bleeding from the mass in the lungs occurs. But the surgery is risky, and your doctor may instead suggest embolization. In this procedure, your doctor, usually a radiologist, threads a small catheter into the artery that supplies blood to the cavity containing the fungus ball, and injects a special material that clogs the artery. Though this procedure can stop massive bleeding, it doesn't prevent it from recurring, so it's generally considered a temporary treatment.
References
- Segal BH. Aspergillosis. New England Journal of Medicine. 2009;360:1870.
- Treatment of aspergillosis. Arlington, Va.: Infectious Diseases Society of America. Clinical Infectious Diseases. 2008;46:327.
- Aspergillosis. Centers for Disease Control and Prevention. http://www.cdc.gov/nczved/dfbmd/disease_listing/aspergillosis_gi.html. Accessed Jan. 3. 2011.
- Aspergillosis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/sec14/ch180/ch180c.html?qt=aspergillosis&alt=sh. Accessed Jan. 3, 2011.
- Denning DW. Aspergillosis. In: Fauci AS, et al. Harrison's Principles of Internal Medicine. 17th ed. New York, N.Y.: McGraw Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=2896200. Accessed Jan. 4, 2011.
- Sugar AM. Clinical features and diagnosis of invasive aspergillosis. http://www.uptodate.com/home/index.html. Accessed Dec. 30, 2010.
- Sherif R, et al. Pulmonary aspergillosis: Clinical presentation, diagnostic tests, management and complications. Current Opinion in Pulmonary Medicine. 2010;16:242.
- Rosenow EC (expert opinion). Mayo Clinic, Rochester, Minn. January 13, 2011.
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