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Pathophysiology and risk factors

Aspergillosis refers to a family of lung diseases caused by Aspergillus species (mostly A fumigatus).  This environmental fungus is ubiquitous and found in soil, organic matter, and air.  Aspergillus spores (conidia) are constantly inhaled (~1000 spores daily).  Normally, they are cleared by the lungs' mucociliary escalator and never cause disease.  However, in susceptible individuals, 4 major manifestations can develop:

  • Allergic bronchopulmonary aspergillosis (ABPA) develops when spores trapped in bronchial mucus develop TH2 sensitization.  Patients with underlying asthma and/or mucostasis (eg, bronchiectasis, cystic fibrosis) are at highest risk.
  • (Simple) aspergilloma is a fungus ball formed when spores colonize a preexisting lung cavity and then germinate into a mass of hyphae.  Conditions that lead to the formation of lung cavities (eg, previous tuberculosis, lung surgery, emphysema bleb) set the stage for aspergilloma.

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