Aspergillosis - Diagnosis 

Diagnosing aspergillosis 

Your GP or specialist will check your symptoms and carry out a physical examination.

If they think you may have aspergillosis, you'll need further tests to confirm a diagnosis.

Allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS)

If allergic bronchopulmonary aspergillosis (ABPA) is suspected, you'll have a skin prick test. You may be referred to a specialist at an allergy clinic for the test.

Your skin will be pricked with a needle that contains a small amount of aspergillus mould. If you're allergic, the area of skin where the needle was inserted will come up in a hard red bump.

Blood tests are also used to check for immunoglobulin E (IgE) antibodies, which will be produced by your immune system if you're allergic to the aspergillus mould. Antibodies are special proteins that help fight infections and are markers of allergy.

You may also have a computerised tomography (CT) scan to check whether there's a build-up of mucus in your lungs or bronchiectasis, which is common in ABPA.

As well as having severe asthma, someone with severe asthma with fungal sensitisation (SAFS) will also be sensitised (allergic) to one or more types of fungi. As with ABPA, this can be diagnosed using a skin prick test, where your skin is pricked with a tiny amount of the suspected allergen to see if there's a reaction. Most people with SAFS will be sensitised to one or more types of fungi.

Chronic pulmonary aspergillosis (CPA), including aspergilloma

If chronic pulmonary aspergillosis (CPA) is suspected, you'll have a chest X-ray. A diagnosis will also be based on symptoms such as weight loss, fatigue, a persistent cough and breathlessness that have lasted for more than three months.

If aspergilloma (a fungal ball) is suspected, you'll probably be referred for a CT scan as well as a chest X-ray. The scan will be used to check for an aspergilloma, which can show up as a dark mass.

A blood test may also be used to check for aspergillus (IgG) antibodies and a sample of your mucus may be tested for fungal growth. Occasionally, a biopsy (small tissue sample) may also be taken if a mass is found in a lung cavity.

Invasive pulmonary aspergillosis (IPA)

Invasive pulmonary aspergillosis (IPA) is diagnosed in the same way as CPA, using a combination of CT scans, blood tests, mucus tests, and possibly a bronchoscopy or biopsy.

It's important that all of the tests are carried out within 72 hours and treatment is started as soon as possible.

Aspergillus bronchitis and tracheobronchitis

A bronchoscopy with bronchial biopsy is recommended to help diagnose aspergillus bronchitis and tracheobronchitis.

Aspergillus or mucus must be present in the airways for a diagnosis of aspergillus bronchitis to be made. Sometimes a sensitive molecular test is needed to confirm this.

A bronchoscopy is a procedure where a bronchoscope (a long, flexible tube with a camera at the end) is inserted into the airways, usually through the nose or mouth. During the examination a small piece of affected tissue is removed (biopsy) for testing in a laboratory.

Page last reviewed: 17/01/2014

Next review due: 17/01/2016

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