Aspergillosis: Symptoms, Types, Causes, Diagnosis & Treatment — Complete Guide

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Aspergillosis is a mold infection that usually affects the lungs. For most people the mold is harmless, but in people with weakened immune systems, lung disease, or asthma it can cause anything from an allergic reaction to a life-threatening invasive infection. [1]

Quick Answer

Aspergillosis is an infection caused by aspergillus, a mold found everywhere indoors and outdoors. Inhaled spores are usually harmless but can cause serious illness in people with weakened immune systems, lung disease or asthma. It ranges from mild allergic reactions to invasive aspergillosis, which may be fatal without prompt treatment. [1] Treatment ranges from observation to corticosteroids, antifungals, surgery or embolization. [2]

What the research says

• Triazole antifungals beat the older amphotericin B for invasive disease. A network meta-analysis of 3 randomized trials (1,368 participants) found that, compared with amphotericin B deoxycholate, voriconazole reduced all-cause mortality at week 12 (RR 0.66; 95% CI 0.47–0.93; moderate certainty) as did isavuconazole (RR 0.52; 95% CI 0.31–0.86; low certainty), and serious adverse events were significantly more frequent with amphotericin B deoxycholate (Chen et al., Frontiers in Pharmacology, 2025) [3].

• Voriconazole, isavuconazole, and posaconazole perform similarly to liposomal amphotericin B. A network meta-analysis of 8 studies of first-line treatment for invasive pulmonary aspergillosis found these triazoles gave a significantly better overall response than amphotericin B deoxycholate, with no difference in efficacy versus liposomal amphotericin B; voriconazole ranked best, and isavuconazole may be safer (Cheng et al., Frontiers in Microbiology, 2024) [4].

• The allergic form is mainly treated with steroids, and antifungal evidence is thin. Allergic bronchopulmonary aspergillosis affects around 10% of people with cystic fibrosis, and a Cochrane review found no completed randomized trials that met criteria for evaluating antifungal therapy for it in cystic fibrosis (Francis and Southern, Cochrane Database of Systematic Reviews, 2022) [5].

Aspergillosis at a Glance

Aspect	Summary
What it is	Infection caused by the aspergillus mold, usually affecting the respiratory system [1]
Who is at risk	People with weakened immune systems, lung cavities, asthma, or cystic fibrosis [1]
Is it contagious	No — it cannot spread from person to person [1]
Four main forms	Allergic reaction (ABPA), aspergilloma (fungus ball), invasive aspergillosis, sinus infection [1]
Key warning signs	Coughing up blood, wheezing, fever and chills, shortness of breath [1]
How it is diagnosed	Imaging (X-ray/CT), sputum test, skin test and blood tests, biopsy [2]
Treatment options	Observation, corticosteroids, antifungal medicines, surgery, embolization [2]

What Is Aspergillosis?

Aspergillosis is an infection caused by aspergillus, a common type of mold (a fungus). It usually affects the respiratory system — the airways and lungs. [1]

Aspergillus lives both indoors and outdoors, so exposure is nearly impossible to avoid. Fortunately, most strains are harmless. However, a few strains can cause serious illness in certain people — typically those with weakened immune systems, underlying lung disease, or asthma. [1]

When susceptible people inhale the fungal spores, one of two things can happen: in some, the spores trigger an allergic reaction; in others, they develop mild to serious lung infections. The most dangerous form, invasive aspergillosis, spreads rapidly through blood vessels and beyond the lungs. [1]

Because symptoms vary so widely, knowing which form you may have is the key to understanding your symptoms, risks, and treatment.

What are the four types of aspergillosis and their symptoms?

Aspergillosis has four main types, allergic bronchopulmonary aspergillosis (ABPA), aspergilloma (fungus ball), invasive aspergillosis and sinus infection, and each causes different symptoms. [1]

1. Allergic Reaction — Allergic Bronchopulmonary Aspergillosis (ABPA)

People with asthma or cystic fibrosis can develop an allergic reaction to the aspergillus mold. Signs of this allergic form include: [1]

• Fever [1]

• Wheezing [1]

• Cough that may bring up blood or mucus [1]

• Worsening asthma [1]

2. Aspergilloma (Fungus Ball)

Ongoing lung conditions — such as emphysema, tuberculosis, or advanced sarcoidosis — can create cavities (air spaces) in the lungs. Fungus fibers that drift into these cavities can grow into tangled masses known as fungus balls or aspergillomas. [1]

An aspergilloma may produce no symptoms or only a mild cough at first. Without treatment, it worsens the underlying lung condition over time. Possible symptoms include: [1]

• Cough bringing up blood (hemoptysis) [1]

• Fatigue [1]

• Shortness of breath [1]

• Unintentional weight loss [1]

• Wheezing [1]

3. Invasive Aspergillosis — The Most Severe Form

Invasive aspergillosis spreads rapidly from the lungs to the brain, heart, kidneys, or skin. It occurs only in people with weakened immune systems — for example, from cancer chemotherapy, bone marrow transplantation, or immune-system disease. Untreated, it may be fatal. [1]

Because symptoms depend on which organs are affected, they vary widely. In general, they can include:

• Coughing up blood (hemoptysis) [1]

• Chest or joint pain [1]

• Fever and chills [1]

• Headaches or eye symptoms [1]

• Shortness of breath [1]

• Skin lesions [1]

4. Sinus Infection

Aspergillus can also invade the sinuses, producing symptoms that resemble severe sinusitis: [1]

• Stuffy nose [1]

• Drainage that may contain blood [1]

• Fever [1]

• Facial pain [1]

• Headache [1]

Symptoms Compared at a Glance

Form of aspergillosis	Who it affects	Key symptoms	Severity
Allergic reaction (ABPA)	People with asthma or cystic fibrosis [1]	Fever, wheezing, cough with blood or mucus, worsening asthma [1]	Moderate — allergic
Aspergilloma (fungus ball)	People with lung cavities (emphysema, TB, sarcoidosis) [1]	May start mild; coughing up blood, fatigue, shortness of breath, weight loss [1]	Moderate to serious
Invasive aspergillosis	Immunocompromised people only [1]	Hemoptysis, chest/joint pain, fever, headaches, skin lesions, breathlessness [1]	Severe — can be fatal [1]
Sinus infection	Anyone exposed	Stuffy nose, bloody drainage, fever, facial pain, headache [1]	Mild to moderate

What Causes Aspergillosis?

The aspergillus mold is everywhere and unavoidable. Outdoors, it lives in: [1]

• Soil and decaying leaves [1]

• Compost piles [1]

• Plants, trees, and grain crops [1]

For people with healthy immune systems, everyday exposure is rarely a problem. Immune cells surround and destroy the inhaled spores before they can cause harm. [1]

The problem begins when the immune system is weakened. With fewer infection-fighting cells, the aspergillus mold can take hold, invading the lungs and, in serious cases, other parts of the body. [1]

One reassuring fact: aspergillosis is not contagious. It cannot spread from one person to another. [1]

Who is at risk of aspergillosis?

Aspergillosis risk is highest in people with weakened immune systems, though not everyone exposed to the mold gets sick. Five groups face meaningfully higher risk: [1]

1. Weakened immune system — The highest risk belongs to people taking immune-suppressing medicines after transplant surgery. Risk is greatest after bone marrow or stem cell transplants. Certain blood cancers and later-stage AIDS also elevate risk. [1]

2. Low white blood cell level — Chemotherapy, organ transplant, and leukemia can lower white blood cells. An inherited condition called chronic granulomatous disease, which affects immune cells, carries risk too. [1]

3. Lung cavities — Air spaces in the lungs created by prior disease raise the chance of developing aspergillomas. [1]

4. Asthma or cystic fibrosis — People with these conditions may mount an allergic response to the mold, especially when lung problems are long-standing or hard to control. [1]

5. Long-term corticosteroid therapy — Long-term steroid use raises risk, depending on the underlying disease and other medicines being taken. [1]

What are the complications of aspergillosis?

The main complications of aspergillosis are severe lung bleeding and a systemic infection that spreads to the brain, heart and kidneys, and both may be fatal. [1]

• Bleeding. Both aspergillomas and invasive aspergillosis can cause severe, sometimes fatal, lung bleeding. [1]

• Systemic infection. The most serious complication of invasive aspergillosis: the infection spreads to the brain, heart, and kidneys. It moves quickly and may be fatal. [1]

When should you see a doctor about aspergillosis?

Routine care: If you have asthma or cystic fibrosis, see your healthcare provider whenever you notice a change in your breathing. [1]

Emergency — seek immediate medical care if you have a weakened immune system and develop any of the following:

• Unexplained fever [1]

• Shortness of breath [1]

• Cough bringing up blood [1]

Invasive aspergillosis is so dangerous that doctors sometimes begin antifungal treatment as soon as it is suspected — even before testing confirms the diagnosis. [1]

How is aspergillosis diagnosed?

Pinpointing aspergilloma or invasive aspergillosis can be difficult. Aspergillus is hard to tell apart from other molds under a microscope, and its symptoms mimic other lung conditions such as tuberculosis. [2]

Doctors typically use a combination of four tests:

Test	What it does
Imaging test	A chest X-ray or CT scan can usually reveal a fungal mass (aspergilloma) and may show signs of invasive aspergillosis and ABPA [2]
Respiratory secretion test	Sputum (coughed-up mucus) is stained with a dye and checked for aspergillus fibers, then cultured to grow the mold and confirm it [2]
Tissue and blood tests	A skin test injects aspergillus antigen into the forearm — antibodies create a hard red bump; blood tests look for high levels of certain antibodies indicating an allergic response; together they may confirm ABPA [2]
Biopsy	Tissue from the lungs or sinuses is examined under a microscope to confirm invasive aspergillosis — sometimes necessary [2]

What treatment options are available for aspergillosis?

Treatment depends entirely on which form of aspergillosis you have. [2]

1. Observation

Simple, single aspergillomas often do not need treatment at all. Medicines are usually not effective against fungal masses, so doctors monitor with chest X-rays. If the aspergilloma progresses, antifungal medicines may be recommended. [2]

2. Oral Corticosteroids (for Allergic Reactions)

For ABPA, the goal is preventing existing asthma or cystic fibrosis from getting worse. Oral corticosteroids are the best way to achieve this. Antifungals alone are not helpful for ABPA, but they may be combined with corticosteroids to reduce the steroid dose and improve lung function. [2]

3. Antifungal Medicines (for Invasive Aspergillosis)

Antifungals are the standard treatment for invasive pulmonary aspergillosis:

• Voriconazole (Vfend) — the most effective option [2]

• Amphotericin B — another option [2]

Important: All antifungal medicines can cause serious side effects, including kidney and liver damage. Interactions with other medicines are also common. [2]

4. Surgery

Because antifungals do not treat aspergilloma well, surgery to remove the fungal mass is the first choice when an aspergilloma causes bleeding in the lungs. [2]

5. Embolization

Embolization stops lung bleeding caused by an aspergilloma. A doctor injects material that hardens and blocks the blood supply to the bleeding area. It works temporarily — the bleeding is likely to start again. [2]

Treatment Summary

Type	First-line approach	Additional options
Aspergilloma (simple)	Observation with chest X-rays [2]	Antifungals if it progresses; surgery if bleeding [2]
Allergic reaction (ABPA)	Oral corticosteroids [2]	Antifungals combined to reduce steroid dose [2]
Invasive aspergillosis	Antifungals — voriconazole (or amphotericin B), started immediately [1] [2]	Monitoring for kidney/liver side effects
Aspergilloma with bleeding	Surgery to remove the mass [2]	Embolization to stop bleeding (temporary) [2]

How can you prevent aspergillosis by reducing mold exposure?

Avoiding aspergillus entirely is nearly impossible — the mold is simply too common. But if you are at high risk, you can reduce exposure:

• If you have had a transplant or are receiving chemotherapy, avoid places with high mold exposure: construction sites, compost piles, and buildings that store grain. [1]

• If your immune system is weakened, your provider may advise wearing a face mask to avoid aspergillus and other airborne infectious agents. [1]

• Remember: aspergillosis is not contagious, so you cannot catch it from another person. [1]

How should you prepare for an aspergillosis appointment?

People who develop aspergillosis usually have an underlying condition — asthma, cystic fibrosis, or a weakened immune system from illness or immune-suppressing medicines. If you are already being treated, call the healthcare professional who provides that care. [2]

Before Your Visit (6 Steps)

1. Be aware of any pre-appointment restrictions.

2. Write down your symptoms, including any that seem unrelated.

3. Note key personal information, such as major stresses or recent life changes.

4. List all medicines, vitamins, and supplements, including doses.

5. Take a family member or friend to help remember details.

6. Write down your questions.

Questions to Ask Your Doctor (9)

1. What is likely causing my symptoms?

2. What are other possible causes?

3. What tests do I need?

4. Do I need to be hospitalized?

5. What treatment do you recommend?

6. What are possible side effects from the medicines you're recommending?

7. How will you monitor my response to treatment?

8. Am I at risk of long-term complications from this condition?

9. I have another health condition — how can I best manage these together?

Questions Your Doctor Will Likely Ask (6)

1. When did your symptoms begin?

2. How severe are they, and are they getting worse?

3. Have you had a fever?

4. Are you having difficulty breathing?

5. Are you coughing up blood?

6. What else concerns you?

Conclusion

By now, you understand the essentials of this mold-borne condition:

• Aspergillus is everywhere — exposure is unavoidable, but only a few strains and only certain people develop illness.

• The four forms behave very differently — from a manageable allergic reaction in asthma to a rapidly fatal invasive infection in immunocompromised patients.

• Type determines treatment — observation, corticosteroids, antifungals, surgery, or embolization; and the invasive form must be treated immediately, sometimes before tests even confirm it.

With this knowledge, you can recognize the red flags early — especially coughing up blood, fever, or breathlessness with a weakened immune system, which call for emergency care.

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Frequently Asked Questions

What is aspergillosis?

Aspergillosis is an infection caused by the common aspergillus mold, which lives indoors and outdoors. It usually affects the respiratory system and ranges from allergic reactions in people with asthma to life-threatening invasive disease in people with weakened immune systems.

How do you get aspergillosis?

You get aspergillosis by inhaling aspergillus spores found in soil, decaying leaves, compost, plants, and grain crops. Healthy immune systems destroy inhaled spores, so illness mainly occurs in people with weakened immunity, lung cavities, or asthma.

Is aspergillosis contagious?

No. Aspergillosis cannot spread from one person to another. It comes only from inhaling mold spores in the environment.

What are the symptoms of aspergillosis?

Symptoms vary by type but commonly include coughing up blood, wheezing, fever and chills, shortness of breath, and chest or joint pain. Invasive aspergillosis can also cause headaches, eye symptoms, and skin lesions.

Who is most at risk for invasive aspergillosis?

Invasive aspergillosis occurs only in people with weakened immune systems, such as those taking immune-suppressing medicines after transplant surgery, people receiving chemotherapy, those with blood cancers or leukemia, and people with later-stage AIDS.

How is aspergillosis treated?

Treatment depends on the type: simple aspergillomas may only need observation, allergic aspergillosis (ABPA) is treated with oral corticosteroids, invasive aspergillosis is treated immediately with antifungals such as voriconazole, and bleeding aspergillomas may require surgery or embolization.

Can aspergillosis be fatal?

Yes, if left untreated. Invasive aspergillosis can spread rapidly to the brain, heart, and kidneys, and severe lung bleeding from aspergillomas can also be fatal — which is why early recognition and prompt treatment are essential.

References

1. Mayo Clinic Staff. Aspergillosis - Symptoms and causes. Mayo Clinic. Sept. 22, 2025. https://www.mayoclinic.org/diseases-conditions/aspergillosis/symptoms-causes/syc-20369619

2. Mayo Clinic Staff. Aspergillosis - Diagnosis and treatment. Mayo Clinic. Sept. 22, 2025. https://www.mayoclinic.org/diseases-conditions/aspergillosis/diagnosis-treatment/drc-20369623

3. Chen Y, Zhao J, Wang Y, et al. The efficacy and safety of first-line monotherapies in primary therapy of invasive aspergillosis: a systematic review. Front Pharmacol. 2025;15:1530999. PMID: 39881866. https://doi.org/10.3389/fphar.2024.1530999

4. Cheng J, Han H, Kang W, et al. Comparison of antifungal drugs in the treatment of invasive pulmonary aspergillosis: a systematic review and network meta-analysis. Front Microbiol. 2024;15:1504826. PMID: 39687872. https://doi.org/10.3389/fmicb.2024.1504826

5. Francis NZ, Southern KW. Antifungal therapies for allergic bronchopulmonary aspergillosis in people with cystic fibrosis. Cochrane Database Syst Rev. 2022;(9):CD002204. PMID: 36053129. https://doi.org/10.1002/14651858.CD002204.pub5

Medical disclaimer

This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions about a medical condition.