Dear Dr. Donohue: About four months ago, I started coughing up flecks of blood. My doctor put me on antibiotics for bronchitis. They didn't do any good. I went to a lung doctor, who made the diagnosis of aspergillosis. By this time the blood had disappeared, and the doctor said not to do anything at the present. Is that the usual treatment of this infection? -- A.K.

Dear A.K.: If ever there were a fungus that fit the saying "there's a fungus among us," it has to be Aspergillus. It's everywhere -- in decaying vegetation, in soil, in food, in water and in the air. No one on planet Earth escapes contact with it. However, it causes trouble only in a very few.

One Aspergillus-caused problem (not yours) is an allergic reaction in those who have either asthma or cystic fibrosis. A typical story is that of an asthmatic farmer who experiences a severe asthma attack upon entering a barn containing moldy hay. The mold is Aspergillus. Cortisone drugs control this kind of aspergillosis.

Invasive aspergillosis is a very serious infection in which the fungus infiltrates lung tissue and causes a pneumonialike illness. It happens to people whose immune systems are not up to par. Antifungal medicines are urgently needed for these people. This isn't your variety of aspergillosis either.

Most likely you have a fungal ball, a skein of fungi, in a lung cavity. The cavity could be from an old, healed TB infection, emphysema or a similar lung problem. The fungal ball can erode blood vessels and cause bleeding, which shows up as blood-tinged sputum. Your bleeding has stopped.

There's no consensus about what to do with someone like you. Observation is often the wisest choice. If the bleeding resumes, then surgical removal -- a quite delicate operation -- is one possibility. Some suggest instilling antifungal medicines into the lung cavity. For the present, your doctor has chosen the safest approach.
 

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