Aspergillosis: an Update on Clinical Spectrum, Diagnostic Schemes, and Management

Abstract

Purpose of Review This review gives an overview of the diseases caused by Aspergillus , including a description of the species involved and the infected clinical systems. We provide insight into the various diagnostic methods available for diagnosing aspergillosis, particularly invasive aspergillosis (IA), including the role of radiology, bronchoscopy, culture, and non-culture-based microbiological methods. We also discuss the available diagnostic algorithms for the different disease conditions. This review also summarizes the main aspects of managing infections due to Aspergillus spp., such as antifungal resistance, choice of antifungals, therapeutic drug monitoring, and new antifungal alternatives. Recent Findings The risk factors for this infection continue to evolve with the development of many biological agents that target the immune system and the increase of viral illnesses such as coronavirus disease. Due to the limitations of present mycological test methods, establishing a fast diagnosis is frequently difficult, and reports of developing antifungal resistance further complicate the management of aspergillosis. Many commercial assays, like AsperGenius®, MycAssay Aspergillus®, and MycoGENIE®, have the advantage of better species-level identification and concomitant resistance-associated mutations. Fosmanogepix, ibrexafungerp, rezafungin, and olorofim are newer antifungal agents in the pipeline exhibiting remarkable activity against Aspergillus spp. Summary The fungus Aspergillus is found ubiquitously around the world and can cause various infections, from harmless saprophytic colonization to severe IA. Understanding the diagnostic criteria to be used in different patient groups and the local epidemiological data and antifungal susceptibility profile is critical for optimal patient management.

Calcium oxalate crystals in pulmonary aspergillosis

“…reactions, airway or lung invasion, to extrapulmonary dissemination, mostly caused by Aspergillus fumigatus. 4,5 Since imaging findings in pulmonary aspergillosis vary and are usually nonspecific, 6 and both microscopic examination and cultures are reported to have low sensitivity, 2 the diagnosis of pulmonary aspergillosis relies on a combination of microbiological and histopathological findings, host factors, and clinical and radiological evidence. 5 Fine-needle aspiration cytology, 7 exfoliative cytology, 8 and imprint cytology 9 can provide a relatively reliable, safe and quick method of diagnosing pulmonary infection, particularly in immunocompromised patients, 7 as well as in distinguishing infection from malignancy.…”

“…Aspergillus is a ubiquitous fungus in the environment and after inhalation of airborne spores, the clinical spectrum is mostly dependent on the host immune response 3 . A wide range of clinical syndromes can occur in aspergillosis, from asymptomatic colonization, allergic reactions, airway or lung invasion, to extrapulmonary dissemination, mostly caused by Aspergillus fumigatus 4,5 …”

Chemical Genetics in C. elegans Identifies Anticancer Mycotoxins Chaetocin and Chetomin as Potent Inducers of a Nuclear Metal Homeostasis Response

“…Interest in ETPs is growing, and variants designed for derivatization have been synthesized that retain activity against a wide range of cancer cell types. ,, ETP producing fungi infect immunocompromised individuals, and mycotoxins are environmental hazards present in damp buildings and food crops. , While mechanisms for ETP toxicity have been identified, very little is known about adaptive responses that promote resistance in cells other than in the Chaetomiaceae fungi that synthesize them . Understanding these responses could help improve safety and efficacy, provide insights into how cells might develop resistance, and improve the treatment of infections and exposures.…”

Potential Fungal Zoonotic Pathogens in Cetaceans: An Emerging Concern

“…Aspergillus is a genus of filamentous fungi comprising numerous species of clinical and environmental importance. In humans, it is notably implicated in a range of conditions known as aspergilloses, with manifestations varying from non-invasive allergic reactions to severe invasive pulmonary infections, influenced by the host’s immune responses [ 102 , 103 , 104 ]. The ubiquitous nature of Aspergillus conidia, coupled with their potential to initiate localized or systemic infections post-inhalation or -inoculation, poses significant health risks, particularly in the context of host immune states [ 102 , 103 , 104 ]).…”