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Journal of B.U.ON. : Official Journal... Dec 2018Aspergillosis, which is saprophytic in nature, is known to cause massive destruction of paranasal sinuses in immunocompromised hosts, but in immunocompetent individuals... (Review)
Review
Aspergillosis, which is saprophytic in nature, is known to cause massive destruction of paranasal sinuses in immunocompromised hosts, but in immunocompetent individuals invasive aspergillosis is rare. Diagnosis is posed from history, physical examination including anterior and posterior rhinoscopy, endoscopy of the nose and paranasal sinuses, radiological findings (CT and/or MRI), fungus cultures and histopathological examination. Non-specific presenting symptoms provide time for infection to extent from sinuses to vital surroundings such as bony, vascular and central nervous system structures, thereby increasing morbidity and mortality. Mass lesions involving the sinuses are initially misdiagnosed as tumors, inflammatory pseudotumors or pituitary adenomas. Therefore, diagnosis should be always confirmed by histopathology. Aspergillus sinusitis is a potentially fatal complication of immunosupression or of chemotherapy-induced leucopenia. Concerning patients with hematologic malignancies, it seems that its incidence is progressively increased. A combination of early diagnosis and application of specific antifungals provides the perfect management and prognosis in the corresponding patients. In the current special review, we present new data regarding the infection in patients with hematologic malignancies.
Topics: Aspergillosis; Aspergillus; Hematologic Neoplasms; Humans; Immunocompromised Host; Incidence
PubMed: 30722105
DOI: No ID Found -
Mycopathologia Dec 2014Individuals with structural lung disease or defective immunity are predisposed to Aspergillus-associated disease. Manifestations range from allergic to cavitary or... (Review)
Review
Individuals with structural lung disease or defective immunity are predisposed to Aspergillus-associated disease. Manifestations range from allergic to cavitary or angio-invasive syndromes. Despite daily spore inhalation, immunocompetence facilitates clearance through initiation of innate and adaptive host responses. These include mechanical barriers, phagocyte activation, antimicrobial peptide release and pattern recognition receptor activation. Adaptive responses include Th1 and Th2 approaches. Understanding Aspergillus virulence mechanisms remains critical to the development of effective research and treatment strategies to counteract the fungi. Major virulence factors relate to fungal structure, protease release and allergens; however, mechanisms utilized to evade immune recognition continue to be important in establishing infection. These include the fungal rodlet layer, dihydroxynaphthalene-melanin, detoxifying systems for reactive oxygen species and toxin release. One major immunoevasive toxin, gliotoxin, plays a key role in mediating Aspergillus-associated colonization in the context of cystic fibrosis. Here, it down-regulates vitamin D receptor expression which following itraconazole therapy is rescued concurrent with decreased Th2 cytokine (IL-5 and IL-13) concentrations in the CF airway. This review focuses on the interaction between Aspergillus pathogenic mechanisms, host immune responses and the immunoevasive strategies employed by the organism during disease states such as that observed in cystic fibrosis.
Topics: Aspergillosis; Aspergillus; Humans; Immune Evasion; Virulence Factors
PubMed: 24972669
DOI: 10.1007/s11046-014-9768-y -
Revista Iberoamericana de Micologia 2018The prognosis of invasive fungal infections (IFI) depends on the speed of diagnosis and treatment. Conventional diagnostic methods are of low sensitivity, laborious and... (Review)
Review
The prognosis of invasive fungal infections (IFI) depends on the speed of diagnosis and treatment. Conventional diagnostic methods are of low sensitivity, laborious and too slow, leading to the need for new, faster, and more efficient diagnostic strategies. There are several techniques for diagnosing a candidemia that are faster than the conventional blood culture (BC). Once yeast growth in BC is detected, species identification can be speeded up by mass spectrometry (30minutes), commercialised molecular techniques (60-80minutes) or fluorescent in situ hybridization (90minutes). The combined detection of biomarkers (antimicellium, mannan and anti-mannan or β-glucan) has shown to be of greater use than their individual use. Commercialised nucleic acid amplification techniques (Septifast®, T2Candida®) are very reliable alternatives to BC. The detection of the capsular antigen of Cryptococcus, by means of latex agglutination or immuno-chromatography, is a valuable technique for cryptococcosis diagnosis. Direct microscopic examination and culture of representative specimens is used for the conventional diagnosis of IFI by filamentous fungi. Detection of galactomannan and β-glucan are considered diagnostic criteria for probable invasive aspergillosis and probable IFI, respectively, despite the lack of specificity of the latter. The detection of fungal volatile organic compounds in breath is an interesting diagnostic strategy in pulmonary infections. Although widely used, nucleic acid detection techniques are not considered diagnostic criteria for IFIs caused by moulds in consensus documents, due to their lack of standardisation. However, they are the only alternative to culture methods in invasive infections by Scedosporium/Lomentospora, Fusarium, zygomycetes, or dematiaceous fungi.
Topics: Aspergillosis; Candidiasis, Invasive; Humans; Invasive Fungal Infections
PubMed: 30471895
DOI: 10.1016/j.riam.2018.05.003 -
Mycopathologia Jun 2024Aspergillosis encompasses a wide range of clinical conditions based on the interaction between Aspergillus and the host. It ranges from colonization to invasive... (Review)
Review
Aspergillosis encompasses a wide range of clinical conditions based on the interaction between Aspergillus and the host. It ranges from colonization to invasive aspergillosis. The human lung provides an entry door for Aspergillus. Aspergillus has virulence characteristics such as conidia, rapid growth at body temperature, and the production of specific proteins, carbohydrates, and secondary metabolites that allow A. fumigatus to infiltrate the lung's alveoli and cause invasive aspergillosis. Alveolar epithelial cells play an important role in both fungus clearance and immune cell recruitment via cytokine release. Although the innate immune system quickly clears conidia in immunocompetent hosts, A. fumigatus has evolved multiple virulence factors in order to escape immune response such as ROS detoxifying enzymes, the rodlet layer, DHN-melanin and toxins. Bacterial co-infections or interactions can alter the immune response, impact Aspergillus growth and virulence, enhance biofilm formation, confound diagnosis, and reduce treatment efficacy. The gut microbiome's makeup influences pulmonary immune responses generated by A. fumigatus infection and vice versa. The real-time PCR for Aspergillus DNA detection might be a particularly useful tool to diagnose pulmonary aspergillosis. Metagenomics analyses allow quick and easy detection and identification of a great variety of fungi in different clinical samples, although optimization is still required particularly for the use of NGS techniques. This review will analyze the current state of aspergillosis in light of recent discoveries in the microbiota and mycobiota.
Topics: Humans; Aspergillosis; Mycobiome; Aspergillus fumigatus; Aspergillus; Virulence Factors; Microbiota; Virulence; Metagenomics; Host-Pathogen Interactions
PubMed: 38864956
DOI: 10.1007/s11046-024-00853-2 -
Revue Medicale Suisse Nov 2014Aspergillus pulmonary infection causes a spectrum of diverse diseases according to host immunity. The two major entities are invasive pulmonary aspergillosis and chronic... (Review)
Review
Aspergillus pulmonary infection causes a spectrum of diverse diseases according to host immunity. The two major entities are invasive pulmonary aspergillosis and chronic pulmonary aspergillosis. The later can be divided into aspergilloma, then into chronic cavitary, more or less fibrosing aspergillosis, and finally into chronic necrotizing aspergillosis, or semiinvasive aspergillosis. The present article reviews this complex classification, which is necessary to reflect the diverse clinical aspect of the disease. Allergic broncho-pulmonary aspergillosis (ABPA), which is more a hypersensitivity reaction than an infectious process, will not be discussed here.
Topics: Aspergillosis, Allergic Bronchopulmonary; Chronic Disease; Diagnosis, Differential; Humans; Invasive Pulmonary Aspergillosis; Pulmonary Aspergillosis
PubMed: 25603567
DOI: No ID Found -
Revista Iberoamericana de Micologia 2018Critically ill patients without severe immunosuppression make up a population in which invasive aspergillosis (IA) has been identified as an emergent pathology. Chronic... (Review)
Review
Critically ill patients without severe immunosuppression make up a population in which invasive aspergillosis (IA) has been identified as an emergent pathology. Chronic treatment with corticosteroids, chronic obstructive pulmonary disease, and liver cirrhosis are repeatedly identified risk factors. However, due to the non-specificity of the symptoms and signs in the critical patient, and the relative low diagnostic capacity of the complementary tests, the diagnosis of the IA is a challenge for the specialist in critical care medicine. The application of diagnostic algorithms adapted to critical patients, in whom activation will depend on the isolation of Aspergillus in a respiratory specimen, is the most efficient diagnostic methodology in this population. Among the diagnostic approaches, the determination of galactomannan in bronchoalveolar fluid is the most useful diagnostic test. Once the suspicion is established, treatment should be started as soon as possible. Voriconazole, amphotericin B, and isavuconazole are the most effective treatments. Although voriconazole and amphotericin B are the drugs with the most scientific evidence, they are related with adverse effects and pharmacokinetic difficulties. Therefore, isavuconazole, which has shown high efficacy and safety in other populations, is a potential alternative of great interest for critically ill patients.
Topics: Antifungal Agents; Aspergillosis; Critical Illness; Humans; Invasive Fungal Infections
PubMed: 30554674
DOI: 10.1016/j.riam.2018.07.001 -
Cold Spring Harbor Perspectives in... Nov 2014Survival rates among immunocompromised patients with invasive mold infections have markedly improved over the last decade with earlier diagnosis and new antifungal... (Review)
Review
Survival rates among immunocompromised patients with invasive mold infections have markedly improved over the last decade with earlier diagnosis and new antifungal treatment options. Yet, increasing antifungal resistance, breakthrough infections with intrinsically resistant fungi, and potentially life-threatening adverse effects and drug interactions are becoming more problematic, especially with prolonged therapy. Evidence-based recommendations for treating invasive aspergillosis and mucormycosis provide excellent guidance on the initial workup and treatment of these molds, but they cannot address all of the key management issues. Herein, we discuss 10 general treatment principles in the management of invasive mold disease in immunocompromised patients and discuss how these principles can be integrated to develop an effective, individualized treatment plan.
Topics: Antifungal Agents; Aspergillosis; Disease Management; Fungi; Humans; Immunocompromised Host; Mucormycosis
PubMed: 25377139
DOI: 10.1101/cshperspect.a019737 -
Seminars in Respiratory and Critical... Jun 2021Invasive fungal infections threaten lung transplant outcomes with high associated morbidity and mortality. Pharmacologic prophylaxis may be key to prevent posttransplant...
Invasive fungal infections threaten lung transplant outcomes with high associated morbidity and mortality. Pharmacologic prophylaxis may be key to prevent posttransplant invasive fungal infections, but cost, adverse effects, and absorption issues are barriers to effective prophylaxis. Trends in fungal infection diagnostic strategies utilize molecular diagnostic methodologies to complement traditional histopathology and culture techniques. While lung transplant recipients are susceptible to a variety of fungal pathogens, spp. and spp. infections remain the most common. With emerging resistant organisms and multiple novel antifungal agents in the research pipeline, it is likely that treatment strategies will continue to evolve.
Topics: Antifungal Agents; Aspergillosis; Humans; Invasive Fungal Infections; Lung Transplantation; Mycoses
PubMed: 34030208
DOI: 10.1055/s-0041-1729173 -
Medicina 2023Invasive aspergillosis (IA) is a serious disease with high mortality. There are several risk factors and in-hospital outbreaks related with construction have been...
Invasive aspergillosis (IA) is a serious disease with high mortality. There are several risk factors and in-hospital outbreaks related with construction have been described. An entity related to COVID-19 infection, known as COVID-19 associated pulmonary aspergillosis (CAPA), has recently appeared. Early and appropriate treatment is of paramount importance, especially in immunocompromised and critically ill patients. Diagnosis is based on recognition of predisposing factors, clinical signs, imaging, direct examination, culture, histopathology, and biomarkers such as galactomannan. The drug of choice is voriconazole, but alternative therapies must be taken into account given the increasing presence of resistant isolates.
Topics: Humans; COVID-19; Aspergillosis; COVID-19 Testing
PubMed: 36774601
DOI: No ID Found -
Seminars in Respiratory and Critical... Feb 2024In the last decade, fungal respiratory diseases have been increasingly investigated for their impact on the clinical course of people with cystic fibrosis (CF), with a... (Review)
Review
In the last decade, fungal respiratory diseases have been increasingly investigated for their impact on the clinical course of people with cystic fibrosis (CF), with a particular focus on infections caused by spp. The most common organisms from this genus detected from respiratory cultures are and , followed by , , and . These species have been identified to be both chronic colonizers and sources of active infection and may negatively impact lung function in people with CF. This review article discusses definitions of aspergillosis, challenges in clinical practice, and current literature available for laboratory findings, clinical diagnosis, and treatment options for pulmonary diseases caused by spp. in people with CF.
Topics: Humans; Cystic Fibrosis; Pulmonary Aspergillosis; Aspergillosis; Aspergillus fumigatus
PubMed: 38286138
DOI: 10.1055/s-0043-1777267