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The European Respiratory Journal Sep 1998Aspergillus is a ubiquitous fungus. It is commonly isolated as an upper respiratory tract saprophyte and is the most frequent contaminant in laboratory specimens.... (Review)
Review
Aspergillus is a ubiquitous fungus. It is commonly isolated as an upper respiratory tract saprophyte and is the most frequent contaminant in laboratory specimens. Because species of aspergillus are omnipresent, one must be cautious in ascribing a causal role to the fungus obtained from patients. Aspergillus has low pathogenicity for humans and animals and rarely invades the immunologically competent host. Although the fungus can affect any organ system, the respiratory tract is involved in >90% of afflicted patients. Pulmonary aspergillosis, depending whether the host is atopic or immunosuppressed, may be classified under four categories: allergic or hypersensitivity syndromes, saprophytic colonization, invasive (infective) dissemination, and chemical or toxic pneumonitis. These entities differ clinically, radiologically, immunologically, and in their response to various therapeutic agents. An increased awareness, an aggressive approach to securing the diagnosis, and instituting early and appropriate therapy are needed to reduce the high morbidity and mortality caused by many of the aspergillus-related syndromes.
Topics: Aspergillosis; Aspergillosis, Allergic Bronchopulmonary; Female; Humans; Lung Diseases, Fungal; Male; Prognosis
PubMed: 9762804
DOI: 10.1183/09031936.98.12030705 -
International Journal of Infectious... Feb 2023A renal transplant recipient aged 68 years experienced multiple complications after an initial good graft function from a deceased donor transplant. Late in the first...
A renal transplant recipient aged 68 years experienced multiple complications after an initial good graft function from a deceased donor transplant. Late in the first week, the patient was oliguric with hematuria; the graft failed in week 2 after the development of a hematoma from a rupture of a renal artery aneurysm. He had a recurrent bleed from the internal iliac graft site and subsequently developed painful dark patches on his leg, distal to where the transplant had been. Histology from the explanted graft and skin biopsies demonstrated Aspergillus flavus; this was also grown in the culture of the external iliac artery tissue. Systemic aspergillosis is rare but well recognized, especially in the immunocompromised. Presentations include mycotic aneurysms and secondary cutaneous aspergillosis from hematogenous spread. Diagnosis requires confirmation by histology or direct culture, but a high β-glucan concentration and positive galactomannan antigen can suggest invasive fungal infection in the early stages of the disease. Cases should be managed with systemic antifungals and involvement of local microbiology services; unfortunately, the prognosis is poor.
Topics: Male; Humans; Aspergillosis; Kidney Transplantation; Aspergillus; Skin; Antifungal Agents
PubMed: 36462573
DOI: 10.1016/j.ijid.2022.11.034 -
The Journal of Infection May 2014The epidemiology, pathogenesis, diagnosis, and management of Aspergillus osteomyelitis are not well understood. (Review)
Review
BACKGROUND
The epidemiology, pathogenesis, diagnosis, and management of Aspergillus osteomyelitis are not well understood.
METHODS
Protocol-defined cases of Aspergillus osteomyelitis published in the English literature were reviewed for comorbidities, microbiology, mechanisms of infection, clinical manifestations, radiological findings, inflammatory biomarkers, antifungal therapy, and outcome.
RESULTS
Among 180 evaluable patients, 127 (71%) were males. Possible predisposing medical conditions in 103 (57%) included pharmacological immunosuppression, primary immunodeficiency, and neutropenia. Seventy-three others (41%) had prior open fracture, trauma or surgery. Eighty (44%) followed a hematogenous mechanism, 58 (32%) contiguous infections, and 42 (23%) direct inoculation. Aspergillus osteomyelitis was the first manifestation of aspergillosis in 77%. Pain and tenderness were present in 80%. The most frequently infected sites were vertebrae (46%), cranium (23%), ribs (16%), and long bones (13%). Patients with vertebral Aspergillus osteomyelitis had more previous orthopedic surgery (19% vs 0%; P = 0.02), while those with cranial osteomyelitis had more diabetes mellitus (32% vs 8%; P = 0.002) and prior head/neck surgery (12% vs 0%; P = 0.02). Radiologic findings included osteolysis, soft-tissue extension, and uptake on T2-weighted images. Vertebral body Aspergillus osteomyelitis was complicated by spinal-cord compression in 47% and neurological deficits in 41%. Forty-four patients (24%) received only antifungal therapy, while 121 (67%) were managed with surgery and antifungal therapy. Overall mortality was 25%. Median duration of therapy was 90 days (range, 10-772 days). There were fewer relapses in patients managed with surgery plus antifungal therapy in comparison to those managed with antifungal therapy alone (8% vs 30%; P = 0.006).
CONCLUSIONS
Aspergillus osteomyelitis is a debilitating infection affecting both immunocompromised and immunocompetent patients. The most common sites are vertebrae, ribs, and cranium. Based upon this comprehensive review, management of Aspergillus osteomyelitis optimally includes antifungal therapy and selective surgery to avoid relapse and to achieve a complete response.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antifungal Agents; Aspergillosis; Aspergillus; Child; Child, Preschool; Debridement; Diagnostic Tests, Routine; Female; Humans; Infant; Male; Middle Aged; Osteomyelitis; Treatment Outcome; Young Adult
PubMed: 24378282
DOI: 10.1016/j.jinf.2013.12.008 -
Clinical Microbiology and Infection :... Jun 2014Methods for susceptibility testing of Aspergillus are developed and validated by the European Committee on Antibiotic Susceptibility Testing Subcommittee on Antifungal... (Review)
Review
Methods for susceptibility testing of Aspergillus are developed and validated by the European Committee on Antibiotic Susceptibility Testing Subcommittee on Antifungal Susceptibility Testing. Breakpoints for phenotypic antimicrobial susceptibility testing have been determined by breakpoint committees and as part of regulatory processes for the approval of new drugs. Dosages, pharmacokinetics, resistance mechanisms, MIC distributions, pharmacodynamics and epidemiological cut-off values are used in the breakpoint-setting process. Clinical breakpoints are for everyday use in the clinical laboratory to advise on patient therapy. Resistance in Aspergillus fumigatus has been increasingly reported since standards became available.
Topics: Antifungal Agents; Aspergillosis; Aspergillus; Drug Resistance, Fungal; Humans; Microbial Sensitivity Tests
PubMed: 24372722
DOI: 10.1111/1469-0691.12514 -
Clinical Microbiology and Infection :... 2001Aspergillus is a genus of fungi commonly found in all environments. Remarkably, only a few species cause disease and equally remarkably, those same species cause... (Review)
Review
Aspergillus is a genus of fungi commonly found in all environments. Remarkably, only a few species cause disease and equally remarkably, those same species cause multiple diseases. In the lung, exposure to the fungus, the immunological status of the individual and the condition of the lung determine the pattern of disease. In asthmatic patients and those with cystic fibrosis, allergic bronchopulmonary aspergillosis (ABPA) is a complication that reduces pulmonary function and, in asthmatics, is substantially improved by itraconazole therapy. Patients with pre-existing lung cavities develop aspergillomas (fungal masses inside the cavity). Aspergillomas carry a 40% 5 years survival, and it not clear whether antifungal therapy is helpful. Similar in presentation to aspergilloma is chronic necrotizing pulmonary aspergillosis (CNPA). Development of new or expansion of existing pulmonary cavities with surrounding paracavitary shadowing is the hallmark of CNPA These two entities are probably a continuum of the same pathological process. Patients with CNPA respond to systemic antifungal therapy, but this may need to be lifelong. Surgery is appropriate for isolated aspergillomas, but not pleural or multicavity lesions. Aspergillus empyema is a complication of aspergilloma and CNPA, or surgery for these diseases and is slow to respond to treatment.
Topics: Antifungal Agents; Aspergillosis; Aspergillosis, Allergic Bronchopulmonary; Chronic Disease; Cystic Fibrosis; Empyema; Humans; Lung Diseases, Fungal; Necrosis; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 11525215
DOI: 10.1111/j.1469-0691.2001.tb00006.x -
Current Opinion in Microbiology Dec 2019The human lung is continually exposed to airborne conidia of the fungus Aspergillus fumigatus (AF) and related species. The innate immune system efficiently eliminates... (Review)
Review
The human lung is continually exposed to airborne conidia of the fungus Aspergillus fumigatus (AF) and related species. The innate immune system efficiently eliminates inhaled AF conidia from the lung in normal individuals, but immunocompromised patients are at risk for highly lethal invasive aspergillosis (IA). Some individuals not at risk for IA may still suffer from failed clearance of AF in the form of noninvasive colonization associated with conditions such as allergic bronchopulmonary aspergillosis. Understanding of normal innate immune function against AF as well as failures of these functions will enable better treatment of these patient groups. In this review, we will focus on recent research that elucidates mechanisms of host defense and their failures resulting in colonization as well as tissue invasion.
Topics: Aspergillosis; Aspergillus fumigatus; Host-Pathogen Interactions; Humans; Immunity, Innate; Lung
PubMed: 31103956
DOI: 10.1016/j.mib.2019.04.003 -
Journal de Mycologie Medicale Mar 2023Invasive mould infections are life-threatening and mainly occur in immunocompromised patients. Whereas aspergillosis is described during haemophagocytic... (Review)
Review
Invasive mould infections are life-threatening and mainly occur in immunocompromised patients. Whereas aspergillosis is described during haemophagocytic lymphohistiocytosis (HLH), only a few cases of concomitant mucormycosis with HLH have been reported. Here, we present an uncommon coinfection of mucormycosis and aspergillosis associated with HLH probably due to a varicella zoster virus (VZV) viraemia which was unresponsive to triple antifungal therapy (liposomal amphotericin B combined with isavuconazole and caspofungin). A review of the cases of mucormycosis with HLH showed that this uncommon association was always lethal and underscored the relevance of screening for mould infections in patients with HLH.
Topics: Humans; Mucormycosis; Antifungal Agents; Coinfection; Lymphohistiocytosis, Hemophagocytic; Aspergillosis; Fungi
PubMed: 36270214
DOI: 10.1016/j.mycmed.2022.101325 -
Frontiers in Public Health 2022This study aimed to investigate the species distribution, antifungal sensitivities, clinical characteristics, and risk factors of patients with invasive aspergillosis...
BACKGROUND
This study aimed to investigate the species distribution, antifungal sensitivities, clinical characteristics, and risk factors of patients with invasive aspergillosis (IA) in a tertiary teaching hospital in Anhui Province.
METHODS
In the present study, 156 isolates were collected from patients admitted to a 2,800-bed comprehensive hospital between January 2019 and April 2021. The epidemiology of species was well-examined, and its antifungal susceptibility was specifically measured by the microbroth dilution method. The risk factors of patients with IA were documented and analyzed intensively. In addition, gene sequencing was employed to determine gene mutations of cytochrome P450 14-α sterol demethylase () associated with azole resistance among .
RESULTS
The species distribution was dominated by (56.41%), (20.51%), and (15.38%) locally. In particular, all species showed very low minimum inhibitory concentrations (MICs, ≤ 0.5 μg/ml) for azoles and echinocandins, slightly high MICs (1.66-2.91 μg/ml) for amphotericin B, and exceptionally high MICs (>64 μg/ml) for flucytosine. Azole-resistant rate of species in this local region reached up to 5.79%. Correlation analyses of multiple antifungals indicate a significant MIC relevance between isavuconazole and voriconazole (Pearson correlation coefficient was 0.81, < 0.0001). The clinical risk factors for patients with IA were found primarily to be pulmonary diseases ( = 0.007) and patients' age ( < 0.001). Notably, three mutant loci (TR46/Y121F/T289A) of the gene were identified in azole-resistant .
CONCLUSIONS
The species emerged increasingly, of which and remained the main pathogens for invasive infections in the local region. The vast majority of species exhibited good susceptibility to all the antifungals, except flucytosine. The local occurrence of azole-resistant species grew gradually and needed monitoring in time. Pulmonary diseases and age were likely considered as highly associated risk factors for IA. To our knowledge, the clinically isolated azole-resistant with TR46/Y121F/T289A mutations identified here were rarely reported in the area of China.
Topics: Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Azoles; Drug Resistance, Fungal; Flucytosine; Fungal Proteins; Humans; Lung Diseases; Risk Factors
PubMed: 35493371
DOI: 10.3389/fpubh.2022.835092 -
Frontiers in Cellular and Infection... 2022Aspergillosis remains difficult to diagnose in animals. Laboratory-based assays are far less developed than those for human medicine, and only few studies have been... (Review)
Review
Challenges to establish the diagnosis of aspergillosis in non-laboratory animals: looking for alternatives in veterinary medicine and demonstration of feasibility through two concrete examples in penguins and dolphins.
Aspergillosis remains difficult to diagnose in animals. Laboratory-based assays are far less developed than those for human medicine, and only few studies have been completed to validate their utility in routine veterinary diagnostics. To overcome the current limitations, veterinarians and researchers have to propose alternative methods including extrapolating from human diagnostic tools and using innovative technology. In the present overview, two specific examples were complementarily addressed in penguins and dolphins to illustrate how is challenging the diagnosis of aspergillosis in animals. Specific focus will be made on the novel application of simple testing in blood based on serological assays or protein electrophoresis and on the new information garnered from metabolomics/proteomics to discover potential new biomarkers. In conclusion, while the diagnostic approach of aspergillosis in veterinary medicine cannot be directly taken from options developed for human medicine, it can certainly serve as inspiration.
Topics: Animals; Aspergillosis; Dolphins; Feasibility Studies; Humans; Proteomics; Spheniscidae
PubMed: 35928207
DOI: 10.3389/fcimb.2022.757200 -
Yonsei Medical Journal 1988
Topics: Aged; Aspergillosis; Empyema; Humans; Lung Diseases, Fungal; Male
PubMed: 3381551
DOI: 10.3349/ymj.1988.29.1.84