What is Aspergillus niger (a fungus species)?

From the Guidelines

Aspergillus niger is a species of filamentous fungi that can cause opportunistic infections in immunocompromised individuals, and treatment usually involves antifungal medications like voriconazole or amphotericin B, as recommended by the Infectious Diseases Society of America in their 2016 guidelines 1.

Key Points

• Aspergillus niger is widely found in soil, decaying vegetation, and indoor environments, and is generally considered non-pathogenic to humans with healthy immune systems.
• However, it can cause opportunistic infections in immunocompromised individuals, such as those with HIV/AIDS, undergoing chemotherapy, or taking immunosuppressive medications.
• The fungus typically appears as black colonies with a white or yellow edge when grown on culture media, and can cause aspergillosis, particularly pulmonary infections or otomycosis (ear infections).
• Treatment for Aspergillus niger infections usually involves antifungal medications, with the specific regimen depending on the infection site and severity, as outlined in the 2016 guidelines by the Infectious Diseases Society of America 1.

Recommendations

• Voriconazole is recommended as the primary treatment for invasive aspergillosis in most patients, according to the 2016 guidelines by the Infectious Diseases Society of America 1.
• Liposomal amphotericin B can be considered as alternative primary therapy in some patients, as suggested by a randomized trial comparing two doses of liposomal amphotericin B (L-AMB) 1.
• The treatment regimen should be individualized based on the patient's specific circumstances, including the infection site and severity, as well as any underlying medical conditions or immunocompromised state.

Important Considerations

• Aspergillus niger has significant industrial importance, and is used in the production of citric acid, enzymes like amylases and proteases, and other commercial products.
• The frequency and relative importance of Aspergillus infections are on the rise in developed countries, possibly related to increased numbers of immunocompromised patients, as noted in the 2000 practice guidelines for diseases caused by Aspergillus 1.
• The 2016 guidelines by the Infectious Diseases Society of America provide a comprehensive overview of the diagnosis, treatment, and prevention of aspergillosis, and are intended to summarize the current evidence for treatment of different forms of aspergillosis 1.

From the FDA Drug Label

Voriconazole has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections Aspergillus fumigatus Aspergillus flavus Aspergillus niger Aspergillus terreus

• Voriconazole efficacy against Aspergillus niger:
  • In study 307/602,1 out of 4 patients with Aspergillus niger infections had a satisfactory global response 2.
  • In study 304,2 out of 2 patients with Aspergillus niger infections had success 2.
  • In studies 304 and 309/604,4 out of 5 patients with Aspergillus niger infections had success 2. Voriconazole is effective against Aspergillus niger.

From the Research

Aspergillus niger Treatment

• Aspergillus niger is a type of fungus that can cause invasive aspergillosis, a serious infection that can be life-threatening 3, 4, 5.
• Voriconazole is a broad-spectrum triazole antifungal agent that has been shown to be effective in treating invasive aspergillosis, including cases caused by Aspergillus niger 3, 5.
• Inhaled liposomal amphotericin B and oral voriconazole have also been used in combination to treat intractable chronic progressive pulmonary aspergillosis caused by Aspergillus niger 4.

Antifungal Therapies

• Currently available antifungal therapies for Aspergillus spp. include triazoles, echinocandins, and amphotericin B products 6.
• These therapies have significant limitations, including toxicities, drug-drug interactions, pharmacokinetic variability, and emerging resistance 6.
• New options are being developed, including rezafungin, ibrexafungerp, inhaled opelconazole, and oral forms of amphotericin B 6.

Treatment Outcomes

• Voriconazole has been shown to have superior efficacy and better survival rates compared to amphotericin B deoxycholate for primary treatment of invasive aspergillosis 3, 5, 7.
• The use of other licensed antifungal therapies (OLAT) after initial treatment with voriconazole or amphotericin B deoxycholate can impact treatment outcomes, with fewer patients in the voriconazole group requiring OLAT 7.
• Salvage therapy with lipid formulations of amphotericin B after initial treatment with amphotericin B deoxycholate has limited efficacy 7.