From the Guidelines
Aspergillus pulmonary infection is a type of fungal infection that can manifest in different forms, including chronic pulmonary aspergillosis (CPA), invasive pulmonary aspergillosis (IPA), and allergic forms of aspergillosis.
Types of Aspergillus Pulmonary Infection
- Chronic Pulmonary Aspergillosis (CPA): a rare and problematic pulmonary disease that complicates many other respiratory disorders, affecting approximately 240,000 people in Europe 1. CPA can manifest as chronic cavitary pulmonary aspergillosis (CCPA), Aspergillus nodule, or single aspergilloma.
- Invasive Pulmonary Aspergillosis (IPA): a more rapidly progressive infection that usually occurs in moderately immunocompromised patients, and should be managed as invasive aspergillosis 1.
- Allergic Forms of Aspergillosis: include allergic bronchopulmonary aspergillosis (ABPA) and other forms of allergic reactions to Aspergillus species.
Diagnosis and Management
The diagnosis of CPA requires a combination of characteristics, including one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection, or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months 1.
- Surgical Excision: is recommended for simple aspergilloma, if technically possible, and preferably via video-assisted thoracic surgery technique 1.
- Long-term Oral Antifungal Therapy: is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis, and prevent progression 1.
- Voriconazole: is recommended for the primary treatment of invasive aspergillosis in most patients 1.
Challenges and Limitations
The diagnosis and management of Aspergillus pulmonary infection can be challenging due to non-specific clinical signs and radiographic findings, and the frequent use of azole antifungal prophylaxis may contribute to the development of drug-resistant Aspergillus spp. 1. Therefore, careful monitoring of azole serum concentrations, drug interactions, and possible toxicities is recommended, and alternative diagnostic approaches, such as metagenomic sequencing, may be useful in managing pulmonary invasive fungal infections in patients with haematological malignancies 1.
From the Research
Definition and Types of Aspergillus Pulmonary Infection
- Aspergillus pulmonary infection, also known as pulmonary aspergillosis, is a spectrum of pulmonary disorders caused by the Aspergillus fungus, ranging from hypersensitivity reactions to invasive diseases with significant mortality 2, 3, 4, 5.
- The types of Aspergillus pulmonary infection include:
- Allergic bronchopulmonary aspergillosis (ABPA): a hypersensitivity reaction to Aspergillus antigens, commonly found in patients with asthma or cystic fibrosis 2, 3, 4.
- Chronic pulmonary aspergillosis (CPA): a locally invasive disease, typically presenting in immunocompetent patients with underlying lung pathology 2, 3, 4, 5.
- Invasive pulmonary aspergillosis (IPA): a severe infection in immunocompromised patients, characterized by invasion of pulmonary vasculature by Aspergillus hyphae 2, 3, 4, 5, 6.
- Aspergilloma: typically found in patients with previously formed cavities in the lungs 3, 4.
Risk Factors and Patient Populations
- Immunocompromised patients, such as those with neutropenia or immunodeficiency, are at higher risk of developing invasive pulmonary aspergillosis 2, 3, 4, 5.
- Patients with chronic obstructive pulmonary disease (COPD), liver disease, or critically ill patients are also at increased risk of invasive pulmonary aspergillosis 2, 3, 4.
- Patients with asthma or cystic fibrosis are more likely to develop allergic bronchopulmonary aspergillosis 2, 3, 4.
Diagnosis and Treatment
- Diagnosis of pulmonary aspergillosis is complex and relies on clinical, radiological, and microbiological criteria, which differ according to the type of pulmonary aspergillosis and patient population 5, 6.
- Treatment of pulmonary aspergillosis is primarily with antifungal agents, but may also involve surgical resection or other measures 2, 3, 4, 5.
- Emerging risk factors, such as critically ill patients and those with chronic obstructive pulmonary disease, and the development of noninvasive biomarkers and more effective antifungal agents, have improved patient outcomes 2, 3, 4, 5.