Aspergillus

The genus Aspergillus includes over 185 fungal species;  20 species have been identified as opportunistic pathogens in humans.

Aspergillus fumigatus causes allergic bronchopulmonary aspergillosis, pulmonary aspergilloma, chronic necrotizing pulmonary aspergillosis and life-threatening invasive aspergillosis in immune compromised patients.

Diagnosis is difficult: cultures are unreliable. Microscopic examination from biopsy specimens when the disease is expected will reveal mycelial growth with septated hyphae.

A beta-D glucan assay is a nonspecific blood test for invasive deep mycosis, including aspergillosis. Another  test detects galactomannan, a constituent of the cell wall of Aspergillus organisms with reports of > 90% sensitivity and > 85% specificity. Newer tests identify fungal DNA and permit rapid diagnosis.

Amphotericin B is has been used to treat invasive aspergillosis. New antifungals such as voriconazole, are less toxic with better outcomes.

The incidence of aspergillosis infection has increased with more immune suppressed, hospitalized patients. Often treatments of other diseases supress immune defenses: some examples are cytotoxic chemotherapy for cancer, immune suppression after organ transplants,  graft-vs-host disease following stem cell transplantation.

The rapidly increasing popularity of immune supressing antibody treatments such as tumor necrosis factor antagonists (e.g. infliximab) create a high risk for invasive aspergillosis in non-hospitalized patients.

Thomas F. Patterson. Fungal Infection in the Immunocompromised Patient: Risk Assessment and the Role of Antifungal Agents. Medscape CME Online Accessed July 2006

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