|Fungi and Disease|
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
A profusion of fungi exists in the environment. Some fungi are able to cause an invasive infection in otherwise healthy individuals. Other fungi are opportunistic fungi that become invasive when immune defenses are compromised. Diagnosis of fungal infection is difficult. There are many problems when you try to connect a test result to a disease. Fungi are so abundant and there are so many varieties in every environment that it is seldom easy to pick just one cause among many. Fungi are inhaled and ingested. Foods always contain fungal spores and actively growing molds. Attempts to culture fungi often fail; only a small number grow in the culture media commonly used. Some new methods of detecting fungal DNA may be useful but development of reliable tests is slow and expensive.
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