Latest News on Aspergillosis Research: Dec – 2019

Aspergillosis

This review discusses important advances in fungal diagnostics and within the antifungal armamentarium as applied to aspergillus species. Recent insights concerning host defenses against aspergillus species and therefore the immunopathogenesis of aspergillus-related diseases are presented. [1]

Aspergillus fumigatus and Aspergillosis

Aspergillus fumigatus is one among the foremost ubiquitous of the airborne saprophytic fungi. Humans and animals constantly inhale numerous conidia of this fungus. The conidia are normally eliminated within the immunocompetent host by innate immune mechanisms, and aspergilloma and allergic bronchopulmonary aspergillosis, uncommon clinical syndromes, are the sole infections observed in such hosts. Thus, A. fumigatus was considered for years to be a weak pathogen. With increases within the number of immunosuppressed patients, however, there has been a dramatic increase in severe and typically fatal invasive aspergillosis, now the foremost common mold infection worldwide. [2]

Allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) complicates asthma and CF. The survival factors in Aspergillus fumigatus that support saprophytic growth in bronchial mucus aren’t understood. Prednisone remains the foremost definitive treatment but needn’t be administered indefinitely. MHC II –restricted CD4+ T H2 clones are derived from patients with ABPA. the entire serum IgE concentration is elevated sharply but is “nonspecific. ” IgE serum isotypic antibodies to A fumigatus are useful in diagnosis; this is often in contrast to things for patients with asthma without ABPA. High-resolution computerized tomography of the chest demonstrates multiple areas of bronchiectasis in most patients with ABPA and may be a useful radiologic tool. [3]

Central nervous system aspergillosis in allogeneic stem cell transplant recipients

Invasive aspergillosis (IA) is comparatively common in allogeneic somatic cell transplant (SCT) recipients. Although lungs are the foremost common site, central systema nervosum (CNS) involvement is additionally observed during this setting. we’ve retrospectively studied 14 cases of CNS aspergillosis found during a cohort of 455 allogeneic SCT recipients (incidence 3%). All patients, except one, had experienced acute graft-versus-host disease treated with high-dose methylprednisolone, and eight patients (57%) had also received ATG. The median time to the diagnosis of CNS aspergillosis was 124 days (range 49–347 days) from SCT. Pulmonary aspergillosis had been diagnosed earlier in four patients (29%). [4]

Chronic Pulmonary Aspergillosis Misdiagnosed as Smear-Negative Pulmonary Tuberculosis in a TB Clinic in Nigeria

The clinical manifestations of chronic pulmonary aspergillosis (CPA) and consumption (PTB) are practically indistinguishable. We present a case of CPA during a 35-year-old HIV-negative trader, who had had three unsuccessful treatment courses for smear-negative PTB. He presented with a five-year history of recurrent symptoms implicational TB (haemoptysis, weight loss and productive cough). His lower respiratory tract smear was acid-fast bacilli negative and GeneXpert analysis was negative for tubercle bacillus. Chest X-rays revealed bilateral apical cavities and bullae. His Aspergillus-specific IgG tests were positive (>40 mg/L). He was managed with itraconazole 200mg twice daily with marked improvement in his clinical presentation and his quality of life after 4 months of therapy. [5]

Reference

[1] Segal, B.H., 2009. Aspergillosis. New England Journal of Medicine, 360(18), (Web Link)

[2] Latgé, J.P., 1999. Aspergillus fumigatus and aspergillosis. Clinical microbiology reviews, 12(2), (Web Link)

[3] Greenberger, P.A., 2002. Allergic bronchopulmonary aspergillosis. Journal of Allergy and Clinical Immunology, 110(5), (Web Link)

[4] Central nervous system aspergillosis in allogeneic stem cell transplant recipients
E Jantunen, L Volin, O Salonen, A Piilonen, T Parkkali, V-J Anttila, A Paetau & T Ruutu
Bone Marrow Transplantation volume 31, (Web Link)

[5] Biamila, T., Bongomin, F., Irurhe, N., Nwosu, A. O. and Oladele, R. O. (2018) “Chronic Pulmonary Aspergillosis Misdiagnosed as Smear-Negative Pulmonary Tuberculosis in a TB Clinic in Nigeria”, Journal of Advances in Medicine and Medical Research, 26(10), (Web Link)

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