Pulmonary Aspergillosis: An Evolving Challenge for Diagnosis and Treatment
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REVIEW
Pulmonary Aspergillosis: An Evolving Challenge for Diagnosis and Treatment Alessandro Russo . Giusy Tiseo . Marco Falcone . Francesco Menichetti
Received: May 29, 2020 Ó The Author(s) 2020
ABSTRACT Aspergillus is a mold that may lead to different clinical pictures, from allergic to invasive disease, depending on the patient’s immune status and structural lung diseases. Chronic pulmonary aspergillosis is an infection with a locally invasive presentation, reported especially in patients with chronic pulmonary disease, while aspergilloma is typically found in patients with previously formed cavities in the lungs. Allergic bronchopulmonary aspergillosis is due to a hypersensitivity reaction to Aspergillus antigens and is more frequently described in patients with moderate-severe asthma or cystic fibrosis. Invasive pulmonary aspergillosis mainly occurs in patients with neutropenia or immunodeficiency, but has increasingly been recognized as an emerging disease of non-neutropenic patients. The significance of this infection has dramatically increased in recent years, considering the high number of patients with an impaired immune state associated with the management and treatment of neoplasm, solid or hematological transplantation, autoimmune diseases, and inflammatory conditions. Moreover, Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12555416. A. Russo (&) G. Tiseo M. Falcone F. Menichetti Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy e-mail: [email protected]
prolonged steroid treatment is recognized as an important risk factor, especially for invasive disease. In this setting, critically ill patients admitted to intensive care units and/or with chronic obstructive pulmonary disease could be at higher risk for invasive infection. This review provides an update on the clinical features and risk factors of pulmonary aspergillosis. Current approaches for the diagnosis, management, and treatment of these different forms of pulmonary aspergillosis are discussed.
Keywords: Aspergillus; Invasive aspergillosis; neutropenic patients
Galactomannan; Lung disease; Non-
Key Summary Points ABPA, CPA, and IPA represent the three main categories of pulmonary aspergillosis. ABPA should be suspected in patients with uncontrolled asthma or cystic fibrosis. Treatment of CPA is important to prevent life-threatening hemoptysis. Assessments of emerging risk factors for IPA and early diagnosis are crucial to improve outcome. Adequate duration of antifungal therapy for IPA is an unresolved issue.
Infect Dis Ther
INTRODUCTION The clinical presentation of Aspergillus lung disease is determined by the interaction between the fungus and host. There are three main categories of pulmonary aspergillosis: allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA), and invasive pulmonary aspergillosis (IPA), as reported in Fig. 1. ABPA is due to a hypersensitivity rea
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