Editorial

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Open AccessEditorial

Special Issue “Aspergillus fumigatus: From Diagnosis to Therapy”

by William J. Steinbach

J. Fungi 2016, 2(4), 31; https://doi.org/10.3390/jof2040031 - 08 Dec 2016

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Abstract

Aspergillus fumigatus is an enigmatic pathogen. Full article

(This article belongs to the Special Issue Aspergillus fumigatus: From Diagnosis to Therapy)

Review

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Open AccessReview

Allergic Aspergillus Rhinosinusitis

by Arunaloke Chakrabarti and Harsimran Kaur

J. Fungi 2016, 2(4), 32; https://doi.org/10.3390/jof2040032 - 08 Dec 2016

Cited by 25 | Viewed by 9960

Abstract

Allergic fungal rhinosinusitis (AFRS) is a unique variety of chronic polypoid rhinosinusitis usually in atopic individuals, characterized by presence of eosinophilic mucin and fungal hyphae in paranasal sinuses without invasion into surrounding mucosa. It has emerged as an important disease involving a large [...] Read more.

Allergic fungal rhinosinusitis (AFRS) is a unique variety of chronic polypoid rhinosinusitis usually in atopic individuals, characterized by presence of eosinophilic mucin and fungal hyphae in paranasal sinuses without invasion into surrounding mucosa. It has emerged as an important disease involving a large population across the world with geographic variation in incidence and epidemiology. The disease is surrounded by controversies regarding its definition and etiopathogenesis. A working group on “Fungal Sinusitis” under the International Society for Human and Animal Mycology (ISHAM) addressed some of those issues, but many questions remain unanswered. The descriptions of “eosinophilic fungal rhinosinusitis” (EFRS), “eosinophilic mucin rhinosinusitis” (EMRS) and mucosal invasion by hyphae in few patients have increased the problem to delineate the disease. Various hypotheses exist for etiopathogenesis of AFRS with considerable overlap, though recent extensive studies have made certain in depth understanding. The diagnosis of AFRS is a multi-disciplinary approach including the imaging, histopathology, mycology and immunological investigations. Though there is no uniform management protocol for AFRS, surgical clearing of the sinuses with steroid therapy are commonly practiced. The role of antifungal agents, leukotriene antagonists and immunomodulators is still questionable. The present review covers the controversies, recent advances in pathogenesis, diagnosis, and management of AFRS. Full article

(This article belongs to the Special Issue Aspergillus fumigatus: From Diagnosis to Therapy)

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Open AccessReview

Treatment of Primary Pulmonary Aspergillosis: An Assessment of the Evidence

by Ethan R. Stewart and George R. Thompson

J. Fungi 2016, 2(3), 25; https://doi.org/10.3390/jof2030025 - 08 Sep 2016

Cited by 7 | Viewed by 4452 | Correction

Abstract

Aspergillus spp. are a group of filamentous molds that were first described due to a perceived similarity to an aspergillum, or liturgical device used to sprinkle holy water, when viewed under a microscope. Although commonly inhaled due to their ubiquitous nature within the [...] Read more.

Aspergillus spp. are a group of filamentous molds that were first described due to a perceived similarity to an aspergillum, or liturgical device used to sprinkle holy water, when viewed under a microscope. Although commonly inhaled due to their ubiquitous nature within the environment, an invasive fungal infection (IFI) is a rare outcome that is often reserved for those patients who are immunocompromised. Given the potential for significant morbidity and mortality within this patient population from IFI due to Aspergillus spp., along with the rise in the use of therapies that confer immunosuppression, there is an increasing need for appropriate initial clinical suspicion leading to accurate diagnosis and effective treatment. Voriconazole remains the first line agent for therapy; however, the use of polyenes, novel triazole agents, or voriconazole in combination with an echinocandin may also be utilized. Consideration as to which particular agent and for what duration should be made in the individual context for each patient based upon underlying immunosuppression, comorbidities, and overall tolerance of therapy. Full article

(This article belongs to the Special Issue Aspergillus fumigatus: From Diagnosis to Therapy)

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Open AccessReview

PCR Technology for Detection of Invasive Aspergillosis

by Rosemary A. Barnes and P. Lewis White

J. Fungi 2016, 2(3), 23; https://doi.org/10.3390/jof2030023 - 11 Aug 2016

Cited by 6 | Viewed by 4565

Abstract

The application of molecular technologies to aid diagnosis and management of infectious diseases has had a major impact and many assays are in routine use. Diagnosis of aspergillosis has lagged behind. Lack of standardization and limited commercial interest have meant that PCR was [...] Read more.

The application of molecular technologies to aid diagnosis and management of infectious diseases has had a major impact and many assays are in routine use. Diagnosis of aspergillosis has lagged behind. Lack of standardization and limited commercial interest have meant that PCR was not included in consensus diagnostic criteria for invasive fungal disease. In the last ten years careful evaluation and validation by the Aspergillus European PCR initiative with the development of standardized extraction, amplification and detection protocols for various specimen types, has provided the opportunity for clinical utility to be investigated. PCR has the potential to not only exclude a diagnosis of invasive aspergillosis but in combination with antigen testing may offer an approach for the early diagnosis and treatment of invasive aspergillosis in high-risk populations, with the added benefit of detection of genetic markers associated with antifungal resistance. Full article

(This article belongs to the Special Issue Aspergillus fumigatus: From Diagnosis to Therapy)

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Open AccessReview

Galactomannan and 1,3-β-d-Glucan Testing for the Diagnosis of Invasive Aspergillosis

by Frédéric Lamoth

J. Fungi 2016, 2(3), 22; https://doi.org/10.3390/jof2030022 - 04 Jul 2016

Cited by 56 | Viewed by 11654

Abstract

Invasive aspergillosis (IA) is a severe complication among hematopoietic stem cell transplant recipients or patients with hematological malignancies and neutropenia following anti-cancer therapy. Moreover, IA is increasingly observed in other populations, such as solid-organ transplant recipients, patients with solid tumors or auto-immune diseases, [...] Read more.

Invasive aspergillosis (IA) is a severe complication among hematopoietic stem cell transplant recipients or patients with hematological malignancies and neutropenia following anti-cancer therapy. Moreover, IA is increasingly observed in other populations, such as solid-organ transplant recipients, patients with solid tumors or auto-immune diseases, and among intensive care unit patients. Frequent delay in diagnosis is associated with high mortality rates. Cultures from clinical specimens remain sterile in many cases and the diagnosis of IA often only relies on non-specific radiological signs in the presence of host risk factors. Tests for detection of galactomannan- (GM) and 1,3-β-d-glucan (BDG) are useful adjunctive tools for the early diagnosis of IA and may have a role in monitoring response to therapy. However, the sensitivity and specificity of these fungal biomarkers are not optimal and variations between patient populations are observed. This review discusses the role and interpretation of GM and BDG testing for the diagnosis of IA in different clinical samples (serum, bronchoalveolar lavage fluid, cerebrospinal fluid) and different groups of patients (onco-hematological patients, solid-organ transplant recipients, other patients at risk of IA). Full article

(This article belongs to the Special Issue Aspergillus fumigatus: From Diagnosis to Therapy)

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Open AccessReview

Triazole Resistance in Aspergillus spp.: A Worldwide Problem?

by Olga Rivero-Menendez, Ana Alastruey-Izquierdo, Emilia Mellado and Manuel Cuenca-Estrella

J. Fungi 2016, 2(3), 21; https://doi.org/10.3390/jof2030021 - 04 Jul 2016

Cited by 115 | Viewed by 9655

Abstract

Since the first description of an azole-resistant A. fumigatus strain in 1997, there has been an increasing number of papers describing the emergence of azole resistance. Firstly reported in the USA and soon after in Europe, it has now been described worldwide, challenging [...] Read more.

Since the first description of an azole-resistant A. fumigatus strain in 1997, there has been an increasing number of papers describing the emergence of azole resistance. Firstly reported in the USA and soon after in Europe, it has now been described worldwide, challenging the management of human aspergillosis. The main mechanism of resistance is the modification of the azole target enzyme: 14-α sterol demethylase, encoded by the cyp51A gene; although recently, other resistance mechanisms have also been implicated. In addition, a shift in the epidemiology has been noted with other Aspergillus species (mostly azole resistant) increasingly being reported as causative agents of human disease. This paper reviews the current situation of Aspergillus azole resistance and its implications in the clinical setting. Full article

(This article belongs to the Special Issue Aspergillus fumigatus: From Diagnosis to Therapy)

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Open AccessReview

Pediatric Invasive Aspergillosis

by Rachel L. Wattier and Lynn Ramirez-Avila

J. Fungi 2016, 2(2), 19; https://doi.org/10.3390/jof2020019 - 13 Jun 2016

Cited by 10 | Viewed by 5696

Abstract

Invasive aspergillosis (IA) is a disease of increasing importance in pediatrics due to growth of the immunocompromised populations at risk and improvements in long-term survival for many of these groups. While general principles of diagnosis and therapy apply similarly across the age spectrum, [...] Read more.

Invasive aspergillosis (IA) is a disease of increasing importance in pediatrics due to growth of the immunocompromised populations at risk and improvements in long-term survival for many of these groups. While general principles of diagnosis and therapy apply similarly across the age spectrum, there are unique considerations for clinicians who care for children and adolescents with IA. This review will highlight important differences in the epidemiology, clinical manifestations, diagnosis, and therapy of pediatric IA. Full article

(This article belongs to the Special Issue Aspergillus fumigatus: From Diagnosis to Therapy)

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Open AccessReview

Chronic Pulmonary Aspergillosis—Where Are We? and Where Are We Going?

by Gemma E. Hayes and Lilyann Novak-Frazer

J. Fungi 2016, 2(2), 18; https://doi.org/10.3390/jof2020018 - 07 Jun 2016

Cited by 49 | Viewed by 12735

Abstract

Chronic pulmonary aspergillosis (CPA) is estimated to affect 3 million people worldwide making it an under recognised, but significant health problem across the globe, conferring significant morbidity and mortality. With variable disease forms, high levels of associated respiratory co-morbidity, limited therapeutic options and [...] Read more.

Chronic pulmonary aspergillosis (CPA) is estimated to affect 3 million people worldwide making it an under recognised, but significant health problem across the globe, conferring significant morbidity and mortality. With variable disease forms, high levels of associated respiratory co-morbidity, limited therapeutic options and prolonged treatment strategies, CPA is a challenging disease for both patients and healthcare professionals. CPA can mimic smear-negative tuberculosis (TB), pulmonary histoplasmosis or coccidioidomycosis. Cultures for Aspergillus are usually negative, however, the detection of Aspergillus IgG is a simple and sensitive test widely used in diagnosis. When a fungal ball/aspergilloma is visible radiologically, the diagnosis has been made late. Sometimes weight loss and fatigue are predominant symptoms; pyrexia is rare. Despite the efforts of the mycology community, and significant strides being taken in optimising the care of these patients, much remains to be learnt about this patient population, the disease itself and the best use of available therapies, with the development of new therapies being a key priority. Here, current knowledge and practices are reviewed, and areas of research priority highlighted. Full article

(This article belongs to the Special Issue Aspergillus fumigatus: From Diagnosis to Therapy)

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Open AccessReview

Allergic Bronchopulmonary Aspergillosis

by Michael C. Tracy, Caroline U. A. Okorie, Elizabeth A. Foley and Richard B. Moss

J. Fungi 2016, 2(2), 17; https://doi.org/10.3390/jof2020017 - 06 Jun 2016

Cited by 67 | Viewed by 12971

Abstract

Allergic bronchopulmonary aspergillosis (ABPA), a progressive fungal allergic lung disease, is a common complication of asthma or cystic fibrosis. Although ABPA has been recognized since the 1950s, recent research has underscored the importance of Th2 immune deviation and granulocyte activation in its pathogenesis. [...] Read more.

Allergic bronchopulmonary aspergillosis (ABPA), a progressive fungal allergic lung disease, is a common complication of asthma or cystic fibrosis. Although ABPA has been recognized since the 1950s, recent research has underscored the importance of Th2 immune deviation and granulocyte activation in its pathogenesis. There is also strong evidence of widespread under-diagnosis due to the complexity and lack of standardization of diagnostic criteria. Treatment has long focused on downregulation of the inflammatory response with prolonged courses of oral glucocorticosteroids, but more recently concerns with steroid toxicity and availability of new treatment modalities has led to trials of oral azoles, inhaled amphotericin, pulse intravenous steroids, and subcutaneously-injected anti-IgE monoclonal antibody omalizumab, all of which show evidence of efficacy and reduced toxicity. Full article

(This article belongs to the Special Issue Aspergillus fumigatus: From Diagnosis to Therapy)

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Open AccessReview

Aspergillosis in Chronic Granulomatous Disease

by Jill King, Stefanie S. V. Henriet and Adilia Warris

J. Fungi 2016, 2(2), 15; https://doi.org/10.3390/jof2020015 - 26 May 2016

Cited by 48 | Viewed by 6309

Abstract

Patients with chronic granulomatous disease (CGD) have the highest life-time incidence of invasive aspergillosis and despite the availability of antifungal prophylaxis, infections by Aspergillus species remain the single most common infectious cause of death in CGD. Recent developments in curative treatment options, such [...] Read more.

Patients with chronic granulomatous disease (CGD) have the highest life-time incidence of invasive aspergillosis and despite the availability of antifungal prophylaxis, infections by Aspergillus species remain the single most common infectious cause of death in CGD. Recent developments in curative treatment options, such as haematopoietic stem cell transplantation, will change the prevalence of infectious complications including invasive aspergillosis in CGD patients. However, invasive aspergillosis in a previously healthy host is often the first presenting feature of this primary immunodeficiency. Recognizing the characteristic clinical presentation and understanding how to diagnose and treat invasive aspergillosis in CGD is of utmost relevance to improve clinical outcomes. Significant differences exist in fungal epidemiology, clinical signs and symptoms, and the usefulness of non-culture based diagnostic tools between the CGD host and neutropenic patients, reflecting underlying differences in the pathogenesis of invasive aspergillosis shaped by the nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase deficiency. Full article

(This article belongs to the Special Issue Aspergillus fumigatus: From Diagnosis to Therapy)

Other

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Open AccessCorrection

Correction: Stewart, E.R.; Thompson, G.R. Treatment of Primary Pulmonary Aspergillosis: An Assessment of the Evidence. J. Fungi 2016, 2, 25.

by Ethan R. Stewart and George R. Thompson

J. Fungi 2016, 2(4), 27; https://doi.org/10.3390/jof2040027 - 04 Nov 2016

Cited by 2 | Viewed by 2933

Abstract

The authors of the published paper [1] would like to correct Table 1.[...] Full article

(This article belongs to the Special Issue Aspergillus fumigatus: From Diagnosis to Therapy)

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