Diagnosis and Treatment of Invasive Aspergillosis Caused by Non-<i>fumigatus Aspergillus</i> spp.
With increasing frequency, clinical and laboratory-based mycologists are consulted on invasive fungal diseases caused by rare fungal species. This review aims to give an overview of the management of invasive aspergillosis (IA) caused by non-<i>fumigatus Aspergillus</i> spp.—namely <i...
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| Format: | Article |
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MDPI AG
2023-04-01
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| Series: | Journal of Fungi |
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| Online Access: | https://www.mdpi.com/2309-608X/9/4/500 |
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| author | Jannik Stemler Christina Többen Cornelia Lass-Flörl Jörg Steinmann Katharina Ackermann Peter-Michael Rath Michaela Simon Oliver Andreas Cornely Philipp Koehler |
| author_facet | Jannik Stemler Christina Többen Cornelia Lass-Flörl Jörg Steinmann Katharina Ackermann Peter-Michael Rath Michaela Simon Oliver Andreas Cornely Philipp Koehler |
| author_sort | Jannik Stemler |
| collection | DOAJ |
| description | With increasing frequency, clinical and laboratory-based mycologists are consulted on invasive fungal diseases caused by rare fungal species. This review aims to give an overview of the management of invasive aspergillosis (IA) caused by non-<i>fumigatus Aspergillus</i> spp.—namely <i>A. flavus</i>, <i>A. terreus</i>, <i>A. niger</i> and <i>A. nidulans</i>—including diagnostic and therapeutic differences and similarities to <i>A. fumigatus</i>. <i>A. flavus</i> is the second most common <i>Aspergillus</i> spp. isolated in patients with IA and the predominant species in subtropical regions. Treatment is complicated by its intrinsic resistance against amphotericin B (AmB) and high minimum inhibitory concentrations (MIC) for voriconazole. <i>A. nidulans</i> has been frequently isolated in patients with long-term immunosuppression, mostly in patients with primary immunodeficiencies such as chronic granulomatous disease. It has been reported to disseminate more often than other <i>Aspergillus</i> spp. Innate resistance against AmB has been suggested but not yet proven, while MICs seem to be elevated. <i>A. niger</i> is more frequently reported in less severe infections such as otomycosis. Triazoles exhibit varying MICs and are therefore not strictly recommended as first-line treatment for IA caused by <i>A. niger</i>, while patient outcome seems to be more favorable when compared to IA due to other <i>Aspergillus</i> species. <i>A. terreus</i>-related infections have been reported increasingly as the cause of acute and chronic aspergillosis. A recent prospective international multicenter surveillance study showed Spain, Austria, and Israel to be the countries with the highest density of <i>A. terreus</i> species complex isolates collected. This species complex seems to cause dissemination more often and is intrinsically resistant to AmB. Non-<i>fumigatus</i> aspergillosis is difficult to manage due to complex patient histories, varying infection sites and potential intrinsic resistances to antifungals. Future investigational efforts should aim at amplifying the knowledge on specific diagnostic measures and their on-site availability, as well as defining optimal treatment strategies and outcomes of non-<i>fumigatus</i> aspergillosis. |
| first_indexed | 2024-03-11T04:50:56Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2309-608X |
| language | English |
| last_indexed | 2024-03-11T04:50:56Z |
| publishDate | 2023-04-01 |
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| spelling | doaj.art-55558a2e6eef422fa95a81645b6aedbc2023-11-17T19:59:02ZengMDPI AGJournal of Fungi2309-608X2023-04-019450010.3390/jof9040500Diagnosis and Treatment of Invasive Aspergillosis Caused by Non-<i>fumigatus Aspergillus</i> spp.Jannik Stemler0Christina Többen1Cornelia Lass-Flörl2Jörg Steinmann3Katharina Ackermann4Peter-Michael Rath5Michaela Simon6Oliver Andreas Cornely7Philipp Koehler8Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937 Cologne, GermanyDepartment I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937 Cologne, GermanyInstitute of Hygiene and Medical Microbiology, European Diamond Excellence Center for Medical Mycology (ECMM), Medical University of Innsbruck, 6020 Innsbruck, AustriaInstitute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, 90419 Nuremberg, GermanyInstitute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, 90419 Nuremberg, GermanyInstitute of Medical Microbiology, University Hospital Essen, European Diamond Excellence Center for Medical Mycology (ECMM), 45147 Essen, GermanyInstitute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937 Cologne, GermanyDepartment I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937 Cologne, GermanyDepartment I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937 Cologne, GermanyWith increasing frequency, clinical and laboratory-based mycologists are consulted on invasive fungal diseases caused by rare fungal species. This review aims to give an overview of the management of invasive aspergillosis (IA) caused by non-<i>fumigatus Aspergillus</i> spp.—namely <i>A. flavus</i>, <i>A. terreus</i>, <i>A. niger</i> and <i>A. nidulans</i>—including diagnostic and therapeutic differences and similarities to <i>A. fumigatus</i>. <i>A. flavus</i> is the second most common <i>Aspergillus</i> spp. isolated in patients with IA and the predominant species in subtropical regions. Treatment is complicated by its intrinsic resistance against amphotericin B (AmB) and high minimum inhibitory concentrations (MIC) for voriconazole. <i>A. nidulans</i> has been frequently isolated in patients with long-term immunosuppression, mostly in patients with primary immunodeficiencies such as chronic granulomatous disease. It has been reported to disseminate more often than other <i>Aspergillus</i> spp. Innate resistance against AmB has been suggested but not yet proven, while MICs seem to be elevated. <i>A. niger</i> is more frequently reported in less severe infections such as otomycosis. Triazoles exhibit varying MICs and are therefore not strictly recommended as first-line treatment for IA caused by <i>A. niger</i>, while patient outcome seems to be more favorable when compared to IA due to other <i>Aspergillus</i> species. <i>A. terreus</i>-related infections have been reported increasingly as the cause of acute and chronic aspergillosis. A recent prospective international multicenter surveillance study showed Spain, Austria, and Israel to be the countries with the highest density of <i>A. terreus</i> species complex isolates collected. This species complex seems to cause dissemination more often and is intrinsically resistant to AmB. Non-<i>fumigatus</i> aspergillosis is difficult to manage due to complex patient histories, varying infection sites and potential intrinsic resistances to antifungals. Future investigational efforts should aim at amplifying the knowledge on specific diagnostic measures and their on-site availability, as well as defining optimal treatment strategies and outcomes of non-<i>fumigatus</i> aspergillosis.https://www.mdpi.com/2309-608X/9/4/500invasive aspergillosisepidemiologyinvasive fungal diseaseimmunocompromised hostsurgeryantifungal treatment |
| spellingShingle | Jannik Stemler Christina Többen Cornelia Lass-Flörl Jörg Steinmann Katharina Ackermann Peter-Michael Rath Michaela Simon Oliver Andreas Cornely Philipp Koehler Diagnosis and Treatment of Invasive Aspergillosis Caused by Non-<i>fumigatus Aspergillus</i> spp. Journal of Fungi invasive aspergillosis epidemiology invasive fungal disease immunocompromised host surgery antifungal treatment |
| title | Diagnosis and Treatment of Invasive Aspergillosis Caused by Non-<i>fumigatus Aspergillus</i> spp. |
| title_full | Diagnosis and Treatment of Invasive Aspergillosis Caused by Non-<i>fumigatus Aspergillus</i> spp. |
| title_fullStr | Diagnosis and Treatment of Invasive Aspergillosis Caused by Non-<i>fumigatus Aspergillus</i> spp. |
| title_full_unstemmed | Diagnosis and Treatment of Invasive Aspergillosis Caused by Non-<i>fumigatus Aspergillus</i> spp. |
| title_short | Diagnosis and Treatment of Invasive Aspergillosis Caused by Non-<i>fumigatus Aspergillus</i> spp. |
| title_sort | diagnosis and treatment of invasive aspergillosis caused by non i fumigatus aspergillus i spp |
| topic | invasive aspergillosis epidemiology invasive fungal disease immunocompromised host surgery antifungal treatment |
| url | https://www.mdpi.com/2309-608X/9/4/500 |
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