Aspergillosis (invasive)

Aspergillosis is a name for a group of conditions caused by exposure to Aspergillus - a ubiquitous, filamentous fungus that primarily causes infection in immunocompromised hosts and individuals with underlying pulmonary disease

Invasive aspergillosis refers to disseminated infection affecting the immunocompromised, which often starts in the lungs but may involve other organs and tissues through haematogenous spread. It is rapidly progressive, and symptoms often manifest only once the disease is advanced.(1,3)

This condition carries a very poor prognosis with one recent analysis estimating a crude mortality rate of 85% globally. (2)

In most instances, for individuals with presumptive and established invasive aspergillosis, either voriconazole or isavuconazole is recommended. (3)

Amphotericin may be used if initial treatment fails (4) and echinocandin derivatives such as caspofungin, micafungin and anidulafungin are effective agents in the treatment of invasive pulmonary aspergillosis refractory to standard treatment, or if the patient cannot tolerate first-line agents. (5)

Reference

1. Kanj A, Abdallah N, Soubani AO. The spectrum of pulmonary aspergillosis. Respir Med. 2018 Aug;141:121-131
2. Denning DW. Global incidence and mortality of severe fungal disease. Lancet Infect Dis. 2024 Jul;24(7):e428-e438
3. Bocci MG et al. Pulmonary Aspergillosis in Immunocompromised Critically Ill Patients: Prevalence, Risk Factors, Clinical Features and Diagnosis-A Narrative Review. J Fungi (Basel). 2025 Aug 24;11(9)
4. Karthaus M, Buchheidt D; Invasive aspergillosis: new insights into disease, diagnostic and treatment. Curr Pharm Des. 2013;19(20):3569-94.
5. Aruanno M et al. Echinocandins for the Treatment of Invasive Aspergillosis: from Laboratory to Bedside. Antimicrob Agents Chemother. 2019 Jul 25;63(8).