In light of world aspergillosis day (1/2/19) I have collated 10 quickfire facts about aspergillosis, which is an infection caused by Aspergillus fungus. Hopefully these will be informative.
1. Aspergillosis is caused by various species of Aspergillus fungus (including A. fumigatus, A. flavus, A. terreus, A. niger and A. nidulans). Other Aspergillus species are able to produce the disease although the frequency is extremely low.
The image below shows A. fumigatus under the microscope!
2. The infective part of the fungus are the spores; every day we inhale on average hundreds of spores.
Inhalation of Aspergillus spores can have a range of consequences- ranging from allergic type reactions to life threatening invasive infection (in healthy individuals there will usually be no consequence).
3. Patients at risk of aspergillosis are those with impaired immune systems, including those with a primary immunodeficiency or undergoing chemotherapy.
4. Over 30 million people are at risk of aspergillosis each year worldwide.
5. Over 300,000 patients suffer from aspergillosis annually worldwide.
6. Mortality rates can be as high as 90% for invasive aspergillosis patients.
7. Diagnosis of aspergillosis is extremely difficult and is often unsuccessful. Methods include CT scans, biopsy, antigen tests, PCR or culturing of the fungus from blood/sputum/bronchoalveolar lavage samples.
8. The first line treatment for aspergillosis is voriconazole, but alternatives include liposomal amphotericin B.
The structure of voriconazole is shown below.
9. Resistance to antifungals (including voriconazole) is increasingly reported worldwide, making treatment a huge clinical challenge.
10. Resistance to antifungals has been described to develop in the environment (as a result of cross resistance to fungicides which are similar in structure to medical antifungals) and also in the clinic. In order to conserve antifungals, stewardship is required.