Diagnosis and Treatment of Invasive Aspergillosis Caused by Non-fumigatus Aspergillus spp.

被引：21

作者：

Stemler, Jannik ^{[1
,2
,3
]}

Toebben, Christina ^{[1
,2
,3
]}

Lass-Floerl, Cornelia ^{[4
]}

Steinmann, Joerg ^{[5
,6
]}

Ackermann, Katharina ^{[5
]}

Rath, Peter-Michael ^{[6
]}

Simon, Michaela ^{[7
]}

Cornely, Oliver Andreas ^{[1
,2
,3
,8
]}

Koehler, Philipp ^{[1
,2
]}

机构：

[1] Univ Cologne, Univ Hosp Cologne, Ctr Integrated Oncol Aachen Bonn Cologne Duesseldo, Fac Med,Dept Internal Med 1,European Diamond Excel, D-50937 Cologne, Germany

[2] Univ Cologne, Inst Translat Res, Cologne Excellence Cluster Cellular Stress Respons, D-50923 Cologne, Germany

[3] German Ctr Infect Res DZIF, Partner Site Bonn Cologne, D-50923 Cologne, Germany

[4] Med Univ Innsbruck, Inst Hyg & Med Microbiol, European Diamond Excellence Ctr Med Mycol ECMM, A-6020 Innsbruck, Austria

[5] Paracelsus Med Univ, Inst Clin Hyg Med Microbiol & Infectiol, Klinikum Nurnberg, D-90419 Nurnberg, Germany

[6] Univ Hosp Essen, Inst Med Microbiol, European Diamond Excellence Ctr Med Mycol ECMM, D-45147 Essen, Germany

[7] Univ Cologne, Univ Hosp Cologne, Inst Med Microbiol Immunol & Hyg, Fac Med, D-50937 Cologne, Germany

[8] Univ Cologne, Clin Trials Ctr Cologne ZKS Koln, D-50935 Cologne, Germany

来源：

JOURNAL OF FUNGI | 2023年 / 9卷 / 04期

关键词：

invasive aspergillosis; epidemiology; invasive fungal disease; immunocompromised host; surgery; antifungal treatment; antifungal stewardship; CHRONIC GRANULOMATOUS-DISEASE; ORGAN TRANSPLANT RECIPIENTS; LIPOSOMAL AMPHOTERICIN-B; FUNGAL-INFECTIONS; IN-VITRO; MOLD INFECTIONS; PULMONARY ASPERGILLOSIS; AZOLE RESISTANCE; BRONCHOALVEOLAR LAVAGE; CLINICAL EPIDEMIOLOGY;

D O I：

10.3390/jof9040500

中图分类号：

Q93 [微生物学];

学科分类号：

071005 ; 100705 ;

摘要：

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-fumigatus Aspergillus spp.-namely A. flavus, A. terreus, A. niger and A. nidulans-including diagnostic and therapeutic differences and similarities to A. fumigatus. A. flavus is the second most common Aspergillus 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. A. nidulans 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 Aspergillus spp. Innate resistance against AmB has been suggested but not yet proven, while MICs seem to be elevated. A. niger 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 A. niger, while patient outcome seems to be more favorable when compared to IA due to other Aspergillus species. A. terreus-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 A. terreus species complex isolates collected. This species complex seems to cause dissemination more often and is intrinsically resistant to AmB. Non-fumigatus 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-fumigatus aspergillosis.

引用

页数：20

共 126 条

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