🧩 NAC Aspergillosis Research Digest Aspergillosis (October 2025: week 44)

Highlights

• Pulmonary aspergillosis in chronic lung disease can be severe and life-threatening, especially in patients with underlying interstitial lung conditions. Prompt diagnosis and subtype-targeted treatment are crucial for better outcomes (7).

• Advanced sinus imaging in dogs improves veterinary precision for diagnosing and treating fungal infections such as aspergillosis (1).

• Poultry farms in Turkey are best protected against aspergillosis outbreaks through consistent hygiene and environment management (3).

• Pediatric liver transplant patients remain at high risk of deadly fungal infections, so ongoing immune and drug monitoring is vital (2).

• New antifungal agents such as isavuconazole are yielding positive results in children, adults, and drug-resistant cases (10).

• Agricultural fungicide use is driving azole resistance in Aspergillus, prompting urgent “One Health” responses across medicine and farming (8).

• Research is underway to determine the best antifungal prophylaxis for heart transplant recipients (6).

• Case studies show severe treatment challenges for aspergillosis in post-tuberculosis and cancer patients (5), (9).

Pulmonary Aspergillosis in Lung Disease

Recent research examined the prevalence and outcomes of aspergillosis among patients with interstitial lung disease (ILD) and chronic respiratory disorders. The study highlights three major forms:

• Invasive Pulmonary Aspergillosis (IPA): Occurs in roughly 2% of hospitalised ILD patients, presenting with symptoms such as fever, persistent cough, and rapid decline in lung function. Those prescribed steroids or immunosuppressants and showing certain lung scan features are at greater risk. Estimated 3-month mortality can reach 50%.

• Chronic Cavitary Pulmonary Aspergillosis (CPA): Represents about 0.6% of cases in target populations, with slower onset but significant respiratory impairment over time. Mortality is lower than IPA but remains notable.

• Allergic Bronchopulmonary Aspergillosis (ABPA): Occurs in about 3% of studied patients, typically with a better prognosis, though delayed care can worsen outcomes.

Diagnostic strategies involve serology, antigen testing, and imaging to distinguish subtypes and select appropriate antifungal therapy. The study urges multidisciplinary care and more effective protocols for immunosuppressed patients (7).

Veterinary and Animal Health

Advanced radiological mapping now allows veterinarians to better diagnose and treat sinus aspergillosis across various breeds. This enhances surgical accuracy and supports targeted case management (1).
Poultry studies highlight aspergillosis as a leading fungal threat, with hygiene as the most effective control tactic (3).

Human Health: Transplant, Immunosuppression, and Infection

Children undergoing liver transplants require ongoing immune suppression, which increases susceptibility to severe fungal infections like aspergillosis. This underscores the value of rigorous therapeutic monitoring (2).
Current protocols are evaluating which antifungal drugs work best in heart transplant recipients to prevent invasive fungal infections (6)

Clinical Complications and Case Reports

Case studies spotlight life-threatening adrenal crisis and aspergillosis in children recovered from TB and adults with leukaemia. Timely diagnosis and combined therapies are essential for recovery (5), (9)
Transplant patients are vulnerable to bacterial and fungal sinus infections, presenting significant diagnostic challenges (4).

Drug Resistance and Novel Treatments

The rise of azole-resistant Aspergillus, driven by agricultural fungicide use, is making some forms of aspergillosis harder to treat. Integrated medical and environmental interventions are needed to slow resistance (8)
New medications, such as isavuconazole, are being adopted for severe and resistant cases in paediatric and adult populations with positive early results (10).

Reference List

1. Cross-Sectional Radiological and Reconstructive Anatomy of the Paranasal Sinuses in Normal Mesaticephalic Dogs
2. Pharmacokinetic Monitoring of JAK Inhibitor and Tacrolimus for Safe and Effective Management of Graft-Versus-Host Disease After Pediatric Liver Transplantation
3. A Review on Aspergillosis in Turkey: As a Main Fungal Disease in Poultry
4. Necrotizing Pseudomonal Sinusitis in a Transplant Patient
5. Post‐Tuberculosis Adrenal Crisis in a Young Boy: A Case Report
6. Antifungal prophylaxis against invasive Candida and Aspergillus infection in adult heart transplant recipients: protocol for a systematic review and meta-analysis
7. Clinical characteristics and prognosis of pulmonary aspergillosis complicating interstitial lung diseases
8. Azole fungicides and Aspergillus resistance, five EU agency report highlights the problem for the first time using a One Health approach
9. Blinatumomab Along With Combined Antifungal Agents for Refractory Adult Acute Lymphoblastic Leukemia With Invasive Aspergillosis: A Case Report
10. Real-life use of isavuconazole in Spanish children and adolescents