Aspergillosis Research Update: Week Ending: 30 March 2026

Contents

• Key highlights
• 1. Influenza-associated pulmonary aspergillosis (IAPA)
• 2. Aspergillus colonisation in bronchiectasis
• 3. Immune recognition and vaccine development
• 4. Drug repurposing: antiretrovirals and antifungals
• 5. Co-infection in immunocompromised patients
• 6. COVID-19 and CAPA risk
• 7. Paediatric invasive fungal disease trends
• 8. Plastic bronchitis and Aspergillus (contextual)
• 9. Veterinary aspergillosis
• Overall themes this week
• What this means for patients

Key highlights

• Increasing clarity on influenza-associated pulmonary aspergillosis (IAPA) and ongoing uncertainty around prophylaxis
• New insights into immune recognition of Aspergillus relevant to vaccine development
• Evidence that persistent Aspergillus colonisation may worsen bronchiectasis outcomes
• Early-stage research into drug repurposing strategies
• Continued reports of complex co-infections in immunocompromised patients

Paper summaries

Incidence and outcomes of influenza-associated pulmonary aspergillosis and the role of antifungal prophylaxis: a structured literature review

Sedik S, Felber D, Schellongowski P, Salzer HJF, Bellmann R, Muhr T, Auer J, Krippl P, Lux M, Zajic P, Werner M, Bauer N, Watzinger N, Mesaric G, Tinawi Y, Dichtl K, Wolfgruber S, Biswas S, Prattes J, Hoenigl M
Critical Care, 26 March 2026
PMID: 41888868

Summary
This structured review examines how often influenza-associated pulmonary aspergillosis occurs, the outcomes associated with it, and whether antifungal prophylaxis has a role in prevention.

Key points

• IAPA remains a serious complication of influenza in critically ill patients.
• Mortality appears high, particularly in patients requiring intensive respiratory support.
• The evidence for antifungal prophylaxis remains inconclusive.
• Diagnostic uncertainty continues, especially when trying to distinguish colonisation from invasive disease.

Relevance
This is important because it mirrors concerns seen with COVID-19-associated pulmonary aspergillosis and underlines the need for clearer ICU diagnostic and prevention pathways.

Effect of transient versus persistent Aspergillus colonisation on clinical outcomes in bronchiectasis

Michaud A, Jarand J, Thornton CS
ERJ Open Research, 23 March 2026
PMID: 41878279

Summary
This study looks at whether transient and persistent Aspergillus colonisation have different effects on people with bronchiectasis.

Key points

• Persistent colonisation was associated with worse respiratory outcomes.
• Patients with persistent colonisation appeared to have more symptoms and exacerbations.
• Transient colonisation seemed less clinically important.
• The findings sit outside Allergic Bronchopulmonary Aspergillosis (ABPA), which makes them especially interesting.

Relevance
This is one of the most clinically relevant papers this week for chronic lung disease. It suggests Aspergillus in sputum may not always be an incidental finding, especially if it is repeatedly present.

α-1,3-Glucan-Driven Remodeling of the Conidial Cell Wall in an Aspergillus fumigatus Vaccine Strain Alters Innate Immune Recognition

Singh K, Ankur A, Yarava JR, Fernandes CM, Vascelli G, Sulla A, Zelante T, Del Poeta M, Wang T
Journal of the American Chemical Society, 26 March 2026
PMID: 41883285

Summary
This experimental paper explores how changes in the Aspergillus fumigatus conidial cell wall alter how the innate immune system detects the fungus.

Key points

• Changes in α-1,3-glucan altered the structure of the fungal cell wall.
• That remodelling changed how the fungus was recognised by innate immune pathways.
• The work may help inform future vaccine design or immune-targeted therapies.

Relevance
This is early-stage science rather than immediately practice-changing work, but it improves understanding of how Aspergillus may evade immune recognition and how future preventive strategies could be designed.

Synergistic antifungal activity of antiretrovirals with amphotericin B against Aspergillus species

Khan AA, Salama EA, Seleem MN
PLOS One, 25 March 2026
PMID: 41880294

Summary
This laboratory study investigates whether antiretroviral drugs can enhance the antifungal activity of amphotericin B against Aspergillus species.

Key points

• Some antiretrovirals showed synergistic activity with amphotericin B.
• The combination improved inhibition of hyphal growth.
• This raises the possibility of drug repurposing in invasive aspergillosis.

Relevance
This is interesting as a proof-of-concept study. It is not ready for clinical use, but it points toward possible future combination strategies, especially where resistance or toxicity limits current treatment options.

Coexistence of pulmonary aspergillosis and cryptococcosis following treatment for SARS-CoV-2 infection in a kidney transplant recipient: a rare case report and literature review

Hu C, Ying L, Zhan Y, Wang J, Ye J, Lu J, Jin H, Tan X, Gu L, Yao Y, Jiang N
BMC Nephrology, 23 March 2026
PMID: 41872830

Summary
This case report describes a kidney transplant recipient who developed both pulmonary aspergillosis and cryptococcosis after SARS-CoV-2 infection.

Key points

• Demonstrates the potential for multiple opportunistic fungal infections in highly immunosuppressed patients.
• Shows how diagnosis can become particularly complex when symptoms and imaging overlap.
• Reinforces the need for a broad differential diagnosis in transplant recipients and similar high-risk groups.

Relevance
Although a single case, it is a useful reminder that fungal infection in immunocompromised patients may not always be limited to one pathogen, particularly after severe viral infection or intense immunosuppression.

Severe COVID-19 in the Republic of Korea: Epidemiology, Risk Factors, Therapeutics, and Prognostic Models From Nationwide Data

Choi JY
Journal of Korean Medical Science, 23 March 2026
PMID: 41873446

Summary
This review of nationwide Korean data includes discussion of severe COVID-19 complications, including COVID-19-associated pulmonary aspergillosis.

Key points

• There was a trend toward increased COVID-19-associated pulmonary aspergillosis (CAPA).
• Risk appeared higher in patients needing the most advanced respiratory support, including ECMO.

Relevance
This reinforces the continuing importance of CAPA internationally and supports ongoing vigilance in critical care settings, especially where viral lung injury and immunomodulatory treatment intersect.

Temporal Trends and Clinical Outcomes of Pediatric Invasive Fungal Diseases: A Ten-Year Retrospective Study from a Tertiary-Care Center in Thailand

Niyomthammarat C, Meesilpavikkai K, Chintanapakdee W, Sophonphan J, Anugualruengkitt S, Puthanakit T, Jantarabenjakul W
Research Square, 23 March 2026
Status: Preprint v1

Summary
This ten-year retrospective study of paediatric invasive fungal disease includes a substantial number of invasive aspergillosis episodes.

Key points

• Invasive aspergillosis was one of the major fungal disease categories identified.
• Outcomes varied according to underlying condition and likely also the speed of diagnosis and treatment.

Relevance
This paper does not currently have a PubMed listing because it is a preprint rather than a final indexed journal paper, but it still offers useful background on paediatric invasive fungal disease burden.

Initial presentation, etiology and risk factors for adverse outcomes in infection-associated plastic bronchitis in children

Cao H, Liang D, Huang H, He Q, Wu L
Frontiers in Pediatrics, 28 March 2026
PMCID: PMC13021623

Summary
This retrospective paediatric study is not primarily an aspergillosis paper, but it mentions allergic bronchopulmonary aspergillosis among conditions relevant to plastic bronchitis.

Key points

• ABPA appears as part of the broader differential diagnosis in children with this presentation.
• The study mainly concerns airway obstruction and risk factors for poor outcome rather than aspergillosis itself.

Relevance
This has limited direct relevance to most aspergillosis readers, but it is a useful contextual reminder that Aspergillus-related disease can form part of wider airway pathology discussions.

Note: I have not added a PubMed link here because no PMID was supplied. If you want, I can convert this heading to a Europe PMC or PMC link instead.

Aspergillus deflectus-associated disseminated invasive aspergillosis in a German Shepherd dog with discospondylitis: first isolation in Europe

Gernone F, Uva A, Aresu L, Bonfanti U, Ricciardi M, Miglianti M, Barrs VR
Veterinary Research Communications, 25 March 2026
PMID: 41880044

Summary
This veterinary case report documents disseminated invasive aspergillosis caused by Aspergillus deflectus in a German Shepherd dog, reported as the first isolation in Europe.

Key points

• Expands awareness of the range of Aspergillus species capable of causing invasive disease.
• Shows how invasive aspergillosis can present as a disseminated multisystem infection.

Relevance
This is not directly about human disease, but it contributes to the wider ecological and pathogenic picture of Aspergillus species.

Overall themes this week

1. Colonisation versus disease remains a major question.
   Persistent Aspergillus colonisation may be clinically important in bronchiectasis and should not automatically be dismissed.
2. Severe viral infection remains a major trigger for invasive aspergillosis.
   Both influenza and COVID-19 continue to feature strongly in the literature.
3. Innovation is active but mostly early-stage.
   Vaccine science, immune recognition work, and drug repurposing studies are all progressing, but none are ready to change routine care yet.
4. Complex patients are at risk of complex fungal disease.
   Transplant recipients and critically ill patients remain especially vulnerable to difficult-to-diagnose opportunistic infections.

What this means for patients

• Finding Aspergillus repeatedly in samples may sometimes matter more than a single isolated result.
• Severe viral illness can increase the risk of serious fungal complications in some people.
• Researchers are exploring better ways to prevent and treat aspergillosis, but most of these approaches are still under investigation.
• People with weakened immune systems remain at greatest risk of invasive disease.