Key Points

Contents

• Can ABPA Be Confused with Parasitic Infections?
• Can Tuberculosis Lead to CPA?
• Could Home Blood Testing Help Aspergillosis Patients?
• What Is Antifungal Resistance?
• Are There Aspergillus Species Other Than Aspergillus fumigatus?
• New Aspergillus Research
• Other Interesting Publications
• What Does This Mean for Patients?
• When Should Patients Seek Medical Advice?

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This week was dominated by review articles rather than major new clinical trials. While there were no obvious practice-changing breakthroughs, several useful papers provide updated summaries of important topics including ABPA diagnosis, Chronic Pulmonary Aspergillosis (CPA), antifungal resistance and future monitoring technologies.

These reviews help clinicians and researchers understand where the field currently stands and identify areas where further research is needed.

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Can ABPA Be Confused with Parasitic Infections?

Our research highlight this week is a review by Mewara and colleagues examining the relationship between Allergic Bronchopulmonary Aspergillosis (ABPA) and parasitic worm (helminth) infections. Read the paper on PubMed.

ABPA and some parasitic infections can trigger remarkably similar immune responses, including:

• Very high Immunoglobulin E (IgE) levels
• Raised eosinophils
• Allergic inflammation
• Positive antibody tests

This can occasionally create diagnostic uncertainty. The authors discuss whether positive parasite blood tests in some patients with ABPA represent genuine infection, previous exposure or immune cross-reactivity caused by overlapping allergic responses.

Are parasitic infections common in the UK?

For most patients living in the UK, USA, Canada and much of Europe, parasitic worm infections remain relatively uncommon. However, doctors may consider them in people who have:

• Lived abroad
• Travelled extensively
• Worked overseas
• Been exposed to contaminated soil or freshwater in higher-risk regions

One parasite of particular interest is Strongyloides stercoralis, which can persist silently for many years and may become dangerous if someone receives high-dose steroids or other immunosuppressive treatments.

Take-home message: A positive blood test rarely tells the whole story. Symptoms, scans, blood tests and clinical history all contribute to making the correct diagnosis.

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Can Tuberculosis Lead to CPA?

A large scoping review examining lung disease after tuberculosis highlighted the growing recognition of Chronic Pulmonary Aspergillosis (CPA) as an important and potentially treatable complication. Read the review on PubMed.

The review identified evidence that antifungal treatment can improve:

• Symptoms
• Radiological findings
• Markers of inflammation

Tuberculosis remains one of the most important risk factors for CPA worldwide.

Many people continue to experience symptoms after completing tuberculosis treatment, including:

• Breathlessness
• Persistent cough
• Fatigue
• Weight loss
• Haemoptysis (coughing up blood)

Increasingly, researchers recognise that some of these patients may have treatable Aspergillus-related disease rather than simply permanent lung damage.

Not all ongoing symptoms after tuberculosis are simply due to old lung damage. Some patients may have treatable Chronic Pulmonary Aspergillosis.

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Could Home Blood Testing Help Aspergillosis Patients?

A review of respiratory biomarkers and patient-centred microsampling explored technologies that may eventually make monitoring chronic respiratory diseases easier and more convenient. Read the review on PubMed.

Areas under investigation include:

• Finger-prick blood testing
• Home sample collection
• Microsampling technologies
• Remote monitoring
• Personalised treatment optimisation

These approaches are particularly attractive for patients with long-term conditions who require regular monitoring.

Although still developing, they align closely with the wider move towards patient-centred care and remote monitoring.

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What Is Antifungal Resistance?

A review from Japan examined azole-resistant Aspergillus species and their implications for patient care. Read the review on PubMed.

Azole antifungal drugs remain central to treatment for:

• Chronic Pulmonary Aspergillosis (CPA)
• Aspergillus bronchitis
• Invasive aspergillosis

The review highlights the continuing importance of:

• Fungal culture
• Susceptibility testing
• Therapeutic drug monitoring
• Clinical review when treatment is not working as expected

Resistance remains relatively uncommon in many patient groups but continues to be monitored closely worldwide.

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Are There Aspergillus Species Other Than Aspergillus fumigatus?

Most patients are familiar with Aspergillus fumigatus, the species most commonly associated with lung disease.

However, a major review published in Clinical Microbiology Reviews examined the black aspergilli, including the Aspergillus niger complex. Read the review on PubMed.

While less common causes of lung disease, these fungi can also be associated with:

• Ear infections
• Nail infections
• Chronic pulmonary disease
• Rare invasive infections

The review serves as a useful reminder that Aspergillus is a large family of related fungi rather than a single organism.

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New Aspergillus Research

One of the few original research studies highlighted this week investigated how Aspergillus fumigatus builds and repairs its cell wall. Read the study on PubMed.

The researchers explored how fungal growth is affected by antifungal drugs that target cell wall synthesis.

Although this laboratory work is unlikely to affect patient care immediately, it improves our understanding of how antifungal drugs work and may help identify future treatment targets.

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Other Interesting Publications

• Fosmanogepix: A review of an emerging antifungal drug that may play a future role in treating resistant fungal infections. PubMed.
• ABPA and Eosinophilic Granulomatosis with Polyangiitis (EGPA): A rare case report describing overlapping eosinophilic disease and ABPA. PubMed.
• Hyper-IgE Syndrome and Pulmonary Aspergillosis: A case report highlighting fungal infection in a rare inherited immune disorder. PubMed.

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What Does This Mean for Patients?

While this was not a week of major breakthroughs, the research reinforces several important messages:

• Diagnosing ABPA can sometimes be complicated because different conditions can produce similar immune responses.
• CPA remains an important and potentially treatable complication after tuberculosis.
• Future monitoring technologies may allow more care to take place at home.
• Antifungal resistance continues to be monitored closely worldwide.
• Research into Aspergillus biology continues to support the development of future treatments.

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When Should Patients Seek Medical Advice?

Patients should contact their healthcare team if they experience:

• Increasing breathlessness
• Coughing up blood
• Persistent fever
• Unexplained weight loss
• New chest pain
• A significant increase in sputum production
• New or worsening treatment side effects

Anyone with a history of living or travelling in regions where parasitic infections are common should mention this to their healthcare team before starting high-dose steroid treatment.

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Review Information

Last reviewed: 8 June 2026

Prepared for: Aspergillosis.org Weekly Research Update

Audience: Patients, carers and non-specialist readers

This article summarises recently published research. Research findings may take years to influence routine clinical practice and should not replace personalised medical advice from your healthcare team.

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