1. Immunodeficiency, rare syndromes & aspergillosis risk
Standing Still: A Case of Stiff Person Syndrome and Common Variable Immunodeficiency
Khazar et al., Cureus, 2025
Summary
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Describes a rare coexistence of Stiff Person Syndrome (SPS) and Common Variable Immunodeficiency (CVID).
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Highlights autoimmune–immunodeficiency overlap and diagnostic complexity.
Why it matters
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CVID is a recognised risk factor for recurrent infections and chronic lung disease, including bronchiectasis and chronic pulmonary aspergillosis (CPA).
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Reinforces the need for multisystem thinking when patients present with neurological and respiratory symptoms.
Limitations
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Single case; no fungal infection reported.
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Indirect relevance to aspergillosis but important for risk stratification.
Beyond Cystic Fibrosis: Recognising Shwachman–Diamond Syndrome in the Respiratory Clinic
Yang et al., Respirology Case Reports, 2025
Summary
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Emphasises misdiagnosis of Shwachman–Diamond syndrome (SDS) as cystic fibrosis.
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Includes discussion of allergic bronchopulmonary aspergillosis (ABPA) in the differential.
Why it matters
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Reinforces that non-CF genetic syndromes can present with:
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Bronchiectasis
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Recurrent infection
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ABPA-like features
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Highly relevant to adult respiratory clinics and late diagnoses.
Clinical takeaway
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ABPA should prompt consideration of underlying immune or genetic disease, not just asthma or CF.
2. Genetics & structural lung disease
Exome sequencing reanalysis identifies a novel CFAP54 variant in primary ciliary dyskinesia
Li et al., Frontiers in Medicine, 2025
Summary
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Identifies a new likely pathogenic CFAP54 variant.
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Expands the phenotypic spectrum of Primary Ciliary Dyskinesia (PCD).
Relevance to aspergillosis
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PCD → impaired mucociliary clearance → chronic infection, bronchiectasis, and secondary fungal disease.
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ABPA and CPA are increasingly recognised in non-CF bronchiectasis populations.
Strength
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Genotype–phenotype correlation strengthens diagnostic confidence.
Limitation
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Aspergillosis not a primary focus, but highly relevant to long-term respiratory outcomes.
3. Haematology, malignancy & invasive aspergillosis
Mixed-Phenotype Acute Leukemia Transforming into AML-M4
Alhayek et al., Cureus, 2025
Summary
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Case of evolving leukemia complicated by pancytopenia, invasive pulmonary aspergillosis (IPA), and COVID-19.
Key points
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Illustrates real-world stacked risk:
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Neutropenia
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Chemotherapy
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Viral infection
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IPA
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Clinical relevance
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Strong reminder that IPA often emerges during diagnostic or therapeutic transitions, not just during induction chemotherapy.
Invasive fungal infections in haematologic diseases: evidence, challenges, and practice
Cho et al., Blood Research, 2025 – Review
Summary
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Comprehensive overview of invasive aspergillosis, candidiasis, and mucormycosis.
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Covers diagnostics, antifungal resistance, and treatment strategies.
Strengths
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Practical, guideline-aligned.
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Emphasises individualised risk assessment and early treatment.
Gap
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Limited discussion of long-term survivors and post-IPA chronic complications (e.g. CPA).
4. Imaging & diagnostics
CT Pulmonary Angiography in invasive pulmonary aspergillosis
Tian, Future Microbiology, 2025
Summary
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Explores the role of CT pulmonary angiography (CTPA) in detecting angioinvasion.
Why it matters
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Vascular occlusion and infarction are hallmarks of IPA.
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CTPA may improve diagnostic confidence when standard CT is equivocal.
Limitations
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Case-based evidence.
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Needs integration into diagnostic algorithms.
Sequential serum galactomannan as an outcome marker
Többen et al., Int J Infect Dis, 2025
Summary
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Registry-based exploratory analysis of serial galactomannan (GM).
Key finding
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Trends in GM may correlate with treatment response, not just diagnosis.
Clinical importance
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Supports GM as a monitoring biomarker, though interpretation remains complex.
Caution
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Not reliable in all patient groups (e.g. non-neutropenic, antifungal pre-exposure).
5. Chronic pulmonary aspergillosis & structural disease
Molecular epidemiology of Aspergillus species in CPA (South India)
Spruijtenburg et al., Medical Mycology, 2025
Summary
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Describes species diversity and genetic variation in CPA patients.
Why it matters
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Highlights:
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Geographic variation
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Potential antifungal resistance implications
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Supports species-level identification in CPA.
Strength
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Strong laboratory–clinical interface.
Advanced pulmonary sarcoidosis
Spagnolo et al., Seminars in Respiratory and Critical Care Medicine, 2025
Summary
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Reviews complications of advanced sarcoidosis, including:
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Bronchiectasis
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Pulmonary hypertension
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Chronic pulmonary aspergillosis
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Key point
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CPA should be actively considered, not viewed as rare, in fibrotic sarcoidosis.
Rezafungin OPAT for chronic pulmonary aspergillosis
Law et al., JAC Antimicrobial Resistance, 2025
Summary
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First real-world case of rezafungin used via outpatient parenteral therapy for CPA.
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Includes a health-economic assessment.
Why this is important
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CPA treatment options are limited.
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Weekly dosing may:
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Reduce hospital burden
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Improve quality of life
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Caution
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Single case; echinocandins are not standard CPA therapy.
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Best viewed as salvage or niche use.
6. Tracheobronchial & atypical aspergillosis
Tracheobronchial Aspergillosis Mimicking Pseudotumour
Castillo Gamboa et al., Clinical Case Reports, 2025
Summary
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Rare presentation of tracheobronchial aspergillosis masquerading as malignancy.
Clinical lesson
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Endobronchial disease can be missed or mislabelled.
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Supports biopsy and fungal testing when appearances are atypical.
7. Immunology, inflammation & host–pathogen interaction
PANoptosis in pathogen infection and systemic disease
Cai et al., Cell Biology and Toxicology, 2025 – Review
Summary
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Reviews PANoptosis (pyroptosis, apoptosis, necroptosis) in infections.
Relevance
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Aspergillus is discussed as a trigger of complex inflammatory cell death pathways.
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May help explain:
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Severe tissue damage
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Dysregulated inflammation in IPA
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Translational value
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Still mechanistic; clinical applications remain distant.
PD-1 / PD-L1 immune checkpoint in fungal infections
Zheng et al., Virulence, 2025 – Review
Summary
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Explores immune exhaustion in ABPA, CPA, and IPA.
Key insight
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Checkpoint pathways may:
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Contribute to chronic infection persistence
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Become future adjunctive immunotherapies
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Important caution
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Immune checkpoint modulation carries significant risk in fungal disease.
8. Antimicrobial stewardship & prophylaxis
Procalcitonin-guided antibiotics in RSV and influenza
Hessels et al., BMJ Open Respiratory Research, 2025
Finding
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Reduced antibiotic use without increased fungal infection risk.
Relevance
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Important reassurance that stewardship does not increase IPA risk in viral respiratory infections.
Letermovir prophylaxis post-HSCT
Kimura et al., J Infect Chemother, 2025
Key result
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Letermovir did not increase invasive aspergillosis or candidemia risk.
Clinical reassurance
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Supports ongoing antiviral prophylaxis strategies in transplant patients.
9. Experimental antifungals
Berberine suppresses Aspergillus fumigatus growth
Wang et al., ACS Infectious Diseases, 2025
Summary
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Demonstrates antifungal activity via:
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Mitochondrial fragmentation
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Reactive oxygen species
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Hog1-MAPK activation
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Reduced fungal burden in a murine IPA model.
Important caution
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Pre-clinical only.
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Not a supplement recommendation for patients.
Overall themes & take-home messages
Key trends this week
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Increasing recognition of rare immunodeficiency and genetic syndromes behind chronic lung disease.
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Better understanding of non-classical aspergillosis presentations.
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Strong interest in immune modulation, biomarkers, and novel therapies.
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Continued need for early diagnosis, especially in haematology and advanced lung disease.
For clinical practice
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Think beyond labels (asthma, CF, cancer).
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Revisit diagnoses when disease behaves atypically.
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CPA and ABPA remain under-recognised but increasingly documented across conditions.
If you’d like, I can:
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