This week’s aspergillosis literature includes important new work on chronic pulmonary aspergillosis (CPA), aspergilloma microbiology, azole resistance evolution, biomarkers, allergic bronchopulmonary aspergillosis (ABPA), and surveillance. As usual, the most clinically useful papers for long-term aspergillosis care are prioritised.

Key points summary

• New evidence suggests that azole persistence and stress tolerance may develop before overt antifungal resistance becomes detectable.
• An aspergilloma appears to be more than a simple fungal ball: it may function as a complex microbial ecosystem involving bacterial adaptation and persistence.
• A new surveillance paper argues for moving beyond Aspergillus fumigatus strain surveillance toward clinical disease surveillance.
• ABPA review literature continues to reflect growing interest in biologic therapies as steroid-sparing treatment.
• A case report reminds clinicians that lung cancer can mimic recurrent aspergillosis, with potential for diagnostic delay.
• Biomarker studies in invasive pulmonary aspergillosis (IPA) are continuing, although most are not yet ready for routine clinical use.

Contents

1. Chronic and structural disease
2. Antifungal resistance and fungal evolution
3. Diagnosis and biomarkers
4. ABPA and allergic disease
5. Surveillance, epidemiology and environment
6. Case reports and diagnostic challenges
7. Other relevant papers

1. Chronic and structural disease

Pseudomonas aeruginosa adaptation and persistence in the aspergilloma microbiome revealed by integrated multi-omics

Ribeiro MM, Liu C, Xu JF, Liang S, Goldman GH
G3 (Bethesda), 17 March 2026
PMID: 41843749

This is one of the most interesting papers this week for those focused on CPA and aspergilloma. The authors examine the microbial ecology of aspergilloma and show that Pseudomonas aeruginosa can adapt and persist within this environment. That matters because aspergilloma has often been thought of mainly as a fungal structure, whereas this paper supports the idea that it may be a more complex polymicrobial niche.

The study strengthens the view that chronic pulmonary aspergillosis may involve not only fungal persistence, but also bacterial-fungal interactions, biofilm-like behaviour, and long-term microbial adaptation. This may help explain why some patients remain symptomatic despite antifungal therapy, and why structural lung disease can be so difficult to stabilise.

Why it matters:

• Highly relevant to aspergilloma and CPA.
• Supports growing interest in the lung microbiome and mixed microbial communities.
• May eventually influence how we think about treatment failure, chronic symptoms, and combined antimicrobial strategies.

2. Antifungal resistance and fungal evolution

Evidence that increased azole persistence and stress resistance precede the in vivo evolution of azole resistance in Aspergillus fumigatus

Delbaje E, Pontes L, Savoldi M, Sedik S, Dichtl K, Hoenigl M, Lass-Flörl C, Silva Pereira C, Schreiber AZ, Rokas A, Lu L, Barbosa JCJ, Fill T, Dos Reis TF, Goldman GH
Microbiology Spectrum, 16 March 2026
PMID: 41837673

This is an important resistance paper. The authors provide evidence that azole persistence and stress resistance may emerge before formal azole resistance becomes established in vivo. In other words, the fungus may first become better at surviving azole exposure before developing the classical resistance patterns that laboratories can detect more easily.

That finding is highly relevant to patients with chronic aspergillosis receiving prolonged azole therapy. It suggests that the road to treatment failure may begin earlier than clinicians currently realise, and that traditional susceptibility testing may capture resistance only after important adaptive changes are already underway.

Why it matters:

• Very important for CPA management and long-term triazole treatment.
• Suggests that “susceptible” isolates may still show clinically relevant survival advantages.
• May help explain some cases of gradual loss of treatment response before overt resistance is identified.

Accelerated mutator phenotype in a clinical Aspergillus fumigatus isolate contributes to adaptive evolution

Song Y, Hokken MWJ, Zoll J, Venselaar H, Verweij PE, Melchers WJG, Rhodes J
Emerging Microbes & Infections, 16 March 2026
PMID: 41838943 |
PMCID: PMC12997362

This paper complements the study above. It describes a clinical Aspergillus fumigatus isolate with an accelerated mutator phenotype, meaning it acquires mutations more readily and can therefore adapt more quickly under selective pressure.

For chronic disease, especially where patients receive long courses of azole therapy, this is a concerning but important concept. Some fungal strains may be inherently more capable of adapting during treatment, which could contribute to the emergence of resistance, persistence, or other survival advantages.

Why it matters:

• Relevant to CPA, azole resistance, and treatment monitoring.
• Supports the idea that fungal evolution during chronic infection may be dynamic and patient-specific.
• May eventually help explain why some patients develop resistance more rapidly than others.

3. Diagnosis and biomarkers

Synergistic effects of S100 calcium-binding protein A12 combined with Pentraxin 3 in invasive pulmonary aspergillosis and their clinical application prospects

Zhou X, Hu X, Liu H
Frontiers in Cellular and Infection Microbiology, 20 March 2026
PMCID: PMC12999553

This paper focuses on invasive pulmonary aspergillosis rather than chronic disease. It explores whether combining host biomarkers such as S100A12 and Pentraxin 3 could improve diagnosis and perhaps risk stratification.

As with many biomarker studies, the concept is promising, but the clinical pathway remains uncertain. Biomarkers that reflect the host inflammatory response may ultimately complement fungal biomarkers and imaging, particularly in intensive care or immunocompromised settings.

Why it matters:

• More relevant to IPA than CPA or ABPA.
• Illustrates continued interest in host-response biomarkers.
• Potentially useful in the future, but not immediately practice-changing for routine aspergillosis care.

Diagnostic and prognostic value of serum miR-155 in chronic obstructive pulmonary disease

Wu Y, Zhang K, Zhong R, Wang W, Luo Z, Ma Z, Liang R, Wu X, Zou X
Scientific Reports, 20 March 2026
PMID: 41857172

This is not primarily an aspergillosis paper, but it includes findings relevant to invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease (COPD). The authors report that serum miR-155 levels were lower in IPA than non-IPA patients within their study population.

That is potentially interesting because COPD is a major risk factor for IPA, and there is growing need for better tools to identify invasive fungal disease in such patients. However, this remains exploratory and should be viewed as an early biomarker signal rather than something ready for clinical use.

Why it matters:

• Relevant mainly for COPD-associated IPA risk.
• Adds to the biomarker literature, but is not yet directly applicable in routine practice.
• Limited immediate relevance for CPA and ABPA.

4. ABPA and allergic disease

Allergic bronchopulmonary aspergillosis in internal medicine

Chedal-Anglay C, Martin de Frémont G, Dupin C
Revue de Médecine Interne, 18 March 2026
PMID: 41856838

This review provides an overview of allergic bronchopulmonary aspergillosis, its diagnosis, and treatment. It reiterates that ABPA is a complex and often under-recognised inflammatory lung disease in which treatment may target inflammation, fungal burden, or both.

Importantly, the review reflects current momentum behind biotherapies (biologics) as a growing part of management. This is particularly relevant for patients in whom long-term corticosteroid exposure is problematic, ineffective, or poorly tolerated.

Why it matters:

• A useful review paper for ABPA education and clinical context.
• Supports the continuing move toward steroid-sparing treatment approaches.
• Relevant to current discussions about personalised management pathways in ABPA.

5. Surveillance, epidemiology and environment

From Aspergillus fumigatus pathogen surveillance to Aspergillus disease surveillance

van Grootveld R, van der Beek MT, Buil JB, Schoffelen AF, de Greeff SC, Bosch T, de Boer MGJ, Kuijper EJ, Verweij PE
Journal of Hospital Infection, 18 March 2026
PMID: 41862136

This is an important conceptual paper. Rather than focusing solely on surveillance of Aspergillus fumigatus as an organism, the authors argue for broader Aspergillus disease surveillance. That is a significant distinction: public health and healthcare systems may gain more by tracking actual disease burden, clinical phenotypes, antifungal resistance patterns, and outcomes than by looking only at isolates.

For services interested in national strategy, referral equity, or long-term burden of disease, this paper points toward a more mature surveillance model. It has particular relevance to discussions about CPA burden, referral pathways, registry development, and national service planning.

Why it matters:

• Important for policy, national strategy, and service development.
• Supports the case for stronger data systems around aspergillosis burden and outcomes.
• Potentially relevant to UK service planning and inequity mapping work.

A deep dive into the diversity of the Aspergillus community in the lakes of northern Iran

Kor M, Hedayati M, Abastabar M, Haghani I, Nabili M, Saravani A, Javidnia J, Brandão J, Moazeni M
Frontiers in Public Health, 20 March 2026
PMCID: PMC12999566

This environmental study analyses the diversity of Aspergillus species in lake environments and identifies potentially pathogenic species in water and sediment samples. It is not a clinical paper, but it adds to the wider evidence base showing that environmental reservoirs of Aspergillus are varied and widespread.

Such work contributes to broader understanding of exposure pathways and may be relevant to discussions around damp environments, environmental fungal burden, and risk in vulnerable individuals.

Why it matters:

• Mainly relevant as background epidemiology and environmental context.
• Useful for the bigger public-health picture of Aspergillus exposure.
• Limited immediate clinical impact for patient management.

6. Case reports and diagnostic challenges

Case Report: Lung squamous cell carcinoma mimicking recurrent aspergillosis in systemic lupus erythematosus

Yu J, Tang Y, Tian S, Zhu W, Dai Q
Frontiers in Medicine, 22 March 2026
PMCID: PMC13002587

This case report is particularly valuable because it highlights a major diagnostic pitfall: lung squamous cell carcinoma presenting as recurrent aspergillosis. In patients with complex lung disease or immunological disease, it can be tempting to interpret recurring pulmonary abnormalities through the lens of known infection, inflammation, or prior fungal disease. This paper is a reminder that alternative diagnoses, including malignancy, must remain in view.

For patients with chronic pulmonary abnormalities, repeated “flare” narratives can sometimes delay the recognition of another process. This has strong relevance for clinical vigilance in CPA and related diagnostic pathways.

Why it matters:

• Important reminder that not everything that looks like recurrent aspergillosis is aspergillosis.
• Relevant to diagnostic delay, differential diagnosis, and the overlap between fungal disease and cancer.
• Useful for clinician education and patient-facing discussion about why diagnosis can sometimes take time.

7. Other relevant papers

Genetic background and immune response in paracoccidioidomycosis: A systematic review and meta-analysis of single nucleotide variants

Coelho SDS, Fava WS, Burger E, Pereira-Latini AC, Pontillo A, Venturini J
PLoS Neglected Tropical Diseases, 19 March 2026
PMID: 41855184 |
PMCID: PMC13001940

This paper is not focused on aspergillosis, but it is relevant to the wider theme of host genetic susceptibility to fungal infection. It adds to the growing literature suggesting that inherited immune variation may partly shape vulnerability to invasive mycoses.

A Case of Disseminated Trichophytosis With Vascular Invasion and Multiple Ulcers: Case Report and Literature Review

Fujino K, Umemoto N, Kakurai M, Yabe H, Maekawa T, Harada K, Makimura K, Shibuya K, Demitsu T
Journal of Dermatology, 19 March 2026
PMID: 41853986

This case is relevant mainly because invasive aspergillosis was initially suspected. It is a useful reminder that other invasive fungal infections may enter the differential diagnosis in immunocompromised patients.

IFUCISTRATEGY: A Spanish Survey on the Management of Invasive Fungal Infection (IFI) in Critically Ill Patients

Zaragoza R, Estella Á, Nuvials X, Robles-Plaza M, Casado-Gómez A
Preprints.org, 17 March 2026
Preprint: PPR1166594

This preprint surveys management practices for invasive fungal infection in critically ill patients. It includes references to pulmonary aspergillosis and reflects continuing emphasis on early testing, bronchoalveolar lavage galactomannan, and timely treatment. As a preprint, it should be interpreted cautiously until peer review is complete.

TET2 germline mutation in a patient with sequential lymphoid malignancies: a novel case report

Mao X, Shen K, Wang J, Wang Z, Ao Q, Wang C, Xiao M
Annals of Hematology, 17 March 2026
PMID: 41843166 |
PMCID: PMC12995931

This paper is included as contextual evidence of aspergillosis occurring in a severely immunocompromised setting. Its relevance is mainly in reinforcing the ongoing burden of pulmonary aspergillosis in haematology patients.

Post-transplant Cyclophosphamide Reduces Bronchiolitis Obliterans Syndrome Risk Through Chronic Graft-versus-Host Disease Prevention: A Multicenter Cohort Study

Eggleston RH, Alkhateeb H, Pennington KM, Zhang Z, Torghabeh MH, Hogan WJ, Khera N, Roy V, Durani U, Yadav H
Chest, 16 March 2026
PMID: 41850483

This paper is not principally about aspergillosis, but may be of indirect relevance to post-transplant lung complications and immunosuppressed populations in whom fungal disease risk remains important.

Overall interpretation

This week’s literature is strongest in three areas: chronic disease ecology, fungal adaptation under azole pressure, and diagnostic complexity. For chronic pulmonary aspergillosis in particular, the most notable message is that disease behaviour may be shaped by more than the fungus alone. The aspergilloma paper supports a richer ecological model involving bacterial adaptation, while the resistance papers suggest that fungal survival under treatment may begin to change before classical resistance becomes obvious.

Together, these studies strengthen the case for thinking about chronic aspergillosis as a dynamic long-term host-microbe-environment problem, rather than a static fungal infection. At the same time, the lung cancer case report is an important reminder that persistent or recurrent disease patterns must still be reviewed critically, especially if the clinical course changes.

What seems most relevant this week?

• Most important for CPA: the aspergilloma microbiome paper and the two azole adaptation/resistance papers.
• Most important for ABPA: the ABPA review summarising diagnosis and evolving treatment approaches.
• Most important for service planning: the surveillance paper arguing for disease-level rather than pathogen-only monitoring.
• Most important diagnostic caution: lung cancer masquerading as recurrent aspergillosis.

References

• Ribeiro MM et al. PMID: 41843749
• Delbaje E et al. PMID: 41837673
• Song Y et al. PMID: 41838943
• Zhou X et al. PMCID: PMC12999553
• Wu Y et al. PMID: 41857172
• Chedal-Anglay C et al. PMID: 41856838
• van Grootveld R et al. PMID: 41862136
• Kor M et al. PMCID: PMC12999566
• Yu J et al. PMCID: PMC13002587
• Coelho SDS et al. PMID: 41855184
• Fujino K et al. PMID: 41853986
• Zaragoza R et al. Preprint: PPR1166594
• Mao X et al. PMID: 41843166
• Eggleston RH et al. PMID: 41850483