Illustration of aspergillosis research papers, a microscope, lung scan and fungal spores representing a weekly update on new Aspergillus and aspergillosis studies.

Weekly aspergillosis research update: papers published 4–12 May 2026

This week’s PubMed search for aspergillosis identified several new papers relevant to aspergillosis diagnosis, treatment, host-pathogen biology, allergic bronchopulmonary aspergillosis (ABPA), invasive pulmonary aspergillosis (IPA), and chronic pulmonary aspergillosis (CPA).

Key themes this week

  • Bronchoscopic intervention in invasive pulmonary aspergillosis: a Chinese clinical analysis reports on bronchoscopic features and interventional therapy in IPA.
  • ABPA guidance and imaging: one expert consensus paper and one adult asthma imaging study add to the ABPA literature.
  • Diagnostics: new papers discuss galactomannan biology, metagenomic next-generation sequencing, and radiological assessment.
  • Complex invasive fungal infection: several case-based reports highlight diagnostic difficulty in mixed or unusual fungal infections.
  • Antifungal pharmacology: a real-life cohort study examines isavuconazole pharmacokinetics and pharmacodynamics.

Allergic bronchopulmonary aspergillosis (ABPA)

Expert consensus on ABPA diagnosis and treatment using integrated traditional Chinese and western medicine

Allergy Committee of Chinese Association of Integrative Medicine.
Zhonghua Yi Xue Za Zhi. 2026 May 12;106(17):1678-1695.
doi: 10.3760/cma.j.cn112137-20260101-00001
PMID: 42103676

This Chinese expert consensus addresses diagnosis and treatment of allergic bronchopulmonary aspergillosis. The abstract notes that ABPA is a hypersensitivity lung disease triggered by sensitisation to Aspergillus fumigatus or other Aspergillus species, with reported incidence of 1.0–3.5% in asthma patients and 7–15% in cystic fibrosis patients.

Why it matters: Although this is a Chinese-language consensus document and includes integrated traditional Chinese and western medicine approaches, it may still be useful to track because international consensus documents can show how ABPA recognition and management are evolving globally.

Radiological manifestations of ABPA in adult asthmatic patients

Wahab F, Hussain Babar T, Nadeem SF, Amin Z, Sarwar S, Ahmad S, Wahab A, Mukhtar S.
Monaldi Archives for Chest Disease. 2026 May 7. Online ahead of print.
doi: 10.4081/monaldi.2026.3648
PMID: 42099257

This paper focuses on radiological findings in adults with asthma and allergic bronchopulmonary aspergillosis. The PubMed abstract describes ABPA as developing through type I or type III hypersensitivity reactions to filamentous fungi such as Aspergillus.

Why it matters: Imaging remains central to recognising ABPA complications such as bronchiectasis, mucus plugging and other structural airway changes. Papers that improve recognition of radiological patterns may help reduce diagnostic delay in patients labelled as having difficult asthma alone.

Invasive pulmonary aspergillosis (IPA) and complex fungal infection

Clinical analysis of comprehensive bronchoscopic interventional therapy for invasive pulmonary aspergillosis

Li J, Cai CL, Zhao LN, Wang YH, Mu XD.
Zhonghua Jie He He Hu Xi Za Zhi. 2026 May 12;49(5):555-560.
doi: 10.3760/cma.j.cn112147-20250719-00420
PMID: 42108177

This Chinese-language clinical analysis investigates bronchoscopic features of invasive pulmonary aspergillosis and summarises the clinical efficacy of comprehensive bronchoscopic interventional therapy. Underlying conditions in the reported cases included diabetes mellitus and haematological malignancy.

Why it matters: Bronchoscopy can contribute both diagnostically and therapeutically in selected patients with IPA, particularly where airway obstruction, fungal plaques, necrotic material or local complications are present. This paper may be of interest to clinicians managing complex IPA cases.

Fatal triple co-infection with Aspergillus, Mucorales and Nocardia in aplastic anaemia

Sadeghi Borkehim S, Azhdari Tehrani H, Javandoust Gharehbagh F, Kord M, Azimi M, Alavi Darazam I.
BMC Infectious Diseases. 2026 May 9.
doi: 10.1186/s12879-026-13190-0
PMID: 42106631

This case report describes a fatal triple co-infection involving Aspergillus, Mucorales and Nocardia in a patient with aplastic anaemia.

Why it matters: In severely immunocompromised patients, invasive fungal disease may not occur in isolation. Mixed infections can complicate diagnosis, delay targeted treatment and require broader microbiological investigation than would be needed for a single-pathogen infection.

Cladribine treatment in pulmonary Langerhans cell histiocytosis complicated by invasive aspergillosis

Piekarczyk P, Pajer M, Kupis W, Wojda E, Nowicka U, Radzikowska E.
Polish Archives of Internal Medicine. 2026 May 4. Online ahead of print.
doi: 10.20452/pamw.17292
PMID: 42100864

This free article reports cladribine treatment in a young patient with isolated progressive pulmonary Langerhans cell histiocytosis complicated by invasive aspergillosis. No abstract was available in the PubMed record.

Why it matters: This appears to be a highly specialised case, but it highlights the intersection between rare lung disease, immunomodulatory treatment and risk of invasive fungal infection.

Invasive pulmonary aspergillosis in an apparently immunocompetent host

Beeravolu HR, Ghewade B, Alone V, Mummaneni R, Patil PA.
Respiratory Medicine Case Reports. 2026 Apr 27;61:102425. eCollection 2026.
doi: 10.1016/j.rmcr.2026.102425
PMID: 42088316

This case report describes invasive pulmonary aspergillosis in an immunocompetent host. Although IPA classically occurs in immunocompromised patients, the authors note that it can occasionally occur without obvious immunosuppression, which may contribute to diagnostic delay.

Why it matters: Case reports of IPA in apparently immunocompetent patients should be interpreted cautiously, but they are useful reminders that clinical context, imaging, microbiology and disease trajectory all matter when assessing possible invasive fungal infection.

Diagnostics, biomarkers and fungal biology

Structure and biosynthetic mechanisms of galactomannans in filamentous fungi

Oka T, Kadooka C, Tanaka Y, Hira D.
Biochimica et Biophysica Acta - General Subjects. 2026 May 7;1870(8):130960. Online ahead of print.
doi: 10.1016/j.bbagen.2026.130960
PMID: 42105885

This review focuses on galactomannans in filamentous fungi. Galactomannan contains mannose and galactofuranose; galactofuranose is absent in humans and is clinically important because galactomannan detection is used in the diagnosis of invasive pulmonary aspergillosis.

Why it matters: Galactomannan is one of the best-known fungal biomarkers in aspergillosis diagnostics. Understanding its structure and biosynthesis helps explain both the value and limitations of galactomannan-based testing.

Metagenomic next-generation sequencing for severe influenza complicated by invasive pulmonary aspergillosis

Niu S, Guo L, Li Z, Liu Y, Zhao L.
Frontiers in Cellular and Infection Microbiology. 2026 Apr 21;16:1746504. eCollection 2026.
doi: 10.3389/fcimb.2026.1746504
PMID: 42093770

This study evaluates the diagnostic performance of metagenomic next-generation sequencing for detecting invasive pulmonary aspergillosis in patients with severe influenza.

Why it matters: Influenza-associated pulmonary aspergillosis is increasingly recognised in critically ill patients. Rapid molecular methods such as metagenomic next-generation sequencing may help identify fungal infection earlier, although interpretation requires care because detection of fungal DNA does not always prove invasive disease.

Antifungal treatment and pharmacology

Real-life pharmacokinetics and pharmacodynamics of isavuconazole

Guidi M, Couchepin J, Reinhold I, Kronig I, Neofytos D, Schreiber PW, André P, Buclin T, Lamoth F.
JAC-Antimicrobial Resistance. 2026 May 5;8(3):dlag071. eCollection 2026 Jun.
doi: 10.1093/jacamr/dlag071

This paper reports real-life pharmacokinetic and pharmacodynamic data for isavuconazole, an antifungal used in invasive aspergillosis and mucormycosis.

Why it matters: Real-world pharmacology studies are important because antifungal exposure can vary between patients. Better understanding of drug levels, exposure-response relationships and clinical outcomes may help refine antifungal monitoring and dosing strategies.

Aspergillus species, virulence and non-human disease

Pathogenic mechanisms of Aspergillus lentulus infection in Galleria mellonella

Zhang L, Ji M, Hasimu H, Abliz P.
Mycopathologia. 2026 May 9;191(3):51.
doi: 10.1007/s11046-026-01072-7
PMID: 42105125

This experimental study investigates pathogenic mechanisms of Aspergillus lentulus infection using Galleria mellonella larvae, focusing on oxidative stress and tissue damage.

Why it matters: Aspergillus lentulus is a clinically important cryptic species within the Aspergillus fumigatus complex and may show reduced susceptibility to some antifungals. Model systems such as Galleria mellonella can help explore fungal virulence mechanisms before moving into more complex models.

Antemortem diagnosis of aspergillosis in a gentoo penguin

Matsumoto N, Itoh M, Toyotome T, Watanabe K, Yamada M, Hagino K, Neo S, Yamada K.
Journal of Veterinary Medical Science. 2026 May 7. Online ahead of print.
doi: 10.1292/jvms.25-0377
PMID: 42091553

This veterinary case report describes antemortem diagnosis of aspergillosis in a gentoo penguin using computed tomography and air sac fluid aspiration.

Why it matters: Aspergillosis is an important disease in birds, particularly captive penguins. Although not directly relevant to human clinical care, veterinary aspergillosis studies can contribute to understanding host susceptibility, environmental exposure and diagnostic approaches across species.

Related respiratory and microbiome research

The gut microbiome in cystic fibrosis

Marsh R, Tricker JM, Delhaes L, Bomberger JM, van der Gast C.
Journal of Cystic Fibrosis. 2026 May 9. Online ahead of print.
doi: 10.1016/j.jcf.2026.05.003
PMID: 42108153

This review discusses recent findings and future opportunities relating to the gut microbiome in cystic fibrosis.

Why it matters: This is not primarily an aspergillosis paper, but cystic fibrosis is an important context for allergic bronchopulmonary aspergillosis and airway fungal colonisation. Microbiome research may eventually help clarify how bacterial, fungal and host factors interact in chronic airway disease.

Summary

This week’s most directly relevant papers include new work on bronchoscopic management of invasive pulmonary aspergillosis, ABPA consensus and imaging, galactomannan biology, molecular diagnosis in influenza-associated pulmonary aspergillosis, and real-world isavuconazole pharmacology. Several case reports also underline the continuing diagnostic difficulty of invasive fungal disease, particularly in complex or immunocompromised patients.

by GAtherton

Weekly aspergillosis research update infographic showing diagnostics, treatment challenges, antifungal resistance and patient risk factors

Weekly Aspergillosis Research Update April - May 2026

Search term: aspergillosis
Period covered: late April–early May 2026

Key highlights this week

  • Diagnostics: new evidence for pentraxin-3 and airway galactomannan testing.
  • Treatment: voriconazole dosing may be difficult during ECMO and needs close monitoring.
  • Resistance: azole-resistant Aspergillus fumigatus detected around patient homes in Brazil.
  • Transplant medicine: aspergillosis remains the dominant invasive mould infection after lung transplantation.
  • Future therapies: early laboratory work identifies a possible new antifungal drug target.

1. New diagnostic marker: pentraxin-3 for invasive pulmonary aspergillosis

Sun C et al. Diagnostic value of pentraxin 3 in plasma and bronchoalveolar lavage fluid for invasive pulmonary aspergillosis in non-neutropenic patients: a prospective multicenter clinical study. Emerging Microbes & Infections, 2026.

View on PubMed – PMID: 42054395

This prospective multicentre study looked at pentraxin-3 in blood and bronchoalveolar lavage fluid as a diagnostic marker for invasive pulmonary aspergillosis in patients who are not neutropenic.

Why it matters: diagnosing invasive aspergillosis can be especially difficult in patients outside the classic high-risk groups. This study supports the wider move toward combining tests and biomarkers rather than relying on one result alone.

2. Galactomannan testing in tracheobronchial aspirates after lung transplant

Monforte A et al. Diagnostic value of galactomannan in tracheobronchial aspirate for Aspergillus infection in lung transplant recipients (the GALACTBAS study). Journal of Clinical Microbiology, 2026.

View on PubMed – PMID: 42059612

This study assessed whether galactomannan testing in tracheobronchial aspirates can help diagnose Aspergillus infection in lung transplant recipients.

Why it matters: aspergillosis after lung transplantation often involves the airways. Testing airway samples may support earlier diagnosis and may sometimes be less invasive than deeper lung sampling.

3. Voriconazole levels may vary during ECMO

Yusuff H et al. Time-varying voriconazole clearance during extracorporeal membrane oxygenation. Antimicrobial Agents and Chemotherapy, 2026.

View on PubMed – PMID: 42059809

This paper looked at voriconazole clearance in critically ill patients receiving extracorporeal membrane oxygenation (ECMO).

Why it matters: voriconazole is commonly used to treat invasive aspergillosis, but drug levels can be unpredictable in critical illness. This supports the importance of therapeutic drug monitoring so dosing can be adjusted safely and effectively.

4. Azole-resistant Aspergillus found around patient homes in Brazil

de Barros Rodrigues DK et al. Environmental circulation of Aspergillus fumigatus with reduced susceptibility to agricultural triazole in Brazil: clonal dissemination of potentially resistant genotypes. Mycoses, 2026.

View on PubMed – PMID: 42037564

This study investigated environmental Aspergillus fumigatus around the homes of two patients with suspected aspergillosis caused by resistant isolates.

Why it matters: the findings add to concern that antifungal resistance can arise and circulate in the environment, including through exposure to agricultural triazoles. This is important because azole resistance can make aspergillosis harder to treat.

5. Invasive mould infections after lung transplantation: aspergillosis dominates

Pennington KM et al. Impact of invasive mold infection-coded diagnoses on utilization, costs, and mortality after lung transplantation. Chest, 2026.

View on PubMed – PMID: 42061698

This study assessed invasive mould infection-coded diagnoses after lung transplantation. Aspergillosis was the most common invasive mould infection reported.

Why it matters: lung transplant recipients remain among the highest-risk groups for severe aspergillosis. The study reinforces the need for prevention, early recognition, rapid diagnosis and specialist management.

6. A possible new antifungal target in Aspergillus fumigatus

Storer ISR et al. A protein-protein interaction inhibitor arrests the cell cycle in Aspergillus fumigatus. mBio, 2026.

View on PubMed – PMID: 42053292

This laboratory study explored a compound that interferes with protein-protein interactions and can arrest the cell cycle in Aspergillus fumigatus.

Why it matters: current antifungal options remain limited, and resistance is a growing problem. Early-stage work like this may help identify future antifungal drug classes.

7. Diabetes and fungal infection risk

Kaur H et al. Fungal infections in diabetes mellitus. Indian Journal of Medical Microbiology, 2026.

View on PubMed – PMID: 42061613

This review discusses fungal infections in people with diabetes, including mucormycosis, aspergillosis and cryptococcosis.

Why it matters: diabetes can affect immune function and increase susceptibility to some infections. For patients with existing lung disease, good diabetes management may be one part of reducing overall infection risk.

8. Aspergillosis during cancer immunotherapy

Niravath P et al. A Phase II Study of Docetaxel and Pembrolizumab plus Interleukin 12 Gene Therapy in Nonmetastatic, Anthracycline-Refractory Triple-Negative Breast Cancer (INTEGRAL). Clinical Cancer Research, 2026.

View on PubMed – PMID: 41661218

This cancer therapy study includes a reported case of pulmonary aspergillosis and respiratory failure during treatment.

Why it matters: modern cancer treatments can alter infection risk in complex ways. Aspergillosis should remain on the radar in patients who become unwell during or after intensive cancer therapy.

Other papers noted this week

  • Canakinumab safety pharmacovigilance analysis – relevant to biologic therapy safety and infection monitoring. PMID: 41998856
  • Canine sinonasal radiotherapy study – includes nasal aspergillosis in dogs, but is mainly veterinary/radiotherapy focused. PMID: 42007656
  • Mucormycosis retrospective study – relevant to invasive fungal disease burden but not directly focused on aspergillosis. PMID: 42050055

Overall message

This week’s papers show how aspergillosis research is moving in several important directions at once: better diagnostic markers, more personalised antifungal dosing, growing concern about environmental resistance, and continued recognition of high-risk groups such as transplant recipients, critically ill patients and people with complex immune or metabolic conditions.

For patients, the main message is that aspergillosis is a complex condition and testing or treatment decisions often need specialist interpretation. No single test result tells the whole story; clinicians usually combine symptoms, scans, culture results, biomarkers and risk factors before deciding on diagnosis and treatment.

by GAtherton

Infographic summarising weekly aspergillosis research including ABPA biologics, antifungal resistance, occupational exposure and invasive aspergillosis studies (April 2026)

Weekly Aspergillosis Research Update: Week ending 27 April 2026

Highlights this week

  • Occupational aspergillosis: workplace exposure to Aspergillus highlighted in a national study.
  • ABPA and biologics: early evidence for tezepelumab in allergic bronchopulmonary aspergillosis.
  • Mucus plugging: important mechanism in ABPA, bronchiectasis and chronic lung disease.
  • Invasive disease: new analysis of antifungal treatment strategies.
  • Resistance: ongoing global surveillance of antifungal susceptibility.

Occupational non-invasive aspergillosis

A French national multicentre study reviewed occupational cases of non-invasive aspergillosis over more than 20 years.

Why it matters: workplace exposure (dust, compost, damp buildings, waste handling) may contribute to disease in some patients and should be considered in clinical history-taking.

Reference: Michel A et al.

PMID: 42033338

Tezepelumab in allergic bronchopulmonary aspergillosis

A small 4-patient case series explored the use of tezepelumab in allergic bronchopulmonary aspergillosis (ABPA) with severe asthma.

Why it matters: adds to growing interest in biologics for ABPA, particularly where steroid burden is high. Evidence remains early and limited.

Reference: Sanz-Sanjosé B et al.

PMID: 42017435

Mucus plugging in chronic lung disease

A narrative review examined mucus plugging in chronic obstructive lung diseases and bronchiectasis, including ABPA.

Why it matters: mucus plugs can block airways, worsen breathlessness, and contribute to infection risk and scan abnormalities.

Reference: Schou C et al.

PMCID: PMC13103984

Invasive aspergillosis treatment

A systematic review and network meta-analysis compared antifungal treatment regimens for invasive aspergillosis.

Why it matters: invasive aspergillosis remains a high-mortality infection; early diagnosis and optimal antifungal therapy are critical. Triazoles and other antifungals remain central to management. :contentReference[oaicite:0]{index=0}

Reference: Gu Q et al.

PMID: 42012594

Natural killer cells and resistant Aspergillus

A laboratory study demonstrated antifungal activity of human natural killer cells against azole-resistant Aspergillus fumigatus.

Why it matters: improves understanding of immune defence mechanisms and may inform future therapies.

Reference: Namie H et al.

PMID: 42012259

Antifungal susceptibility surveillance

A multicentre Taiwan study examined susceptibility patterns of clinical Aspergillus isolates (2021–2023).

Why it matters: resistance patterns vary geographically, influencing antifungal treatment choices.

Reference: Hsieh M et al.

PMID: 42012212

Invasive aspergillosis in severe viral illness

A study explored invasive pulmonary aspergillosis complicating severe fever with thrombocytopenia syndrome.

Why it matters: reinforces the link between severe illness, immune disruption, and risk of invasive aspergillosis.

Reference: Du Q et al.

PMID: 42032512

Lower-priority or indirect papers

Veterinary study (canine nasal aspergillosis)

Primarily a veterinary oncology study with limited relevance to human disease.

Reference:

PMID: 42007656

Canakinumab pharmacovigilance

Focuses on drug safety rather than aspergillosis.

Reference:

PMID: 41998856

Overall message

This week’s research highlights the wide scope of aspergillosis—from environmental and occupational exposure to allergic disease, invasive infection, antifungal resistance, and immune responses. The most relevant developments for patients remain ABPA biologics, mucus plugging, and antifungal resistance trends.

Patient note

This summary is for general information only and does not replace medical advice. Always discuss treatment decisions with your specialist team.

by GAtherton

Infographic showing weekly aspergillosis research update April 2026 including blood mNGS diagnosis, lung immune modulation therapy, and isavuconazole drug modelling

Weekly aspergillosis update – 20 April 2026

This week’s papers point in three useful directions for aspergillosis research: better diagnosis, more precise immune modulation, and improved antifungal pharmacology modelling. The most directly relevant study for day-to-day human aspergillosis care is a new paper on blood metagenomic next-generation sequencing (mNGS) for invasive pulmonary aspergillosis.

1. Blood metagenomic next-generation sequencing for invasive pulmonary aspergillosis

Chen Y, Tang X, Lu S, Guo L, Wang L, Min L, Niu T, Zhou Y.
The diagnostic and prognostic utility of blood metagenomic next-generation sequencing for invasive pulmonary aspergillosis.
Microbiology Spectrum, 17 April 2026.
View on PubMed (PMID: 41995327)

This study addresses one of the hardest clinical problems: distinguishing true invasive pulmonary aspergillosis from colonisation when Aspergillus is detected. A reliable blood-based test could be especially useful where bronchoscopy is not possible or results are unclear.

At present, this should be seen as promising rather than practice-changing, but it is exactly the type of work needed to improve early and accurate diagnosis.

2. Gene delivery of immunomodulatory cytokines to the lung

Makuyana N et al.
Gene delivery of immunomodulatory cytokines to the lung preserves respiratory function during inflammatory challenge.
Science Immunology, 17 April 2026.
View on PubMed (PMID: 41996474)

This preclinical study explores whether delivering immunomodulatory cytokines directly to the lungs can reduce damaging inflammation. The work is linked to influenza-associated pulmonary aspergillosis, where immune-driven lung injury can be severe.

The key idea is that fungal lung disease is not only about infection, but also about how the immune system responds. This represents a shift toward combining antifungal treatment with targeted immune modulation—although this approach is still at an early, experimental stage.

3. Isavuconazole pharmacokinetic modelling (preprint)

Choules MP et al.
Development of an Isavuconazole Physiologically-based Pharmacokinetic Model for Adult and Pediatric Populations.
Research Square, 17 April 2026 (preprint).

This study uses physiologically based pharmacokinetic (PBPK) modelling to predict how isavuconazole behaves in adults and children, including potential drug–drug interactions.

The findings suggest broadly similar interaction risks across age groups, but highlight greater uncertainty and caution in children under 3 years, particularly with drugs such as digoxin and warfarin.

As a preprint, this is best viewed as supportive pharmacology data, not a change to clinical practice.

4. Histopathology in infectious disease diagnosis

Boubacar E et al.
Histopathological Diagnosis of Infectious Diseases: Experience From a Tertiary Care Center in a Sub-Saharan African Country.
International Journal of Surgical Pathology, 16 April 2026.
View on PubMed (PMID: 41989331)

This broader study included a small number of aspergillosis cases and highlights the continued importance of histopathology, particularly when infections mimic cancer or other conditions.

5. Avian aspergillosis biomarker research

Vieu S et al.
Falcon plasma proteomics to improve avian aspergillosis diagnosis.
Journal of Proteomics, 14 April 2026.
View on PubMed (PMID: 41990917)

This veterinary study explores new plasma biomarkers for diagnosing aspergillosis in birds. While not directly applicable to human care, it reflects a broader research trend toward earlier, less invasive diagnosis.

What matters most this week?

The most important development is the blood mNGS study, which targets a real diagnostic gap. The immunology paper is conceptually important for future treatments, while the isavuconazole modelling work supports ongoing improvements in antifungal use.

Bottom line

This week reinforces three key directions in aspergillosis research:

  • Earlier and more accurate diagnosis
  • Better understanding of immune-driven lung damage
  • More precise antifungal drug use and interaction modelling

by GAtherton

Epigenetics and Aspergillosis: Why Your Body Responds Differently – and What Future Treatments May Look Like

Last reviewed: April 2026
Audience: Patients, carers, GPs, specialist nurses

This article explains how the immune system, environment, and emerging research all connect. If helpful, you can explore each topic in more detail using the links throughout this page.

Key Points

  • Epigenetics controls how your genes behave without changing your DNA sequence.
  • It helps explain why people with similar lung disease develop different forms of aspergillosis.
  • Both the human immune system and the fungus itself use epigenetic mechanisms.
  • These processes influence inflammation, immune response, and treatment effectiveness.
  • Future treatments may combine antifungals, biologics, and epigenetic approaches.
  • There are currently no epigenetic therapies for aspergillosis in routine NHS care.

Table of Contents

What is epigenetics?

If you are new to aspergillosis, you may find it helpful to first read our overview of what aspergillosis is.

Epigenetics refers to changes in how your genes are used by your body, without changing the underlying DNA sequence.

You can think of your DNA as a library of instructions. Epigenetics controls:

  • Which instructions are read
  • When they are used
  • How strongly they are activated

This allows your body to adapt to its environment—but it can also contribute to disease.

How epigenetics works (simple explanation)

There are three main mechanisms:

  • DNA methylation – switches genes off
  • Histone modification – controls how tightly DNA is packaged (affecting access to genes)
  • MicroRNAs – fine-tune gene activity

These processes are now recognised as key regulators of immune and fungal biology
(Nie et al., 2018).

Why this matters in aspergillosis

Patients often ask:

“Why did I develop this when others didn’t?”

Epigenetics helps explain why similar exposures to Aspergillus can result in:

  • Allergic disease
  • Chronic infection
  • No disease

This reflects differences in immune system “programming”.

Importantly, this programming is influenced by:

  • Past infections
  • Lung damage (e.g. COPD, TB)
  • Environmental exposure
  • Medications

Is the body “testing” responses before they become permanent?

It can sometimes feel as though the body is “trying out” different ways of responding to infection or environmental exposure.

This idea comes close to how epigenetics works—but it is important to understand it carefully.

A useful way to think about it

Epigenetics allows the body to rapidly adjust how genes behave in response to the environment. This can happen over days, months, or years, and may influence how the immune system reacts to fungi such as Aspergillus.

In this sense, epigenetics can be thought of as allowing the body to explore different “settings” of immune response—for example:

  • A stronger allergic response (as seen in ABPA)
  • A weaker or less effective response (as seen in CPA)
  • A balanced response with minimal symptoms

What epigenetics does not do

It is important to be clear that the body is not deliberately “testing” changes in a planned way, and epigenetic changes are not directly converted into permanent genetic mutations.

Instead:

  • Epigenetic changes are fast and flexible
  • Genetic changes (mutations) occur slowly and randomly
  • Natural selection acts over long timescales to favour traits that improve survival

How the two processes connect

Although separate, epigenetics and evolution can interact over time.

If a particular way of responding to infection is consistently helpful, individuals whose genes naturally produce a similar response may be more likely to thrive over generations.

This means:

  • Epigenetics shapes how the body responds in the short term
  • Evolution shapes which responses persist in the long term

Why this matters in aspergillosis

This helps explain why:

  • Different people respond very differently to the same fungal exposure
  • Symptoms can change over time
  • Modern environments (such as damp housing or long-term steroid use) may produce responses that our immune systems were not originally adapted for

Can epigenetic changes be inherited?

Most epigenetic changes happen within a single lifetime and are not passed on to children. However, there is growing evidence that some epigenetic changes may persist or be transmitted across generations under certain conditions.

This is sometimes called transgenerational epigenetic inheritance.

For example, research suggests that:

  • Environmental exposures (such as diet, stress, or infection) may leave lasting epigenetic marks
  • Some of these marks may influence how genes behave in the next generation
  • This effect is usually partial and not always predictable

In humans, this area is still being studied, and the extent to which epigenetic changes are inherited remains uncertain.

What this means in practice

It is important not to overinterpret this idea:

  • Epigenetic inheritance is not a replacement for genetic inheritance
  • Most traits and diseases are still determined by DNA and environment
  • There is currently no evidence that conditions like aspergillosis are directly passed on through epigenetic changes

However, this research does suggest that environment and health may have longer-term effects than previously thought, potentially influencing future generations in subtle ways.

In simple terms:

Epigenetics allows the body to adapt quickly. Evolution determines what lasts.

Different diseases, different immune patterns

See also:

Allergic pattern (ABPA)

  • Strong Th2 immune response
  • High IgE and eosinophils
  • Exaggerated reaction to fungal spores

Epigenetic changes may increase expression of cytokines such as IL-4, IL-5, and IL-13, driving allergic inflammation.

Chronic infection pattern (CPA)

  • Reduced ability to clear fungus
  • Persistent infection in damaged lung areas
  • Chronic inflammation and tissue damage

Epigenetic changes may “lock in” ineffective immune responses.

Damp, mould, and environmental exposure

Long-term exposure to damp and mould is highly relevant.

It may:

  • Alter airway cell behaviour
  • Increase sensitivity to fungal spores
  • Promote ongoing inflammation

These effects may persist through epigenetic changes, even after exposure is reduced.

See:

Why treatment works differently

Epigenetics may explain why patients respond differently to treatment.

  • Some respond well to steroids
  • Others develop resistance or side effects
  • Biologic response varies between individuals

A key mechanism involves reduced activity of enzymes such as histone deacetylase 2 (HDAC2), which is important for steroid response.

See also: Why antibiotics do not always work

Biologics vs epigenetics

Biologics

  • Target specific immune signals (e.g. IgE, IL-5)
  • Fast and precise
  • Widely used in severe asthma and ABPA

Read more about biologics

Epigenetics

  • Acts at a deeper level
  • Influences multiple pathways
  • May create longer-lasting effects

Epigenetics is unlikely to replace biologics—it is more likely to enhance and personalise them.

What research is trying to do

1. Restoring steroid sensitivity

Research is exploring how to restore HDAC2 activity and improve steroid effectiveness.

2. Trained immunity (immune memory)

Immune cells can be “trained” by past exposures. This may lead to:

  • Better defence
  • Or harmful chronic inflammation

Scientists are studying how to reset this balance.

3. MicroRNA biomarkers

MicroRNAs may help predict:

  • Disease severity
  • Risk of relapse
  • Treatment response

4. Metabolic and immune reprogramming

Immune cell metabolism is closely linked to epigenetic regulation. Modifying this may improve immune function.

Epigenetics in Aspergillus itself

The fungus is not passive—Aspergillus fumigatus also uses epigenetic control.

This influences:

  • Virulence (how aggressive it is)
  • Biofilm formation
  • Resistance to antifungal drugs

Recent research shows that epigenetic regulators directly affect fungal interaction with the host
(Liu et al., 2026).

Other studies show control of toxin production and colonisation
(Hao et al., 2023).

What this means for the future

The most realistic model is layered care:

  • Antifungals
  • Steroids
  • Biologics
  • Environmental control
  • Future epigenetic approaches

Epigenetics may:

  • Improve treatment response
  • Reduce relapse
  • Enable personalised care

These approaches are still in development.

Common Questions

Can I change my epigenetics?

Not directly. However, reducing damp exposure and maintaining general health may support better immune regulation.

Are these treatments available?

No. They are still in research.

Why do my symptoms fluctuate?

Immune regulation changes over time. Epigenetics may contribute alongside infection and exposure.

Is this the next generation of treatment?

It is better seen as an additional layer that may improve existing treatments.

When to seek medical advice

  • Worsening breathlessness
  • Increased cough
  • Chest pain
  • Weight loss
  • Sudden symptom changes

This article is for education and does not replace clinical advice.

References

by GAtherton

Weekly Aspergillosis Research Update (7–11 April 2026)

Last reviewed: April 2026
Audience: Patients, carers, GPs, specialist nurses, and healthcare professionals

Key Points (Summary)

  • Invasive pulmonary aspergillosis (IPA) can closely mimic other serious infections, including miliary tuberculosis, particularly in highly immunocompromised patients.
  • Metagenomic next-generation sequencing (mNGS) is emerging as a valuable diagnostic tool in complex or unclear cases, though it is not yet widely available.
  • Bruton tyrosine kinase (BTK) inhibitors are associated with a measurable risk of invasive fungal infections, with aspergillosis the most frequently reported.
  • Host genetics (e.g. toll-like receptor variants) may influence susceptibility to invasive fungal disease, but this is not yet used clinically.
  • Azole antifungal drugs remain high-risk for drug–drug interactions, particularly in patients receiving cancer therapies.
  • Basic science research continues to identify new fungal targets and pathways, which may inform future treatments.

Contents

Diagnosis and difficult cases

When aspergillosis looks like something else

A case report
(Ji H et al., 2026 – full text)
describes a patient with acute leukaemia who developed widespread “miliary” lung nodules—an imaging pattern classically associated with tuberculosis.

Despite this, the final diagnosis was invasive pulmonary aspergillosis (IPA).

Clinical interpretation

  • Radiological appearances in immunocompromised patients can be non-specific.
  • Aspergillosis may present without classic features such as halo signs or cavitation.
  • Coinfection (e.g. TB + fungal disease) can further complicate interpretation.

This reinforces an important principle in clinical practice: lack of response to treatment should prompt reconsideration of the diagnosis.

The emerging role of mNGS

In this case, metagenomic next-generation sequencing (mNGS) helped establish the diagnosis by detecting fungal DNA directly from clinical samples.

Strengths of mNGS

  • Broad pathogen detection (fungi, bacteria, viruses)
  • Useful in culture-negative infections
  • Can identify unexpected pathogens

Current limitations

  • Limited availability outside specialist centres
  • Cost and turnaround time
  • Interpretation challenges (distinguishing infection from colonisation)

Bottom line: mNGS is promising, but currently complements rather than replaces standard diagnostics (culture, PCR, antigen testing).

Treatment-related risk and immunosuppression

BTK inhibitors and invasive fungal infection

A systematic review and meta-analysis
(PMID: 41954633)
including over 23,000 patients found that:

  • Aspergillosis was the most commonly reported invasive fungal infection
  • Central nervous system involvement was reported in a subset

Why BTK inhibitors increase risk

  • They impair B-cell signalling
  • They affect macrophage and neutrophil function
  • This reduces the body’s ability to control fungal spores

Clinical implications

  • Risk stratification is important
  • Some patients may require antifungal prophylaxis
  • Early recognition of symptoms is critical

This aligns with increasing recognition that modern targeted therapies can have unintended immunological effects.

Genetics and susceptibility

The role of innate immunity

A systematic review
(PMID: 41962654)
examined toll-like receptor (TLR) polymorphisms and fungal infection risk.

TLRs are part of the innate immune system and are responsible for recognising fungal components such as:

  • β-glucans
  • Cell wall proteins

Key insight

  • Certain genetic variants were more frequently reported in patients with invasive aspergillosis

Important context:

  • This does not yet translate into routine testing
  • It may become relevant in the future for personalised risk prediction

Asthma and Aspergillus sensitisation

A 12-week prospective study
(PMID: 41949214)
found that:

  • ~29% of asthma patients were sensitised to Aspergillus fumigatus
  • No significant short-term differences in outcomes were seen compared to non-sensitised patients

Interpretation

  • Sensitisation alone does not necessarily indicate active disease
  • Clinical context remains critical

Important distinction:

  • Sensitisation = immune response to Aspergillus
  • ABPA (Allergic Bronchopulmonary Aspergillosis) = a specific inflammatory disease requiring treatment

Drug interactions

Itraconazole and erlotinib interaction

A case report
(PMID: 41953502)
demonstrated increased exposure to erlotinib when co-administered with itraconazole.

Mechanism

  • Itraconazole inhibits CYP3A4
  • This reduces drug metabolism
  • Drug levels rise, increasing risk of toxicity

Clinical message

  • Always review medications when starting antifungals
  • Particular caution is needed in cancer, transplant, and multi-morbid patients

Useful tool:
Antifungal Interactions Checker

Emerging research and future treatments

Epigenetic regulation in Aspergillus fumigatus

A study
(PMID: 41928566)
identified the role of HosA in regulating fungal growth and virulence.

This type of work helps identify:

  • Potential drug targets
  • Mechanisms of antifungal resistance

New experimental antifungal compounds

A review
(Full text (PMC))
discusses sodium new houttuyfonate (SNH), which has shown activity in animal models of invasive aspergillosis.

Important caution:

  • This is early-stage research
  • It is not available as a treatment

What this means for patients

  • Aspergillosis can sometimes be difficult to diagnose, especially if symptoms overlap with other conditions.
  • If treatment is not working, your medical team may need to review or repeat tests.
  • Some medications (especially for cancer or immune conditions) can increase risk of fungal infection.
  • Antifungal medications are effective but require careful monitoring for interactions.
  • New research is promising, but most advances take time to reach routine care.

When to seek medical advice

Seek medical attention urgently if you have:

  • Worsening breathlessness
  • Persistent fever
  • Coughing up blood
  • New chest pain
  • Symptoms not improving with treatment

If you are immunocompromised, symptoms may progress quickly and should be assessed promptly.

References

Author & Review

This article is part of the Aspergillosis.org weekly research update series. It is intended for general educational purposes and reflects a structured summary of recent research.

Disclaimer: This content is not a substitute for medical advice. Always consult your healthcare team for individual care decisions.

by GAtherton

Cystic Fibrosis, CFTR Gene Variants, and Aspergillosis

Last reviewed: 8 April 2026

Some people with aspergillosis are told they have cystic fibrosis (CF), or that they carry a CFTR gene variant. This can be unexpected and may raise concerns about whether this explains their symptoms or diagnosis.

This article explains how cystic fibrosis and CFTR gene variants relate to Aspergillus-related lung disease, what current research shows, and—importantly—what conclusions should not be drawn.

Contents

Key points

  • Most people with aspergillosis do not have cystic fibrosis.
  • Most people with cystic fibrosis do not develop ABPA or CPA.
  • ABPA is linked to mucus and immune responses, not just infection.
  • CFTR variants may contribute to risk in some people, but are usually only one factor.
  • CPA is mainly driven by structural lung damage, not CFTR genetics.

Back to top ↑

Important reassurance

Most people with aspergillosis do not have cystic fibrosis, and most people with cystic fibrosis do not develop Aspergillus-related disease.

Although these conditions can overlap, they are usually separate. Genetic findings such as CFTR variants should be interpreted carefully and in context.

Back to top ↑

What is cystic fibrosis?

Cystic fibrosis is a genetic condition caused by changes in the CFTR gene. This gene regulates salt and water movement across cells.

When CFTR function is reduced:

  • mucus becomes thick and sticky
  • airways are harder to clear
  • microorganisms persist more easily

This creates an environment where bacteria and fungi can accumulate over time.

Back to top ↑

What is a CFTR gene variant?

CFTR variants range from severe mutations (causing cystic fibrosis) to mild or uncertain variants.

Carriers (with one variant):

  • are common in the general population
  • usually have no symptoms
  • may have subtle effects in some cases

These subtle effects may include reduced mucus clearance or increased susceptibility to airway inflammation.

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How CFTR affects the lungs

CFTR dysfunction affects the lungs in several key ways:

  • Mucus dehydration: mucus becomes thick and difficult to clear
  • Impaired clearance: particles and microbes remain in the airways
  • Chronic inflammation: immune responses become exaggerated

This combination creates a “retention environment” where inhaled organisms—including Aspergillus—may persist.

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How Aspergillus behaves in the lungs

Aspergillus is inhaled by everyone, but its effects vary depending on the lung environment.

  • Healthy lungs: spores are cleared
  • Impaired clearance: spores may persist
  • Sensitive immune system: allergic reactions may develop
  • Damaged lungs: chronic infection may develop

This explains why Aspergillus-related disease is diverse and depends heavily on underlying lung conditions.

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ABPA and cystic fibrosis

ABPA is an allergic immune reaction to Aspergillus.

It is recognised in cystic fibrosis because:

  • mucus retention increases exposure to Aspergillus
  • immune responses can be exaggerated

However:

  • Many CF patients never develop ABPA
  • Most ABPA patients do not have CF

Some studies suggest CFTR variants may increase susceptibility, but this is not consistent across all research.

Key message: ABPA and CF can overlap, but one does not imply the other.

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CPA and cystic fibrosis

CPA is a chronic fungal infection that develops in structurally damaged lungs.

The most important risk factor is:

pre-existing lung damage

This includes:

  • bronchiectasis
  • previous tuberculosis
  • COPD

Cystic fibrosis can lead to bronchiectasis, and therefore indirectly increase CPA risk.

However:

  • CPA is rarely driven directly by CFTR genetics
  • most CPA patients do not have CF

Key message: CPA is primarily a disease of lung structure, not genetics.

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Modern CF treatments and Aspergillus

CFTR modulators (such as elexacaftor/tezacaftor/ivacaftor) have transformed CF care.

They:

  • improve CFTR function
  • thin mucus
  • improve clearance

Studies suggest:

  • reduced Aspergillus detection in some patients
  • fewer ABPA exacerbations in some cases

However:

  • ABPA still occurs
  • existing lung damage remains
  • immune responses are not fully corrected

Overall: these therapies improve risk but do not eliminate Aspergillus-related disease.

Back to top ↑

Does a CFTR variant explain symptoms?

No single factor explains complex lung disease.

Symptoms may result from:

  • underlying lung disease
  • infection
  • inflammation
  • environmental exposure

A CFTR variant may contribute, but is rarely the sole cause.

Back to top ↑

What should patients take from this?

  • CF and CFTR variants can sometimes contribute
  • ABPA has the strongest connection
  • CPA is mainly driven by lung damage
  • Most patients with aspergillosis do not have CF

Back to top ↑

When to seek medical advice

Seek advice if symptoms worsen, change, or include coughing up blood, fever, or chest pain.

Back to top ↑

Conclusion

Cystic fibrosis and CFTR gene variants can play a role in some patients with Aspergillus-related lung disease, particularly where mucus clearance is affected. However, they should not be overemphasised. In most cases, they are just one part of a broader clinical picture involving lung structure, immune response, and environmental exposure.

Back to top ↑

References

This article is for general information and does not replace advice from your clinical team.

by GAtherton

Weekly Aspergillosis Research Update: 31 March – 7 April 2026

This week’s research reinforces several consistent themes in aspergillosis: ongoing diagnostic confusion (particularly with tuberculosis and cancer), increasing movement toward precision medicine, and continued development of both antifungal therapies and biomarkers. There is also a growing emphasis on host-pathogen interactions rather than fungal burden alone.

Key Highlights

  • Isavuconazole levels can become unexpectedly high due to genetics and drug interactions.
  • Chronic pulmonary aspergillosis (CPA) can mimic lung cancer, risking delayed diagnosis.
  • New biomarker (EDN) for ABPA shows promise for diagnosis and monitoring.
  • Azole resistance research highlights differences between Aspergillus species.
  • New antifungal approaches emerging (olorofim, nitroxoline).
  • Host response is central – fibroblasts and immune pathways actively influence disease.
  • TB vs aspergillosis confusion persists in real-world settings.

Contents

Clinical & Diagnostic Studies

CPA mistaken for lung cancer

Paper: PubMed

A case report describes chronic pulmonary aspergillosis presenting as suspected lung malignancy in a patient with asthma and ABPA overlap.

Why this matters: CPA continues to be misdiagnosed due to tumour-like imaging appearances. This reinforces the need to consider fungal disease in patients with underlying lung conditions.

Invasive sinus aspergillosis causing bone destruction

Paper: Free full text

Granulomatous invasive aspergillosis led to facial bone destruction and neurological symptoms.

Why this matters: Delayed diagnosis of invasive disease can lead to severe structural damage. Early imaging and specialist input are critical.

Aspergillus infection in suspected TB patients

Paper: PubMed

Study shows overlap between tuberculosis and aspergillosis in symptomatic patients.

Why this matters: Persistent global issue—shared symptoms delay correct diagnosis and treatment, particularly relevant for CPA pathways.

Invasive aspergillosis in critical illness

Paper: PubMed

Case of invasive pulmonary aspergillosis in a patient with severe viral illness.

Why this matters: Reinforces that aspergillosis is not limited to traditional risk groups and can complicate severe systemic illness.

Treatment & Pharmacology

Isavuconazole toxicity linked to genetics

Paper: Free full text

Case report of supratherapeutic isavuconazole levels linked to CYP3A5 genotype and interacting medications.

Why this matters: Even “predictable” antifungals show variability. Supports therapeutic drug monitoring and future personalised dosing approaches.

Olorofim pharmacokinetics

Paper: PubMed

Study demonstrates tissue distribution of olorofim in preclinical models.

Why this matters: Supports ongoing development of a key next-generation antifungal, particularly for resistant disease.

Nitroxoline shows antifungal activity

Paper: PubMed

Repurposed drug demonstrates activity against Aspergillus via copper disruption and oxidative stress.

Why this matters: Highlights potential for non-azole antifungal strategies in future treatment.

Biology, Immunology & Resistance

Azole resistance and Aspergillus genomics

Paper: PubMed

Genomic study of Aspergillus section Fumigati explores resistance mechanisms and pathogenicity.

Why this matters: Different species may respond differently to antifungals—accurate identification is increasingly important.

Fibroblasts actively support lung defence

Paper: PubMed

Study shows fibroblasts contribute to immune defence and tissue repair during infection.

Why this matters: Disease outcomes depend on host response, not just fungal burden—important for future therapies.

Immune pathway targeting in fungal keratitis

Paper: PubMed

PIM1 inhibition reduces inflammation via STING pathway signalling.

Why this matters: Supports growing interest in targeting immune pathways alongside antifungal therapy.

Biomarkers & Diagnostics

Eosinophil-derived neurotoxin (EDN) in ABPA

Paper: PubMed

EDN proposed as a biomarker for allergic bronchopulmonary aspergillosis.

Why this matters: Could improve diagnosis and monitoring, helping distinguish ABPA from asthma or sensitisation alone.

Commentary on ISHAM ABPA guidelines

Paper: PubMed

Discussion of updated international guidance on ABPA diagnosis and management.

Why this matters: Highlights ongoing refinement of diagnostic criteria and classification systems.

Wider Context

Fungal extracellular vesicles

Paper: PubMed

Review of fungal vesicles in pathogenesis and host interaction.

Why this matters: Emerging area that may influence future diagnostics and therapies.

Aspergillosis in broader disease settings

  • Cystic fibrosis study: PubMed
  • Adenovirus meta-analysis: PubMed
  • Haematology correspondence: PubMed

Why this matters: Aspergillosis continues to appear across a wide range of conditions, particularly in critically ill or immunocompromised patients.

Overall Interpretation

This week’s literature reinforces several strategic priorities:

  • Earlier and more accurate diagnosis remains essential, particularly in distinguishing CPA from TB and cancer.
  • Precision medicine is advancing, with growing roles for pharmacogenomics, drug monitoring, and species-level identification.
  • New antifungal options are progressing, but remain largely in development.
  • Host response is increasingly recognised as central to disease progression and outcomes.

Overall, the field continues to move toward more personalised, biology-driven approaches to diagnosis and management.

by GAtherton

Aspergillosis Research Update: Week Ending: 30 March 2026

Contents

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.

by GAtherton

A Drop of Blood, Real-Time Answers

Last reviewed: 20 March 2026
Audience: Patients, carers, families, and non-specialists
Topic: Point-of-care monitoring of antifungal drug levels

New bedside testing for antifungal drugs — and why patients welcome it

For many people taking antifungal medicines, blood tests are an important part of care. These tests help doctors check whether the amount of medicine in the body is too low, too high, or about right.

A new type of technology is being developed to do this much more quickly, using just a single drop of blood placed onto a specialised chip. Instead of sending blood away to a laboratory and waiting days for a result, this kind of test may be able to provide an answer much more quickly, sometimes during the clinic visit itself.

Patients in a recent focus group responded very positively to this idea. They welcomed not only the technology itself, but also what it could mean for their care: less waiting, less uncertainty, fewer trips to hospital, and more personalised treatment.

Key points

  • A new test can measure antifungal drug levels from a drop of blood.
  • The blood is placed on a specialised chip containing tiny sensors.
  • Results may be available much faster than standard laboratory testing.
  • This could help doctors adjust treatment more quickly and more precisely.
  • Patients in a focus group strongly welcomed the technology.
  • Reported benefits included less anxiety, fewer hospital visits, and more confidence in treatment decisions.

What is this new test?

This is a type of point-of-care test. That means it is designed to be used close to the patient, such as in a clinic or at the bedside, rather than sending the sample away to a central laboratory.

In this case, the aim is to measure the level of an antifungal drug in the blood from a very small sample, sometimes just a finger-prick drop. The drop of blood is placed onto a specialised chip. That chip contains tiny channels and sensors that can detect the amount of drug present.

People sometimes describe this type of system as a “lab on a chip” because it performs some of the work of a laboratory in a very small device.

How does the technology work?

The exact science varies between devices, but the general idea is similar.

  1. A small blood sample is taken.
    This may be from a finger prick rather than a larger blood draw.
  2. The blood is placed onto a specialised chip.
    The chip is designed to handle a tiny volume of blood.
  3. The blood moves through microscopic channels.
    These channels guide the sample to the parts of the chip that do the measurement.
  4. Sensors on the chip detect the antifungal drug.
    These sensors are designed to recognise the drug or react to it in a measurable way.
  5. A reader produces a result.
    A connected device reads the signal from the chip and estimates the drug level.

Some systems use electrical signals, some use light, and some use chemical reactions. Patients do not need to understand all the engineering details to understand the main point: the chip is acting like a mini laboratory.

A simple way to think about it is this:

Instead of sending your blood sample to a distant laboratory, this technology brings part of the laboratory to your fingertip.

Why do antifungal drug levels matter?

Some antifungal medicines need careful monitoring because the “right” level can be quite important.

If the drug level is too low, the medicine may not work well enough. If the drug level is too high, side effects may become more likely.

This can be especially relevant for antifungal drugs such as:

  • itraconazole
  • voriconazole
  • posaconazole

Drug levels can vary from person to person for many reasons, including:

  • how well the body absorbs the medicine
  • interactions with other medicines
  • differences in liver function and metabolism
  • changes in health over time

At present, monitoring usually involves sending blood to a laboratory. That works, but it can mean delays. Results may not come back quickly enough to guide decisions during the clinic appointment itself.

A faster bedside test could help clinicians make treatment decisions more quickly and could support more personalised care.

What did patients say about it?

In the patient focus group, this technology was widely welcomed. Patients were not only interested in the novelty of the test. They also recognised several practical benefits that could make day-to-day care easier and safer.

1. Faster results could reduce anxiety

Many patients described the stress of waiting for test results. Waiting can create a sense of uncertainty: Is the treatment working? Is the dose correct? Are side effects more likely?

A test that gives much quicker results was seen as reassuring. Instead of waiting days, patients liked the idea of getting answers much sooner, possibly while still in clinic.

2. Fewer visits could reduce the burden of care

For many people with chronic lung conditions or long-term illness, going to hospital is not a small task. Travel, parking, breathlessness, fatigue, mobility problems, and long waits can make even a short appointment exhausting.

Patients felt that a faster and simpler test could reduce some of this burden, especially if it could be built into a normal appointment or eventually be offered closer to home.

3. More personalised dosing felt important

Patients often understand from experience that medicines do not affect everyone in the same way. One person may tolerate a treatment well, while another may have side effects or absorb the medicine differently.

Because of this, patients valued the idea that treatment could be adjusted based on their own measured drug level, rather than relying only on standard dosing. This gave a stronger sense that care was being tailored to the individual.

4. Closer monitoring gave reassurance about safety

Antifungal drugs can be very helpful, but patients also know that some of them can have side effects and interactions. That can make treatment feel worrying, especially over longer periods.

Patients said that being able to check drug levels more quickly and more easily could help them feel safer. It suggested that treatment was being watched closely rather than left unchecked between appointments.

5. Immediate results could help patients feel more involved

Another important theme was involvement. Patients often feel that blood is taken, results disappear into the system, and decisions come later without much real-time discussion.

By contrast, a bedside result creates the possibility of discussing the number there and then. Patients felt this could help them better understand their treatment and feel more involved in decisions about dose changes and ongoing care.

6. It seemed to fit better with real life

Patients repeatedly emphasised that long-term treatment has to fit around real lives, not just clinic systems. Many welcomed the idea of a test that was quicker, simpler, and potentially more convenient.

In that sense, what patients welcomed was not just a chip or a machine, but a model of care that felt more responsive and more human-centred.

What could this mean for future care?

If this technology proves accurate, reliable, and affordable, it could support a different way of monitoring antifungal treatment.

Possible future benefits could include:

  • drug level testing during the clinic appointment itself
  • faster dose adjustment when levels are too high or too low
  • closer monitoring when starting or changing treatment
  • fewer repeat visits just to check blood levels
  • potential future use in community settings or, one day, at home

It is important to be realistic. New technologies must be carefully tested before they become routine. They need to be shown to be accurate, dependable, and practical in real healthcare settings.

Even so, patients clearly recognised the potential. For them, this is not just about speed. It is about moving toward care that is:

  • more responsive
  • more personalised
  • more convenient
  • less anxiety-provoking

Common questions

Is this available now?

Usually not as a routine test in most healthcare settings. It is still being developed and studied, although interest in this type of monitoring is growing.

Will this replace ordinary blood tests?

Not immediately. Standard laboratory testing is still important. New bedside systems may first be used alongside existing methods while they are being evaluated and introduced.

Would this work for every antifungal drug?

Not necessarily. Some devices may be designed for specific drugs first. Wider use would depend on the technology and the evidence supporting it.

Could this be used at home?

Possibly one day, but that is likely to depend on how reliable, affordable, and easy to use the technology becomes. For now, clinic or bedside use is the more immediate possibility.

Why is a drop-of-blood test appealing to patients?

Because it may mean quicker answers, less uncertainty, fewer hospital trips, and more confidence that treatment decisions are based on what is happening in their own body.

When to seek medical advice

You should contact your healthcare team if you:

  • develop new or worsening side effects from your antifungal medicine
  • feel your treatment is not helping
  • have concerns about drug interactions with other medicines
  • are unsure whether to continue, stop, or change your medication

A new bedside test could support treatment decisions, but it would not replace medical advice. Symptoms, scans, blood tests, and clinical review would still matter.

Final thoughts

This new chip-based bedside technology may sound futuristic, but the reason patients welcomed it is very straightforward.

They saw the possibility of care that is faster, clearer, safer, and better adapted to real life.

In other words, this is about more than measuring a drug level from a drop of blood. It is about moving away from delayed, one-size-fits-all monitoring and toward real-time, personalised, patient-centred care.

In one sentence

A tiny chip and a drop of blood could help doctors adjust antifungal treatment more quickly — and patients believe that could make care less stressful, less burdensome, and more personal.

Author: Graham Atherton and ChatGPT draft support

For review by: National Aspergillosis Centre / relevant clinical or research reviewer

Note: This article is for general information and should not be used as a substitute for medical advice.

by GAtherton