Aspergillosis Literature Update: Week 5

This week’s aspergillosis research highlights evolving management of life-threatening haemoptysis in Chronic Pulmonary Aspergillosis (CPA), new insights into antifungal resistance mechanisms, and continued evidence linking post-tuberculosis lung disease with CPA risk. Notably, species beyond Aspergillus fumigatus — including Aspergillus flavus and Aspergillus udagawae — feature prominently, reinforcing the importance of accurate species identification and susceptibility testing in complex or refractory disease.

Weekly Aspergillosis Literature Update
9–15 February 2026

1️⃣ Clinical Complications & Interventional Management

Refractory Massive Haemoptysis in Chronic Pulmonary Aspergillosis

Superselective Pulmonary Artery Embolization for Refractory Massive Hemoptysis Post-Bronchial Artery Embolization: A Bail-Out Measure
Cardiovasc Intervent Radiol (Feb 15, 2026)
🔗 https://pubmed.ncbi.nlm.nih.gov/41692834/

Focus: Advanced haemoptysis management in Chronic Pulmonary Aspergillosis (CPA)

  • 6 of 7 patients had CPA

  • All had failed prior bronchial artery embolization (BAE)

  • Pulmonary artery embolization used as salvage therapy

Why this matters:
Suggests a potential pathway for CPA patients with persistent life-threatening bleeding when conventional embolization fails.

2️⃣ Antifungal Resistance & Drug Sensitivity Mechanisms

Novel Caspofungin Resistance in Aspergillus flavus

Ubiquinone-based gene mutation and protein compactness of CoQ5 may contribute to a novel caspofungin resistance mode in Aspergillus flavus
Diagn Microbiol Infect Dis (Feb 9, 2026)
🔗 https://pubmed.ncbi.nlm.nih.gov/41690241/

Focus: Echinocandin resistance biology

  • Suggests mitochondrial/ubiquinone-linked mechanism

  • Moves beyond classical cell wall mutation models

  • Highlights increasing importance of non-fumigatus species

Why this matters:
Resistance biology is becoming more complex — molecular surveillance may need to expand.

Long Non-Coding RNAs and Antifungal Sensitivity

Genome-wide discovery and phenotyping of non-coding transcripts in A. fumigatus reveals lncRNAs with a role in antifungal drug sensitivity
Nat Commun (Feb 11, 2026)
🔗 https://pubmed.ncbi.nlm.nih.gov/41673015/

Focus: Regulatory genomics in antifungal response

  • Identifies long non-coding RNAs influencing drug sensitivity

  • Suggests new regulatory layers in antifungal resistance

  • Opens potential future therapeutic targets

Why this matters:
Signals a shift from single-gene resistance thinking toward systems-level regulation.

3️⃣ Species-Specific Virulence & Emerging Pathogens

Virulence of Aspergillus flavus and Relatives

Virulence of Aspergillus flavus and relatives using the Galleria mellonella model
Virulence (Epub Feb 13, 2026)
🔗 https://pubmed.ncbi.nlm.nih.gov/41685886/

Focus: Comparative pathogenicity

  • Demonstrates variability in virulence among related species

  • Reinforces need for accurate species identification

Why this matters:
Species differentiation has prognostic and potentially therapeutic implications.

Fatal Dissemination from Cryptic Species

Fatal Fungal Peritonitis Caused by Aspergillus udagawae: An Autopsy Case Report
Intern Med (Feb 10, 2026)
🔗 https://pubmed.ncbi.nlm.nih.gov/41672531/

Focus: Disseminated disease from chronic pulmonary infection

  • Multidrug-resistant A. udagawae

  • Autopsy-confirmed fatal fungal peritonitis

  • Highlights invasive potential of cryptic species

Why this matters:
Supports advanced diagnostics and susceptibility testing in refractory cases.

4️⃣ Structural Lung Disease & Secondary Aspergillosis

CPA Following Cavities and Prednisolone

Chronic pulmonary aspergillosis as a complication of lung cavities and prednisolone treatment
Ugeskr Laeger (Feb 9, 2026)
🔗 https://pubmed.ncbi.nlm.nih.gov/41685454/

Focus: Steroids + cavitation as CPA risk factors

  • Imaging and microbiology confirmed diagnosis

  • Long-term azole therapy successful

  • IgG normalisation observed

Why this matters:
Reinforces the structural lung disease + corticosteroid risk interaction.

Post-Tuberculosis Lung Disease and CPA

Post-tuberculosis lung disease and pulmonary aspergillosis management: challenges and considerations
Expert Rev Anti Infect Ther (Feb 12, 2026)
🔗 https://pubmed.ncbi.nlm.nih.gov/41674445/

Focus: Global burden interface

  • Post-TB structural damage predisposes to CPA

  • Major diagnostic and management challenges highlighted

Why this matters:
Post-tuberculosis lung disease remains one of the largest global drivers of CPA.

5️⃣ Mixed & Extrapulmonary Presentations

Abdominal Wall Aspergillosis

Letter: Abdominal Wall Aspergillosis
Surg Infect (Feb 12, 2026)
🔗 https://pubmed.ncbi.nlm.nih.gov/41680095/

Focus: Extrapulmonary aspergillosis

  • Uncommon presentation

  • Reinforces need for broad diagnostic awareness

Mixed Tuberculosis and Aspergillus Infection

Milky Tea-Colored Pleural Effusion: Empyema Complicated by Pneumothorax Due to Mixed Infection With Mycobacterium tuberculosis and Aspergillus fumigatus
Am J Case Rep (Feb 10, 2026)
🔗 https://pubmed.ncbi.nlm.nih.gov/41664446/

Focus: Dual infection

  • Structural damage enables mixed infection

  • TB diagnosis does not exclude concurrent aspergillosis

Overall Themes This Week

  • 🔴 Haemoptysis management continues to evolve in advanced CPA

  • 🧬 Resistance mechanisms are becoming increasingly complex

  • 🌍 Post-tuberculosis lung disease remains central to global CPA burden

  • 🧫 Species identification is clinically important

  • ⚠ Mixed and disseminated infections continue to challenge diagnosis

by GAtherton

Trials, systematic reviews, and state-of-the-science reviews from ~2016–2026 on damp housing, mould, and health

Executive summary (what 10 years of evidence consistently shows)

1) Damp and mouldy housing is a causal driver of respiratory disease

  • Strong, repeated associations with asthma incidence, asthma exacerbations, wheeze, chronic cough, and poorer lung function, especially in children.

  • Effects persist across countries, climates, and housing systems.

  • Evidence is strongest for asthma and allergic respiratory disease, but extends to bronchitis, infections, and symptom burden in people with existing lung disease.

2) Health effects are dose-related, not binary

  • Risk increases with extent, persistence, and visibility of dampness/mould (patch size, odour, condensation, repeated water damage).

  • No safe threshold has been identified → “any dampness matters.”

3) Mental health impacts are now well-established

  • Damp and mould exposure is associated with depression, anxiety, stress, sleep disturbance, and reduced wellbeing.

  • Pathways are both biological (inflammation, immune activation) and psychosocial (lack of control, stigma, housing insecurity).

4) Children are disproportionately affected

  • Strong paediatric evidence links damp homes to asthma development, poorer asthma control, and higher healthcare use.

  • Early-life exposure appears particularly important.

5) Damp housing is a marker of structural inequality

  • Concentrated in low-income, overcrowded, poorly maintained, or privately rented housing.

  • Acts as a health inequality amplifier, not just an environmental exposure.

6) Remediation works—but prevention works better

  • Interventions that fix the building (leaks, insulation, ventilation) improve symptoms.

  • Education alone is insufficient if the housing defect remains.

Thematic synthesis of the literature

1. Respiratory health (strongest evidence base)

Consistent findings across reviews (2016–2025):

  • Dampness and mould exposure increases:

    • Asthma onset in children

    • Asthma severity and exacerbations

    • Wheeze, cough, breathlessness

  • Associations hold even after adjusting for smoking, socioeconomic status, and outdoor pollution.

Key insight

Damp housing is not merely an “asthma trigger” — it is a risk factor for developing disease, especially in childhood.

2. Childhood lung health (very strong, clinically relevant)

  • Paediatric reviews emphasise that clinicians routinely see children whose symptoms are driven or sustained by housing conditions.

  • Poor housing undermines:

    • Controller medication effectiveness

    • Self-management plans

    • Long-term lung development

Clinical implication

Asking about housing conditions should be as routine as asking about pets or smoking in paediatric respiratory clinics.

3. Mental health and wellbeing (rapidly strengthening evidence)

Recent state-of-the-science reviews conclude:

  • Damp and mould exposure is associated with:

    • Depression

    • Anxiety

    • Psychological distress

  • Effects persist even when respiratory disease is accounted for.

Mechanisms proposed

  • Chronic inflammation and immune signalling

  • Sleep disruption

  • Loss of control and “housing stress”

  • Fear for children’s health

Important shift

Damp housing is no longer viewed as purely a respiratory issue—it is a whole-person health exposure.

4. Measurement and exposure assessment (important but imperfect)

What works reasonably well

  • Visual inspection and standard dampness indices

  • Structured questionnaires (especially for asthma cohorts)

  • ERMI (Environmental Relative Moldiness Index) as a research tool

What does NOT yet exist

  • A clinically agreed safe exposure threshold

  • A single test that rules exposure in or out

Consensus

Absence of a perfect test does not mean absence of harm.

5. Built environment, ventilation, and remediation

Clinical trials and housing intervention studies show:

  • Improved ventilation and moisture control:

    • Reduces indoor humidity

    • Improves reported physical and mental health

  • Poorly executed energy efficiency measures can worsen damp if ventilation is not addressed.

Critical point

“Warmth without ventilation” is a known failure mode.

6. Housing as a social determinant of health

Major public health frameworks now explicitly define healthy housing as:

  • Warm

  • Dry

  • Well-ventilated

  • Free from mould and toxins

  • Secure and accessible

Shift in framing

Damp housing is not an individual lifestyle issue—it is a system-level health determinant.

What the evidence does not support (important for countering misinformation)

  • No convincing evidence that:

    • “Detox” supplements treat mould exposure

    • Binding agents reverse health effects

    • Genetic susceptibility alone explains illness without exposure

  • Evidence strongly favours environmental remediation, not biomedical “workarounds”.

Implications for practice, policy, and patient support

For clinicians

  • Ask about damp and mould explicitly.

  • Document housing conditions when symptoms are unexplained or refractory.

  • Support patients with letters or reports—this is evidence-based advocacy, not speculation.

For public health & housing services

  • Damp housing remediation is preventive medicine.

  • Children’s respiratory health and mental health outcomes justify investment.

For patients

  • Symptoms are not imagined.

  • The problem is the building, not personal failure.

  • Improvement often requires structural change, not just treatment escalation.

Bottom line (10-year consensus)

Damp and mouldy housing causes avoidable disease, worsens inequality, and undermines medical care.
Fixing homes is one of the most effective—and underused—public health interventions available.

References

  1. Bentley R, Mason K, Jacobs D, Blakely T, Howden-Chapman P, Li A, Adamkiewicz G, Reeves A.
    Housing as a social determinant of health: a contemporary framework. Lancet Public Health. 2025;10(10):e855–e864. doi:10.1016/S2468-2667(25)00142-2. PMID: 40953578.

  2. Moorcroft C, Whitehouse A, Grigg J.
    Damp and mouldy home: impact on lung health in childhood. Archives of Disease in Childhood. 2025;110(6):419–421. doi:10.1136/archdischild-2023-326035. PMID: 39814530.

  3. Gatto MR, Mansour A, Li A, Bentley R.
    A state-of-the-science review of the effect of damp- and mold-affected housing on mental health. Environmental Health Perspectives. 2024;132(8):086001. doi:10.1289/EHP14341. PMID: 39162373.

  4. Patti MA, Henderson NB, Phipatanakul W, Jackson-Browne M.
    Recommendations for clinicians to combat environmental disparities in pediatric asthma. Chest. 2024;166(6):1309–1318. doi:10.1016/j.chest.2024.07.143. PMID: 39059578.

  5. Punyadasa D, Adderley NJ, Rudge G, Nagakumar P, Haroon S.
    Self-reported questionnaires to assess indoor home environmental exposures in asthma patients: a scoping review. BMC Public Health. 2024;24:2915. doi:10.1186/s12889-024-20418-8. PMID: 39434085.

  6. Kozajda A, Miśkiewicz E.
    Exposure to bioaerosol in the residential environment. Medycyna Pracy. 2024;75(6):545–560. doi:10.13075/mp.5893.01508. PMID: 39688367.

  7. Vesper SJ.
    The development and application of the Environmental Relative Moldiness Index (ERMI). Critical Reviews in Microbiology. 2025;51(2):285–295. doi:10.1080/1040841X.2024.2344112. PMID: 38651788.

  8. Nabaweesi R, Hanna M, Muthuka JK, Samuels AD, Brown V, Schwartz D, Ekadi G.
    The built environment as a social determinant of health. Primary Care. 2023;50(4):591–599. doi:10.1016/j.pop.2023.04.012. PMID: 37866833.

  9. Grant TL, Wood RA.
    The influence of urban exposures and residence on childhood asthma. Pediatric Allergy and Immunology. 2022;33(5):e13784. doi:10.1111/pai.13784. PMID: 35616896.

  10. Coulburn L, Miller W.
    Prevalence, risk factors and impacts related to mould-affected housing: an Australian integrative review. International Journal of Environmental Research and Public Health. 2022;19(3):1854. doi:10.3390/ijerph19031854. PMID: 35162876.

  11. Wimalasena NN, Chang-Richards A, Wang KI, Dirks KN.
    Housing risk factors associated with respiratory disease: a systematic review. International Journal of Environmental Research and Public Health. 2021;18(6):2815. doi:10.3390/ijerph18062815. PMID: 33802036.

  12. Ali SH, Foster T, Hall NL.
    The relationship between infectious diseases and housing maintenance in Indigenous Australian households. International Journal of Environmental Research and Public Health. 2018;15(12):2827. doi:10.3390/ijerph15122827. PMID: 30545014.

  13. Wolkoff P.
    Indoor air humidity, air quality, and health – an overview. International Journal of Hygiene and Environmental Health. 2018;221(3):376–390. doi:10.1016/j.ijheh.2018.01.015. PMID: 29398406.

  14. Mendell MJ, Kumagai K.
    Observation-based metrics for residential dampness and mold with dose–response relationships to health: a review. Indoor Air. 2017;27(3):506–517. doi:10.1111/ina.12342. PMID: 27663473.

  15. Francisco PW, Jacobs DE, Targos L, Dixon SL, Breysse J, Rose W, Cali S.
    Ventilation, indoor air quality, and health in homes undergoing weatherization: a randomized trial. Indoor Air. 2017;27(2):463–477. doi:10.1111/ina.12325. PMID: 27490066.

  16. Barnes CS, Horner WE, Kennedy K, Grimes C, Miller JD.
    Home assessment and remediation. Journal of Allergy and Clinical Immunology: In Practice. 2016;4(3):423–431.e15. doi:10.1016/j.jaip.2016.01.006. PMID: 27157934.

  17. Chew GL, Horner WE, Kennedy K, Grimes C, Barnes CS, Phipatanakul W, Larenas-Linnemann D, Miller JD.
    Procedures to assist health care providers to determine when home assessments for potential mold exposure are warranted. Journal of Allergy and Clinical Immunology: In Practice. 2016;4(3):417–422.e2. doi:10.1016/j.jaip.2016.01.013. PMID: 27021632.

  18. Vesper S, Wymer L.
    The relationship between Environmental Relative Moldiness Index values and asthma. International Journal of Hygiene and Environmental Health. 2016;219(3):233–238. doi:10.1016/j.ijheh.2016.01.006. PMID: 26861576.

by GAtherton

Systemic fungal infections: why speed, diagnosis and stewardship matter

Systemic fungal infections — including aspergillosis, candidiasis, cryptococcosis, mucormycosis and pneumocystis pneumonia — are medical emergencies. When diagnosis or treatment is delayed, mortality rises sharply. This comprehensive review brings together current understanding of how these infections arise, why they are so difficult to diagnose, and what is needed to improve outcomes.

Why fungal infections are often missed

Unlike many bacterial infections, systemic fungal infections can be hard to confirm quickly. Fungal organisms are often present in low numbers, may be released intermittently into the bloodstream, and can be difficult to grow in standard cultures. As a result, no single test is usually sufficient, and clinicians often need a combination of imaging, cultures, antigen tests, molecular tests (PCR), and histopathology.

Because delay can be fatal, antifungal treatment is frequently started on clinical suspicion alone — especially in critically ill or immunocompromised patients. The paper emphasises that this approach is often necessary, but it must be paired with a clear diagnostic strategy.

Antifungal stewardship: knowing when to stop

A central message of the paper is that diagnostic tests are just as important for stopping treatment as for starting it. Antifungal drugs can be toxic, interact with many other medicines, and drive antifungal resistance if used unnecessarily.

The authors stress that:

  • Diagnostic results should be actively reviewed

  • Antifungal therapy should be stopped or stepped down if infection is not supported by evidence

  • This approach protects patients and preserves antifungal effectiveness

Antifungal resistance is a growing threat

Antifungal resistance is no longer rare. The review highlights:

  • Azole resistance in Aspergillus, including cryptic species

  • Rising resistance in several Candida species

  • The global spread of multidrug-resistant Candida auris

Because of this, the authors recommend that all clinically relevant fungal isolates are identified to species level and tested for antifungal susceptibility wherever possible. Making assumptions about drug sensitivity is increasingly unsafe.

Aspergillosis: a broad spectrum of disease

The paper clearly outlines the many forms of aspergillosis, ranging from:

  • Allergic disease (such as allergic bronchopulmonary aspergillosis)

  • Chronic pulmonary aspergillosis, often in people with underlying lung damage

  • Subacute and acute invasive disease, particularly in immunocompromised or critically ill patients

Importantly, the review notes that aspergillosis is not limited to severely immunocompromised people. Chronic and subacute forms often occur in individuals with structural lung disease who are otherwise immunocompetent.

Climate change and emerging fungal risks

One of the most forward-looking sections of the paper addresses how climate change and natural disasters are altering fungal disease patterns. Rising environmental temperatures, flooding, storms and environmental disruption are:

  • Increasing exposure to environmental fungi

  • Enabling fungi to adapt to higher temperatures

  • Contributing to outbreaks after natural disasters and trauma

  • Expanding fungal diseases into new geographic regions

The authors argue that fungal infections must be considered part of future public health and healthcare resilience planning.

Key take-home messages

  • Systemic fungal infections are time-critical medical emergencies

  • Diagnosis usually requires multiple tests, not a single result

  • Early antifungal treatment is often necessary — but must be reviewed

  • Diagnostics are essential for safe antifungal stewardship

  • Antifungal resistance is a real and growing problem

  • Climate change is reshaping fungal epidemiology and risk

Free access to the full article

Elsevier has provided free access to the full paper for a limited time (no registration required):

👉 https://authors.elsevier.com/a/1mZqR4qdNoJLH2
🗓️ Available until 28 March 2026

This article is recommended reading for patients wanting a deeper understanding of fungal disease, as well as clinicians, microbiology teams, and healthcare planners.

by GAtherton

Weekly Aspergillosis Update (2–9 February 2026)(Week 5).

This week’s papers cluster around: (1) ICU/viral-pneumonia–associated invasive pulmonary aspergillosis (IPA),
(2) tuberculosis (TB)–chronic pulmonary aspergillosis (CPA) overlap,
(3) diagnostic criteria and emerging detection approaches, and
(4) antifungal drug interaction risk.

Top highlights (quick take)

  • CAPA criteria matter: case rates vary substantially depending on which definition is used (AspICU vs ISHAM vs EORTC).
  • Viral illness + immune dysfunction = early IPA risk: data add to the “risk stacking” story (including SFTS and broader viral pneumonia).
  • TB–CPA remains a major clinical challenge: CPA can be misread as TB relapse; delayed recognition worsens outcomes.
  • Safety: rifapentine can markedly reduce voriconazole exposure (important in TB–aspergillosis co-infection).

1) ICU, Viral Pneumonia & CAPA / IPA


Decoding CAPA: A Comparative Study of Aspicu, Isham, and Eortc Criteria in Critical COVID-19 Patients Requiring Mechanical Ventilation (Preprint)

Taleb C, Lelubre C, Biston P, Piagnerelli M. Preprints.org. 04 Feb 2026. PPR: PPR1150994

  • What they did: compared CAPA classification using AspICU, ISHAM and EORTC-style criteria in ventilated COVID-19 patients.
  • Key point: CAPA “incidence” changes materially depending on the criteria applied; distributions differed across COVID-19 waves.
  • Why it matters: reinforces that audits, research comparisons and ICU protocols must state which definition is used (and why).


Characteristics of T-lymphocyte subsets in patients with severe fever with thrombocytopenia syndrome complicated with invasive pulmonary aspergillosis: a retrospective study

Xu Y, Liu Y, Qian Y, et al. Front Immunol. 09 Feb 2026. PMCID: PMC12876148

  • What they found: SFTS patients complicated by IPA showed marked T-cell subset abnormalities and high reported secondary IPA rates.
  • Clinical takeaway: another example of viral immune dysregulation predisposing to IPA—analogous to influenza-associated IPA and CAPA.
  • Practice relevance: supports heightened fungal vigilance in severe viral syndromes with immune suppression features.


Immunocompromise and early-onset invasive pulmonary aspergillosis in viral pneumonia: a retrospective cohort study

Sun B, Shen J, Dong M, et al. Front Public Health. 02 Feb 2026. PMCID: PMC12852324

  • Theme: early IPA can emerge in viral pneumonia in the setting of immunocompromise (not only classic neutropenia).
  • Why it matters: backs the “risk stacking” concept—viral lung injury + immune dysfunction (often steroids) can accelerate IPA risk.
  • Use: helpful citation for ICU pathways and education materials.


The COVID-19 pandemic: an underlying factor for increased Stenotrophomonas maltophilia infections—A literature review and case study analysis (Review)

Pompilio A, Di Bonaventura G. Front Microbiol. 06 Feb 2026. PMCID: PMC12867275

  • What’s relevant to aspergillosis: notes co-detection of Stenotrophomonas maltophilia in COVID-19 patients with invasive aspergillosis.
  • Why it matters: underlines polymicrobial complexity in ICU; prompts questions about dysbiosis and pathogen interactions in severe disease.


Pulmonary Cavitation as a Late and Self-Limited Complication of COVID-19 Pneumonia: A Case Report

Osório M, Silveira M. Cureus. 02 Feb 2026. PMCID: PMC12852039

  • Clinical reminder: post-COVID cavitation has a broad differential including CAPA and mucormycosis; requires careful exclusion of fungal disease.
  • Why it matters: useful for follow-up imaging discussions and MDT differential diagnosis teaching.

2) TB–CPA overlap & antifungal pharmacology


Clinical features, diagnostic test performance, treatment and outcome of pulmonary tuberculosis patients with chronic pulmonary aspergillosis in China: a retrospective, observational study

Li J, Wu N, Mei C, et al. Front Cell Infect Microbiol. 06 Feb 2026. PMCID: PMC12864492

  • Main message: CPA in TB patients is common and can be mistaken for TB relapse; diagnostic delay is consequential.
  • Why it matters: strong global relevance—TB remains one of the biggest drivers of CPA burden.
  • Use: good reference for post-TB lung disease pathways and CPA awareness materials.


A clinically significant interaction between voriconazole and rifapentine: a case report and review of evidence

Chen T, Chen X, Zhang Q. Front Med (Lausanne). 09 Feb 2026. PMCID: PMC12875967

  • What happened: TB–aspergillosis co-infection complicated by rifapentine–voriconazole interaction.
  • Key point: rifapentine (a potent enzyme inducer) can substantially reduce voriconazole exposure → risk of treatment failure.
  • Why it matters: high-impact safety message; supports use of therapeutic drug monitoring and/or alternative strategies in TB co-treatment.

3) Diagnostics & detection methods


Combined Biospectroscopy with Multivariate Analysis for the Differential Diagnosis of Leptospirosis Disease: A Pilot Study

Zambrano A, Trilleras J, Arana Rengifo V, et al. ACS Omega. 09 Feb 2026. PMCID: PMC12878783

  • Why it’s here: includes a small aspergillosis group among comparator infections.
  • What it suggests: biospectroscopy + multivariate modelling may separate infections via biochemical “fingerprints” (early-stage concept).
  • Bottom line: promising research direction, but not near-term clinical practice.


Research progress on the current status of respiratory pathogen infections and their detection methods (Review)

Zhu F, Peng M, Chen A, Zhu Q. Front Microbiol. 09 Feb 2026. PMCID: PMC12876234

  • Scope: broad overview of respiratory pathogen detection, including invasive and allergic aspergillosis concepts.
  • Useful for: background reading for non-specialists and training materials (diagnostic modalities and limitations).

4) Aspergillus biology, pathology & wider fungal immunology


Characterization of a bZIP Transcription Factor ZipD in Aspergillus flavus

Jeong D, Cho H, Park H. Mycobiology. 06 Feb 2026. PMCID: PMC12865826

  • What it is: basic science on gene regulation (ZipD) in Aspergillus flavus.
  • Why it matters: contributes to long-term understanding of fungal stress responses and potential future targets.


Mechanistic Insights into Calcium Oxalate Crystals in Aspergillosis of the Maxillary Sinus

Trimukhe A, Bhatt K, Mridha AR, et al. Head Neck Pathol. 02 Feb 2026. PMID: 41627592

  • Key message: calcium oxalate crystal deposition is a mechanistic contributor to local inflammation/tissue injury in sinus aspergillosis.
  • Clinical relevance: useful for ENT/pathology audiences; supports recognition of crystals as an important clue.


Adjunctive GM-CSF therapy enhances host defense against systemic Candida auris infection in immunosuppressed mice

Mattos E, Das Gupta K, Quintanilla D, et al. Front Immunol. 06 Feb 2026. PMCID: PMC12862068

  • Why included: host-directed immunotherapy concepts often discussed alongside invasive aspergillosis.
  • Takeaway: GM-CSF improved antifungal host defense in a preclinical model—supporting interest in adjunctive approaches (not clinical guidance).


The therapeutic potential of high-dose inhaled nitric oxide for antimicrobial effects: a narrative review and future directions (Review)

Berra L, Kamenshchikov N, Tal A, et al. Intensive Care Med Exp. 05 Feb 2026. PMCID: PMC12872992

  • Scope: experimental antimicrobial strategy, mainly ICU-focused.
  • Relevance: future-facing adjunct discussion rather than current aspergillosis practice.

5) Case reports & broader context (selected)


Case Report: Triple autoimmune overlap: rheumatoid arthritis, systemic lupus erythematosus, and hypereosinophilic asthma with systemic manifestations

Front Immunol. 02 Feb 2026. PMCID: PMC12852425

  • Aspergillosis relevance: ABPA considered in complex eosinophilic/asthma phenotypes; reminder that ABPA can present atypically (e.g., without classic bronchiectasis early on).
  • Use: supports education on diagnostic nuance in asthma/eosinophilic lung disease.


HIV-associated neurological infections in a Brazilian tertiary care center: clinical-epidemiological features and predictors of in-hospital mortality

Ramos L, Ninomiya D, Sequeira M, et al. Rev Inst Med Trop Sao Paulo. 02 Feb 2026. PMCID: PMC12858172

  • Context: opportunistic infection landscape in advanced HIV; useful epidemiological background (limited direct aspergillosis focus).

Note: This page summarises research and does not replace clinical guidance. If you are a patient and have concerns about symptoms or treatment, contact your clinical team.

by GAtherton

Latest Aspergillosis & Related Research Updates (Week 4).

Executive overview (what stands out this fortnight)

Key signals

  • Immune dysregulation—not just classic immunosuppression—continues to emerge as a central driver of invasive aspergillosis.

  • Allergic bronchopulmonary aspergillosis (Allergic Bronchopulmonary Aspergillosis) is appearing in atypical and early phenotypes, including absence of bronchiectasis.

  • Antifungal toxicity and pharmacokinetic variability remain clinically important.

  • Paediatric invasive aspergillosis evidence is improving.

  • Environmental and One Health studies continue to inform exposure risk.

  • Overlap with non-tuberculous mycobacteria and microbiome disruption is increasingly evident.

1. Immunocompromise, viral infection, and invasive aspergillosis
Immunocompromise and early-onset invasive pulmonary aspergillosis in viral pneumonia

Sun B et al., Frontiers in Public Health, 2026

Relevance

  • Directly informs understanding of early invasive pulmonary aspergillosis in severe viral pneumonia.
  • Extends COVID-associated pulmonary aspergillosis concepts to non-COVID viral infections.

Key points

  • Viral pneumonia causes early immune dysregulation, including lymphopenia.
  • Invasive aspergillosis may develop before classic intensive care risk factors.
  • Supports earlier fungal surveillance rather than late rescue testing.

Pulmonary cavitation as a late and self-limited complication of COVID-19 pneumonia

Osório M, Silveira M, Cureus, 2026

Relevance

  • Highlights post-viral structural lung damage as a substrate for aspergillosis.

Key points

  • Cavitation discussed alongside COVID-associated pulmonary aspergillosis and mucormycosis.
  • Fungal risk may persist after apparent clinical recovery.

2. Allergic disease and ABPA – expanding phenotypes
Triple autoimmune overlap: rheumatoid arthritis, systemic lupus erythematosus, and hypereosinophilic asthma with ABPA features

Frontiers in Immunology, 2026 (Case Report)

Relevance

  • Challenges rigid diagnostic frameworks for Allergic Bronchopulmonary Aspergillosis.
  • Supports emerging views that ABPA can occur before bronchiectasis develops.

Key points

  • ABPA considered despite normal chest imaging.
  • Diagnosis driven by immunological and eosinophilic markers.

Diagnosis of bronchopulmonary candidiasis—refractory airway hyperresponsiveness and severe pneumonia

Zhang D et al., Frontiers in Medicine, 2026

Relevance

  • Important differential diagnosis for suspected ABPA.

Key points

  • Bronchopulmonary candidiasis can closely mimic ABPA.
  • Normal Aspergillus serology does not exclude other fungal airway disease.

3. Rare immune defects and aspergillosis
Complete and partial forms of X-linked MCTS1 deficiency in patients with mycobacterial disease

Zhou Q et al., Journal of Human Immunity, 2026

Relevance

  • Expands the list of primary immunodeficiencies associated with Aspergillus infection.

Key points

  • Central nervous system aspergillosis identified as a rare but severe phenotype.
  • Suggests impaired cellular immunity as the underlying mechanism.

4. Antifungal therapy – toxicity, variability, and paediatrics
Voriconazole-associated peripheral polyneuropathy: A case report

González BJ et al., Archives of Argentine Pediatrics, 2026
(No PMC full text currently available)

Relevance

  • Highlights clinically important non-hepatic toxicity of azole therapy.

Key points

  • Peripheral neuropathy developed during voriconazole treatment.
  • Symptoms may be insidious and progressive.

RE: Factors affecting voriconazole pharmacokinetic variability in critically ill patients

Langbeen J et al., Critical Care, 2026

Relevance

  • Explains why fixed dosing of voriconazole is often unsafe.

Key points

  • Critical illness alters drug metabolism and clearance.
  • Drug–drug interactions are common.
  • Supports therapeutic drug monitoring and specialist pharmacy input.

Phase 2 clinical trial of posaconazole in paediatric invasive aspergillosis

Kang HJ et al., Antimicrobial Agents and Chemotherapy, 2026
(No PMC full text currently available)

Relevance

  • Rare prospective antifungal data in children.

Key points

  • Posaconazole showed acceptable safety.
  • Clinical responses were encouraging in a high-risk population.

5. Diagnostics, microbiology, and co-infection
Clinical characteristics, molecular diagnosis, and drug resistance profiles of nontuberculous mycobacteria infections

Wang K et al., Clinical and Translational Science, 2026

Relevance

  • Highly relevant to bronchiectasis patients where NTM and aspergillosis frequently coexist.

Key points

  • Molecular diagnostics improve species identification.
  • Resistance patterns complicate treatment strategies.

Impaired systemic antibody response against gut microbiota pathobionts in critical illness

Cho NA et al., Intensive Care Medicine Experimental, 2026

Relevance

  • Links immune–microbiome disruption to susceptibility to Aspergillus fumigatus.

Key points

  • Critical illness impairs antibody responses.
  • Loss of immune balance increases infection risk.

6. Pathogenesis and basic science
Arp2/3 complex contributes to actin-dependent uptake of Aspergillus terreus conidia

Mach N et al., PLOS One, 2026

Relevance

  • Improves understanding of early host–fungus interactions.

Key points

  • Epithelial cells actively internalise Aspergillus conidia.
  • Species differences may influence pathogenicity.

7. Environmental and One Health perspectives
Seasonal variation in Aspergillus abundance in captive penguin burrow sands

Takanobu S et al., Frontiers in Veterinary Science, 2026

Relevance

  • Demonstrates dynamic environmental exposure risk.

Key points

  • Clear seasonal peaks in Aspergillus burden.
  • Correlates with increased disease risk.

Mycotoxins – biomonitoring method including gliotoxin

Berger M et al., MAK Collection for Occupational Health and Safety, 2026

Relevance

  • Gliotoxin explored as a potential biomarker for invasive aspergillosis.

Key points

  • LC-MS/MS methods validated.
  • Currently research-grade rather than clinical.

by GAtherton

Latest Aspergillosis & Related Research Updates (Week 3).

January–February 2026

Search term is 'aspergillosis'.

This update highlights recent publications relevant to aspergillosis, allergic bronchopulmonary aspergillosis, nontuberculous mycobacterial lung disease, antifungal stewardship, diagnostics, and environmental fungal exposure. Papers are grouped by clinical theme, with key findings and clinical relevance highlighted.

1. Diagnostics, Molecular Methods & Imaging Innovation

Clinical Characteristics, Molecular Diagnosis, and Drug Resistance Profiles of Nontuberculous Mycobacteria Infections

Wang K, Xu D, Gao Y, Zhao W, Ma K
Clinical and Translational Science, 19(2):e70479, Feb 2026

Key highlights

  • Retrospective analysis using polymerase chain reaction melting curve technology to identify nontuberculous mycobacterial species.

  • Demonstrates rapid differentiation of clinically relevant species, with integrated resistance profiling.

  • Highlights marked heterogeneity in clinical presentation and antimicrobial resistance patterns.

Why this matters

  • Increasing relevance for patients with bronchiectasis, chronic obstructive pulmonary disease, and aspergillosis, where nontuberculous mycobacteria co-infection complicates diagnosis and treatment.

  • Supports the shift away from prolonged culture-only pathways toward faster molecular diagnostics.

Amplicon-based sequencing as a diagnostic tool for severe pneumonia in the ICU

Michel C, Imamura H, Yin N, et al.
Scientific Reports, 16(1):2845, Jan 2026

Key highlights

  • Amplicon-based sequencing applied directly to respiratory samples in intensive care.

  • Detects invasive aspergillosis alongside bacterial and viral pathogens.

  • Highlights limitations of current definitions of “proven invasive aspergillosis” when relying solely on histopathology.

Why this matters

  • Reinforces the diagnostic gap in critical care–associated pulmonary aspergillosis.

  • Supports broader adoption of molecular and microbiome-informed diagnostics in high-risk settings.

Deep learning detection and classification of fungal and non-fungal calcifications on paranasal sinus CT imaging

Yang Z, Choi I, Yun H, et al.
PLOS One, 21(1):e0340832, Jan 2026

Key highlights

  • Deep learning model distinguishes fungal ball (commonly aspergillosis) from non-fungal calcifications.

  • High diagnostic accuracy on routine sinus computed tomography scans.

  • Addresses a frequent diagnostic uncertainty in chronic rhinosinusitis.

Why this matters

  • Potential to reduce diagnostic delay and unnecessary surgery.

  • Particularly relevant for centres without ready access to specialist radiology expertise.

2. Invasive Aspergillosis: Expanding Risk Profiles & Clinical Phenotypes

Unmasking Invasive Pulmonary Aspergillosis: Insights From a Case Series at a Tertiary Care Center

Munasinghe K, Nanayakkara A, De Zoysa W, et al.
Cureus, 17(12), Jan 2026

Key highlights

  • Case series illustrating heterogeneous clinical presentations.

  • Emphasises delayed recognition outside classic immunocompromised populations.

  • Reinforces global incidence estimates of approximately 250,000 cases annually.

Why this matters

  • Supports growing recognition that invasive pulmonary aspergillosis occurs in broader patient groups, including those with chronic lung disease and critical illness.

Disseminated Invasive Aspergillosis in a Young Patient With Chronic Alcohol Use and Seemingly Preserved Immunocompetence

Khandwala K, Sawliha Syed H, Anwar S, et al.
Clinical Case Reports, 14(2), Jan 2026

Key highlights

  • Disseminated disease involving multiple organs.

  • Chronic alcohol use identified as a functional immunosuppressive state.

  • Challenges traditional “immunocompetent vs immunocompromised” dichotomy.

Why this matters

  • Reinforces the need for high clinical suspicion even when standard immune markers appear preserved.

  • Relevant for emergency, acute medical, and respiratory teams.

Intensification of Treosulfan–Fludarabine Conditioning With Thiotepa in Allogeneic Hematopoietic Stem Cell Transplantation

Tosoni L, Facchin G, Plos R, et al.
Transplant Direct, 12(2):e1896, Jan 2026

Key highlights

  • Real-world study in older or comorbid transplant recipients.

  • Reports four cases of invasive aspergillosis (three pulmonary, one cerebral).

  • Conditioning regimen was otherwise effective and tolerable.

Why this matters

  • Reinforces persistent invasive fungal infection risk despite modern conditioning approaches.

  • Supports ongoing need for antifungal prophylaxis and surveillance.

Infective Endocarditis Caused by Pan-Azole-Resistant Aspergillus fumigatus in a Lung Transplant Recipient

Ukai K, Kawashima M, Ikeuchi K
Transplant Infectious Disease, Jan 2026

Key highlights

  • Rare but severe manifestation: fungal endocarditis.

  • Pan-azole resistance significantly limited treatment options.

  • Occurred in a lung transplant recipient.

Why this matters

  • Adds to evidence of clinically catastrophic azole resistance.

  • Reinforces importance of resistance testing and antifungal stewardship.

3. Antifungal Toxicity & Stewardship

Voriconazole-associated peripheral polyneuropathy: A case report

González BJ, Ivarola P, Miranda M, et al.
Archivos Argentinos de Pediatría, 124(1), Feb 2026

Key highlights

  • Documents peripheral neuropathy linked to prolonged voriconazole exposure.

  • Emphasises reversibility only after early recognition and drug withdrawal.

Why this matters

  • Highly relevant for patients on long-term antifungal therapy for chronic pulmonary aspergillosis.

  • Supports routine neurological symptom surveillance.

Antifungal Stewardship: Time to Reappraise the Priorities toward Increasing Invasive Fungal Infections

Singh S
Annals of African Medicine, Jan 2026

Key highlights

  • Reviews stewardship challenges across aspergillosis, candidemia, and mucormycosis.

  • Highlights overuse, under-diagnosis, and limited access to diagnostics.

  • Calls for stewardship frameworks equivalent to antibacterial programmes.

Why this matters

  • Directly relevant to azole resistance, drug toxicity, and resource-limited settings.

  • Aligns with national and international fungal disease priorities.

4. Allergy, Mycotoxins & Inflammatory Pathways

Common inflammatory markers predict risk of ABPA development in children with cystic fibrosis

Crabtree HED, Malajczuk CJ, Ho HY, et al.
Journal of Cystic Fibrosis, Jan 2026

Key highlights

  • Identifies routinely measured inflammatory markers predictive of allergic bronchopulmonary aspergillosis.

  • Potential for earlier identification and intervention.

Why this matters

  • May support risk stratification in paediatric cystic fibrosis clinics.

  • Relevant for future screening and monitoring protocols.

Potential mechanisms and effects of AFB1-induced asthma

Yu Z, Gao M, Wu X, et al.
PLOS One, 21(1):e0341172, Jan 2026

Key highlights

  • Network toxicology and molecular docking suggest links between aflatoxin B1 exposure and:

    • Asthma

    • Allergic bronchial pulmonary aspergillosis

    • Lung malignancy in severe cases

Why this matters

  • Strengthens environmental and occupational health links to fungal allergy and chronic lung disease.

  • Supports broader discussion of mould exposure beyond infection alone.

Mycotoxins – Determination of aflatoxins, ochratoxin A, gliotoxin, and others in urine by LC–MS/MS

Berger M, Deharde M, Neuhoff J, et al.
MAK Collection for Occupational Health and Safety, 10(2), Jan 2026

Key highlights

  • Validated biomonitoring method for gliotoxin, aflatoxins, and ochratoxins.

  • Discusses potential use of urine biomarkers for early detection of invasive aspergillosis.

Why this matters

  • Provides methodological groundwork for future biomarker-driven diagnostics.

  • Particularly relevant for occupational and environmental exposure assessment.

Money and Microbes: A Global Systematic Review and Meta-Analysis of Currency Contamination

Appiah PO, Odoom A, Tetteh-Quarcoo PB, Donkor ES
Environmental Health Insights, Jan 2026

Key highlights

  • Identifies paper currency as a reservoir for microbial and fungal contamination.

  • Notes links to serious infections, including pulmonary aspergillosis.

Why this matters

  • Highlights overlooked environmental reservoirs of fungal exposure.

  • Relevant for public health messaging and infection control.

by GAtherton

Connecting patients, carers, clinicians and scientists to improve life with aspergillosis

World Aspergillosis Day (WAD) is an annual global event that brings together people who live with, care for, treat, and research long-term forms of aspergillosis — particularly chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA).

Each year, WAD creates a shared space where:

  • patients and carers can hear directly from specialists,

  • clinicians and scientists can learn from patient experience,

  • and everyone can explore how new research translates into better care.

🎥 Missed previous events?
Recordings from earlier World Aspergillosis Day meetings are available on our YouTube channel.

📅 NAC World Aspergillosis Day Meeting 2026

The National Aspergillosis Centre (NAC) will once again host a free online meeting:

🗓 Tuesday 3 February 2026
💻 Online via Microsoft Teams
👥 Open to patients, carers, clinicians, scientists, and anyone who lives or works with aspergillosis

🧬 This year’s theme:

“How can the genomics revolution help patients with chronic aspergillosis?”

Why genomics — and why now?

Modern molecular tests such as PCR and DNA sequencing are becoming faster, cheaper and more accurate. Because of this, the NHS is increasingly exploring how genomic technologies can be used to improve diagnosis, monitoring and treatment across many diseases — including aspergillosis.

This year’s WAD meeting will start an open discussion between patients and professionals about which genomic and molecular tests are likely to matter most for people with aspergillosis in the years ahead.

Topics will include:

  • 🧠 Is there a “gene for aspergillosis”?
    Should people be tested for genetic susceptibility?

  • 💊 Genes and voriconazole dosing
    Can testing the CYP2C19 gene help personalise antifungal treatment?

  • 🦠 Tracking antifungal resistance
    How molecular testing of Aspergillus strains can help hospitals monitor resistance.

  • 🔬 Aspergillus PCR at NAC
    How PCR is already used to diagnose and monitor chronic aspergillosis.

🗣️ Patient voices at the heart of the meeting

As always, patient experience will be central to the day.

This year will include new patient stories, including Alison, who will talk about how her aspergillosis treatment led to the development of adrenal insufficiency, and what that has meant for her care and daily life.

“I don’t know anything about genetics — is this for me?”

Absolutely yes.

You don’t need any background in genetics to take part. Everything will be explained clearly, step by step, with minimal jargon.

Planned discussion topics include:

  • What do my Aspergillus PCR test results actually mean?

  • Is there really a “gene for CPA”?

  • Why do genes matter for antifungal dosing?

In fact, the more questions you ask — especially the “silly” ones — the better. The discussion from the day will be used to create a new patient leaflet, designed to help people better understand their diagnosis and test results.

✅ Registration is now open

🎟 Book your free place via Eventbrite:
👉 www.eventbrite.co.uk/e/world-aspergillosis-day-tickets-1980707139373

💻 Joining via Microsoft Teams

The meeting will be held online using Microsoft Teams, which you can download here:
👉 www.microsoft.com/en-gb/microsoft-teams/group-chat-software

If you haven’t used Teams before, we recommend doing a test call in advance. If you run into any problems setting things up, we’re very happy to help.

We hope you can join us for World Aspergillosis Day 2026 — to learn, to ask questions, and to help shape the future of aspergillosis care together.

by GAtherton

January–February 2026 Aspergillosis Papers (week 3)

Grouped by relevance and impact

🟥 HIGH IMPACT / PRACTICE-RELEVANT

(Most important for patients, clinicians, and services)

1. Chronic Pulmonary Aspergillosis (CPA): outcomes and mortality

Clinical Features and Mortality of Chronic Pulmonary Aspergillosis in Brazil
Open Forum Infectious Diseases, Jan 2026

Why this is important

  • Large multicentre cohort

  • Real-world data from TB-endemic, resource-limited settings

  • Directly relevant to global CPA burden, including post-TB disease

Key messages

  • CPA carries substantial long-term mortality

  • Tuberculosis is a major driver of CPA worldwide

  • Delayed diagnosis and limited antifungal access worsen outcomes

➡ This is one of the most important papers in the list for public health, service planning, and advocacy.

2. Invasive Aspergillosis in Intensive Care (including COVID-19)

Clinical spectrum of ICU-acquired invasive pulmonary aspergillosis according to SARS-CoV-2 infection
Eur J Clin Microbiol Infect Dis, Jan 2026

Why this is important

  • Large prospective multicentre ICU cohort

  • Builds on lessons from COVID-19 Associated Pulmonary Aspergillosis (CAPA)

Key messages

  • ICU-acquired aspergillosis remains common and deadly

  • COVID-19 patients are typically older and more severely ill

  • Early fungal testing in ICU is critical

➡ High relevance for intensivists, respiratory teams, and hospital policy.

3. Drug interactions in invasive aspergillosis

Concurrent administration of triazoles with chemotherapeutic and/or immunosuppressant agents
Mycopathologia, Jan 2026

Why this is important

  • Addresses real-world prescribing risk

  • Highly relevant to cancer, transplant, and haematology patients

Key messages

  • Triazole antifungals cause clinically dangerous drug–drug interactions

  • Requires specialist pharmacy oversight and monitoring

  • Not theoretical – directly affects patient safety

➡ High importance for clinicians and pharmacists, less so for patients directly, but critical for safe care.

🟧 MODERATE IMPACT / CLINICALLY INFORMATIVE

(Important, but narrower scope or smaller evidence base)

4. Aspergillosis beyond the “immunocompromised”

Pulmonary fungal infections in the immunocompetent host
Chest, Jan 2026 – Review

Why this matters

  • Challenges outdated assumptions

  • Useful for GPs and general physicians

Key messages

  • Serious fungal lung disease can occur without classic immune suppression

  • Chronic lung disease, viral infection, or exposure can be sufficient

  • Supports earlier fungal consideration when antibiotics fail

➡ Good educational review, especially for non-specialists.

5. Aspergillus species diversity and resistance

Beyond Fumigatus: a molecular portrait of clinical Aspergillus diversity
Antimicrobial Agents and Chemotherapy, Jan 2026

Why this matters

  • Advances understanding of non-fumigatus Aspergillus

  • Relevant to antifungal resistance

Key messages

  • Aspergillosis is caused by multiple species

  • Species identification may influence treatment success

  • Supports move toward precision mycology

➡ Important scientifically, indirect impact for patients (for now).

6. Minimally invasive treatment of aspergilloma

Minimally invasive management of a centrally located pulmonary aspergilloma
MMCTS, Jan 2026

Why this matters

  • Demonstrates evolving surgical approaches

  • Relevant to selected patients only

Key messages

  • Less invasive procedures may reduce surgical risk

  • Careful patient selection is crucial

➡ Clinically interesting, but case-based and niche.

🟨 LOW IMPACT / EARLY-STAGE / NICHE

(Useful context or future potential, limited immediate impact)

7. ABPA immunology and diagnostics (early-stage science)

Pathogen-specific IgE-reactive cytosolic allergenic epitopes of Aspergillus fumigatus
Ann Clin Microbiol Antimicrob, Jan 2026

Why this matters

  • Laboratory-based discovery research

Key messages

  • May improve future ABPA diagnostics

  • Potential foundation for targeted immunotherapy

➡ Promising but not practice-changing yet.

8. Voriconazole neurotoxicity (single case)

Voriconazole-associated peripheral polyneuropathy: A case report
Arch Argent Pediatr, Feb 2026

Why this matters

  • Highlights a rare but serious adverse effect

Key messages

  • Neurological symptoms on antifungals should not be ignored

  • Reinforces importance of monitoring during long-term therapy

➡ Low evidence level, but high awareness value.

9. Invasive aspergillosis in complex transplant oncology case

An Unforeseen Diagnosis After Liver Transplantation for Acute Liver Failure
Case Reports in Hepatology, Jan 2026

Why this matters

  • Illustrates diagnostic complexity in extreme immunosuppression

Key messages

  • Invasive aspergillosis can be rapidly fatal

  • Symptoms may be masked by other conditions

➡ Educational case, not generalisable.

10. Food enzyme safety (non-clinical)

Safety evaluation of the food enzyme aspergillopepsin I
EFSA Journal, Jan 2026

Why this matters

  • Addresses public concern rather than clinical disease

Key messages

  • Aspergillus-derived food enzymes are safe when regulated

  • Dietary exposure ≠ inhaled fungal spores

➡ Reassuring, but peripheral to aspergillosis care.

🔑 Overall “Most Important” Papers (Quick List)

Top tier

  1. CPA outcomes and mortality (Brazil cohort)

  2. ICU / COVID-19 associated invasive aspergillosis

  3. Triazole drug–drug interactions

Second tier
4. Fungal infection in immunocompetent hosts
5. Aspergillus species diversity & resistance

January–February 2026 Aspergillosis Papers – Source Links

🟥 High-impact / practice-relevant

  • Clinical Features and Mortality of Chronic Pulmonary Aspergillosis in Brazil: a Multicenter Cohort Study
    de Oliveira VF et al., Open Forum Infectious Diseases, Jan 2026
    🔗 https://pubmed.ncbi.nlm.nih.gov/41536616/

  • Clinical spectrum of ICU-acquired invasive pulmonary aspergillosis according to SARS-CoV-2 infection: a multicenter prospective cohort study
    Reizine F et al., European Journal of Clinical Microbiology & Infectious Diseases, Jan 2026
    🔗 https://pubmed.ncbi.nlm.nih.gov/41526761/

  • Concurrent Administration of Triazoles with Chemotherapeutic and/or Immunosuppressant Agents Known to Have Moderate-to-Severe Drug-Drug Interactions in Patients with Hematologic Malignancies Hospitalized for Invasive Aspergillosis
    Walsh TJ et al., Mycopathologia, Jan 2026
    🔗 https://pubmed.ncbi.nlm.nih.gov/41528615/

🟧 Moderate-impact / clinically informative

🟨 Lower-impact / niche / early-stage

  • Pathogen-specific IgE-reactive cytosolic allergenic epitopes of Aspergillus fumigatus for immunodiagnostic and immunotherapeutic applications against allergic aspergillosis
    Koundal P et al., Annals of Clinical Microbiology and Antimicrobials, Jan 2026
    🔗 https://pubmed.ncbi.nlm.nih.gov/41540426/

  • Voriconazole-associated peripheral polyneuropathy: A case report
    González BJ et al., Archivos Argentinos de Pediatría, Feb 2026
    🔗 https://pubmed.ncbi.nlm.nih.gov/40728252/

  • An Unforeseen Diagnosis After Liver Transplantation for Acute Liver Failure: Extranodal NK/T-Cell Lymphoma (includes invasive aspergillosis)
    Soares GL et al., Case Reports in Hepatology, Jan 2026
    🔗 https://pubmed.ncbi.nlm.nih.gov/41542139/

  • Safety evaluation of the food enzyme aspergillopepsin I from the genetically modified Trichoderma reesei strain DP-Nzq40
    EFSA Panel on Food Enzymes, EFSA Journal, Jan 2026
    🔗 https://pubmed.ncbi.nlm.nih.gov/41531469/

by GAtherton

Recent Aspergillosis Research – January 2026 (week 2)

A curated update with direct links to the evidence

Allergic Bronchopulmonary Aspergillosis (ABPA) and Aspergillus Airway Disease

Several recent papers continue to refine how ABPA is diagnosed and managed, particularly outside classic asthma and cystic fibrosis settings.

A practical treatment overview for ABPA in cystic fibrosis is provided by Thimmesch et al., focusing on steroid strategies and antifungal use
👉 https://pubmed.ncbi.nlm.nih.gov/41537324/

A major narrative review of ABPA and Aspergillus-related airway disease in bronchiectasis reframes ABPA as part of a wider spectrum of Aspergillus-driven lung disease, with implications for earlier recognition
👉 https://pubmed.ncbi.nlm.nih.gov/41522133/

Diagnostic uncertainty remains a major challenge. A comparative study of IgG/IgE ELISA versus serum precipitins highlights strengths and limitations of commonly used tests
👉 https://pubmed.ncbi.nlm.nih.gov/41514182/

Treatment optimisation is addressed in a retrospective cohort study examining glucocorticoid dose, duration, and antifungal combinations in ABPA, showing that regimen choice meaningfully affects outcomes
👉 https://pubmed.ncbi.nlm.nih.gov/41492771/

ABPA is increasingly recognised beyond asthma and cystic fibrosis. A short but influential paper proposes Aspergillus sensitisation and ABPA in COPD as a “treatable trait”
👉 https://pubmed.ncbi.nlm.nih.gov/41520264/

Rare but clinically important overlap is illustrated by a case report describing invasive pulmonary aspergillosis overlapping with ABPA
👉 https://pubmed.ncbi.nlm.nih.gov/41496036/

Chronic Pulmonary Aspergillosis (CPA) and Aspergilloma

A large multicentre cohort study from Brazil provides valuable data on CPA in high tuberculosis-burden settings, documenting delayed diagnosis and significant mortality
👉 https://pubmed.ncbi.nlm.nih.gov/41536616/

Surgical innovation is highlighted in a report describing minimally invasive management of a centrally located pulmonary aspergilloma in an adolescent, showing evolving interventional approaches
👉 https://pubmed.ncbi.nlm.nih.gov/41537646/

CPA caused by non-fumigatus species is increasingly recognised, including a case of Aspergillus candidus infection in a lung cancer patient with heavy smoking history
👉 https://pubmed.ncbi.nlm.nih.gov/41495698/

Invasive Pulmonary Aspergillosis (IPA): Expanding Risk Groups

A comprehensive review describes how IPA is increasingly seen in non-neutropenic patients, challenging traditional risk models
👉 https://pubmed.ncbi.nlm.nih.gov/41515529/

ICU-acquired IPA is examined in a large multicentre cohort stratified by SARS-CoV-2 infection, demonstrating different clinical patterns in COVID-positive and COVID-negative patients
👉 https://pubmed.ncbi.nlm.nih.gov/41526761/

Longitudinal mycological data from ICU patients with influenza- and COVID-associated pulmonary aspergillosis (IAPA and CAPA) show how bronchoalveolar lavage galactomannan kinetics relate to outcome
👉 https://pubmed.ncbi.nlm.nih.gov/41508132/

IPA is not confined to traditional risk groups. A case report documents invasive aspergillosis in a child without identifiable risk factors, reinforcing the need for diagnostic vigilance
👉 https://pubmed.ncbi.nlm.nih.gov/41520716/

Rare manifestations continue to appear, including isolated renal aspergillosis after paediatric stem-cell transplantation
👉 https://pubmed.ncbi.nlm.nih.gov/41508322/

Diagnostics, Resistance, and Drug Safety

Concerns about antifungal resistance are reinforced by a clinical screening study demonstrating azole resistance in Aspergillus isolates
👉 https://pubmed.ncbi.nlm.nih.gov/41528781/

A molecular overview of clinical Aspergillus diversity beyond A. fumigatus highlights implications for pathogenicity and antifungal susceptibility
👉 https://pubmed.ncbi.nlm.nih.gov/41528247/

Drug–drug interactions are explored in depth in a study examining concurrent triazole use with chemotherapy and immunosuppressants in invasive aspergillosis, underlining the importance of monitoring
👉 https://pubmed.ncbi.nlm.nih.gov/41528615/

Unusual but serious adverse effects are illustrated by a case of voriconazole-induced hypoglycaemia in a non-diabetic patient
👉 https://pubmed.ncbi.nlm.nih.gov/41506798/

Cutaneous manifestations as early diagnostic clues are reviewed in a paper on skin signs of invasive fungal disease, including secondary cutaneous aspergillosis
👉 https://pubmed.ncbi.nlm.nih.gov/41505800/

New Therapies and Prevention Strategies

A nationwide French observational study reports real-world outcomes from compassionate use of olorofim in invasive mould infections, including refractory aspergillosis
👉 https://pubmed.ncbi.nlm.nih.gov/41531505/

Economic evidence is emerging alongside clinical data. A cost-utility analysis of preventing invasive aspergillosis in lung transplant recipients supports targeted prophylactic strategies
👉 https://pubmed.ncbi.nlm.nih.gov/41490563/

Fundamental and Translational Aspergillus Research

Several papers advance understanding of Aspergillus fumigatus virulence and regulation, including network-based gene regulation models
👉 https://pubmed.ncbi.nlm.nih.gov/41505094/

A detailed mechanistic study shows how CsdA–LaeB regulatory interactions influence virulence and secondary metabolite production
👉 https://pubmed.ncbi.nlm.nih.gov/41498629/

Vaccine-relevant work explores how cell-wall remodelling alters innate immune recognition in an experimental A. fumigatus strain
👉 https://pubmed.ncbi.nlm.nih.gov/41509434/

Population genomics continues to redefine Aspergillus diversity, including the Aspergillus flavus–oryzae complex, with relevance to both clinical and environmental exposure
👉 https://pubmed.ncbi.nlm.nih.gov/41522572/

One Health and Veterinary Aspergillosis

Aspergillosis remains a One-Health issue, with reports including fungal pericarditis due to Aspergillus fumigatus in dogs
👉 https://pubmed.ncbi.nlm.nih.gov/41521069/

and Aspergillus infections in endangered bird species, highlighting environmental and conservation links
👉 https://pubmed.ncbi.nlm.nih.gov/41497419/

by GAtherton

Potential respiratory hazards of fungal exposure in the residential indoor environment: a systematic review (2025)

Summary of the 2025 Systematic Review for Non-Specialists & Patients

Read full paper here: Potential respiratory hazards of fungal exposure in the residential indoor environment: a systematic review - ScienceDirect

What was this review about?

This review looked at all the scientific evidence from 1990–2025 on how indoor fungi (moulds) in homes affect people’s breathing and general respiratory health. It examined 94 studies, mapping out where fungi come from, which species appear most often, and how they affect the lungs, nose, throat, and immune system.

Key Findings in Plain Language

1. The biggest sources of indoor mould are dampness and building damage

Homes with water leaks, damp walls, damaged materials and poor ventilation are the most common sources of fungi—especially Aspergillus and Penicillium. These thrive in wet building materials, bathrooms, kitchens, drains, air-conditioning systems and even water dispensers.

2. Indoor fungi are strongly linked to a wide range of respiratory symptoms

Across many countries, indoor fungal exposure was associated with:

  • Asthma and asthma flare-ups

  • Allergic rhinitis (blocked or runny nose)

  • Chronic cough and throat irritation

  • Adenoid enlargement in children

  • Hypersensitivity pneumonitis (allergic inflammation of the lungs)

  • Reduced lung function

  • Even pulmonary haemorrhage in rare cases

The review shows that even everyday exposure—not just visibly mouldy homes—can worsen respiratory health.

3. Some fungi are more strongly associated with illness

Important associations include:

  • Aspergillus → asthma symptoms, COPD exacerbations, throat irritation, hypersensitivity reactions

  • Penicillium → asthma, allergic rhinitis, hypersensitivity pneumonitis

  • Alternaria → childhood asthma risk

  • Candida & Fusarium → present in wet areas such as bathrooms and may affect vulnerable individuals

4. The geographic picture is uneven

Most research comes from high-income, temperate countries. There are major evidence gaps in tropical and subtropical regions, where humidity is high and fungal exposure is likely worse. This limits current global understanding of risk.

5. Prevention works — but public awareness is low

Simple actions (cleaning, improved ventilation, addressing leaks, correct humidity ranges) can radically reduce fungal burden. One study showed 80–90% reduction in airborne mould counts after residents were given basic remediation advice.

What’s New or Important in This 2025 Review?

1. A fully integrated “source → species → disease → location” map

The review is the first to link fungal sources, the exact fungi found, the diseases they cause, and where the evidence comes from, creating a multi-layered evidence map. This helps identify:

  • Which household features pose the highest risk

  • Which fungi are clinically most important

  • Where research gaps exist

2. Highlights the major global research imbalance

It emphasises that very little evidence exists from low-income and tropical areas—where exposure may be far more severe. This is a call for equity and better global surveillance.

3. Shows that fungi may affect more than the lungs

The review notes new evidence that fungal exposure may also influence neurological and immune-mediated symptoms, suggesting mould exposure could have broader health effects than traditionally recognised.

4. Identifies major gaps in identifying which fungal species cause harm

Many studies only measure “mould level” without identifying the fungus. The review argues for better fungal detection technologies, such as:

  • Portable real-time samplers

  • Multi-omics (DNA, RNA, metabolites)

  • Long-term cohort studies

These tools could finally clarify which fungi cause which illnesses.

5. Strong emphasis on emerging technologies for prevention

Including:

  • UV and photocatalytic TiO₂ devices

  • Improved antifungal cleaning agents

  • Building materials designed to resist mould growth

  • Volcanic minerals and clays that absorb harmful compounds

Why This Review Matters (for Patients, Carers, and Clinicians)

1. It shows mould is not “just an allergy problem”

Indoor fungi can worsen or trigger asthma, COPD, hypersensitivity pneumonitis, chronic sinus issues, and may even influence immune and neurological health. This validates patient experiences where damp homes worsen symptoms.

2. It provides strong evidence for housing-related health advocacy

Patients can use this to:

  • Request landlord repairs

  • Support home assessments

  • Advocate for rehousing if severe mould is present

  • Justify humidifier/dehumidifier use, and ventilation improvements

3. It highlights the importance of early remediation

Even simple cleaning and remediation steps can dramatically reduce mould burden and symptoms—important for families, vulnerable groups, and those with chronic lung disease.

4. It gives clinicians a clearer evidence base

Respiratory teams can use this to:

  • Recognise when housing contributes to disease flare-ups

  • Understand which conditions are most strongly linked to indoor fungi

  • Make better-informed referrals for environmental health assessments

5. It builds a scientific foundation for future guidelines

The authors point out that national building codes, indoor air quality policies, and public health guidance lag behind the evidence—and this review is intended to inform future regulation.

Who Does This Help Most?

Patients with:

  • Asthma

  • Allergic bronchopulmonary aspergillosis (ABPA)

  • Aspergillus bronchitis

  • COPD (especially those with fungal-associated exacerbations)

  • Hypersensitivity pneumonitis

  • Children with recurrent respiratory infections

  • Anyone living in damp, mouldy, water-damaged, or poorly ventilated homes

Clinicians:

Respiratory physicians, GPs, ENT specialists, allergists, immunologists.

Policy & Housing Professionals:

Public health teams, environmental health officers, social landlords, housing associations.

Researchers:

Those developing diagnostics, fungal exposure studies, indoor air quality monitoring, or patient-centred environmental interventions.

by GAtherton