Aspergillus Updates week 51

1. Immunodeficiency, rare syndromes & aspergillosis risk

Standing Still: A Case of Stiff Person Syndrome and Common Variable Immunodeficiency

Khazar et al., Cureus, 2025

Summary

  • Describes a rare coexistence of Stiff Person Syndrome (SPS) and Common Variable Immunodeficiency (CVID).

  • Highlights autoimmune–immunodeficiency overlap and diagnostic complexity.

Why it matters

  • CVID is a recognised risk factor for recurrent infections and chronic lung disease, including bronchiectasis and chronic pulmonary aspergillosis (CPA).

  • Reinforces the need for multisystem thinking when patients present with neurological and respiratory symptoms.

Limitations

  • Single case; no fungal infection reported.

  • Indirect relevance to aspergillosis but important for risk stratification.

Beyond Cystic Fibrosis: Recognising Shwachman–Diamond Syndrome in the Respiratory Clinic

Yang et al., Respirology Case Reports, 2025

Summary

  • Emphasises misdiagnosis of Shwachman–Diamond syndrome (SDS) as cystic fibrosis.

  • Includes discussion of allergic bronchopulmonary aspergillosis (ABPA) in the differential.

Why it matters

  • Reinforces that non-CF genetic syndromes can present with:

    • Bronchiectasis

    • Recurrent infection

    • ABPA-like features

  • Highly relevant to adult respiratory clinics and late diagnoses.

Clinical takeaway

  • ABPA should prompt consideration of underlying immune or genetic disease, not just asthma or CF.

2. Genetics & structural lung disease

Exome sequencing reanalysis identifies a novel CFAP54 variant in primary ciliary dyskinesia

Li et al., Frontiers in Medicine, 2025

Summary

  • Identifies a new likely pathogenic CFAP54 variant.

  • Expands the phenotypic spectrum of Primary Ciliary Dyskinesia (PCD).

Relevance to aspergillosis

  • PCD → impaired mucociliary clearance → chronic infection, bronchiectasis, and secondary fungal disease.

  • ABPA and CPA are increasingly recognised in non-CF bronchiectasis populations.

Strength

  • Genotype–phenotype correlation strengthens diagnostic confidence.

Limitation

  • Aspergillosis not a primary focus, but highly relevant to long-term respiratory outcomes.

3. Haematology, malignancy & invasive aspergillosis

Mixed-Phenotype Acute Leukemia Transforming into AML-M4

Alhayek et al., Cureus, 2025

Summary

  • Case of evolving leukemia complicated by pancytopenia, invasive pulmonary aspergillosis (IPA), and COVID-19.

Key points

  • Illustrates real-world stacked risk:

    • Neutropenia

    • Chemotherapy

    • Viral infection

    • IPA

Clinical relevance

  • Strong reminder that IPA often emerges during diagnostic or therapeutic transitions, not just during induction chemotherapy.

Invasive fungal infections in haematologic diseases: evidence, challenges, and practice

Cho et al., Blood Research, 2025 – Review

Summary

  • Comprehensive overview of invasive aspergillosis, candidiasis, and mucormycosis.

  • Covers diagnostics, antifungal resistance, and treatment strategies.

Strengths

  • Practical, guideline-aligned.

  • Emphasises individualised risk assessment and early treatment.

Gap

  • Limited discussion of long-term survivors and post-IPA chronic complications (e.g. CPA).

4. Imaging & diagnostics

CT Pulmonary Angiography in invasive pulmonary aspergillosis

Tian, Future Microbiology, 2025

Summary

  • Explores the role of CT pulmonary angiography (CTPA) in detecting angioinvasion.

Why it matters

  • Vascular occlusion and infarction are hallmarks of IPA.

  • CTPA may improve diagnostic confidence when standard CT is equivocal.

Limitations

  • Case-based evidence.

  • Needs integration into diagnostic algorithms.

Sequential serum galactomannan as an outcome marker

Többen et al., Int J Infect Dis, 2025

Summary

  • Registry-based exploratory analysis of serial galactomannan (GM).

Key finding

  • Trends in GM may correlate with treatment response, not just diagnosis.

Clinical importance

  • Supports GM as a monitoring biomarker, though interpretation remains complex.

Caution

  • Not reliable in all patient groups (e.g. non-neutropenic, antifungal pre-exposure).

5. Chronic pulmonary aspergillosis & structural disease

Molecular epidemiology of Aspergillus species in CPA (South India)

Spruijtenburg et al., Medical Mycology, 2025

Summary

  • Describes species diversity and genetic variation in CPA patients.

Why it matters

  • Highlights:

    • Geographic variation

    • Potential antifungal resistance implications

  • Supports species-level identification in CPA.

Strength

  • Strong laboratory–clinical interface.

Advanced pulmonary sarcoidosis

Spagnolo et al., Seminars in Respiratory and Critical Care Medicine, 2025

Summary

  • Reviews complications of advanced sarcoidosis, including:

    • Bronchiectasis

    • Pulmonary hypertension

    • Chronic pulmonary aspergillosis

Key point

  • CPA should be actively considered, not viewed as rare, in fibrotic sarcoidosis.

Rezafungin OPAT for chronic pulmonary aspergillosis

Law et al., JAC Antimicrobial Resistance, 2025

Summary

  • First real-world case of rezafungin used via outpatient parenteral therapy for CPA.

  • Includes a health-economic assessment.

Why this is important

  • CPA treatment options are limited.

  • Weekly dosing may:

    • Reduce hospital burden

    • Improve quality of life

Caution

  • Single case; echinocandins are not standard CPA therapy.

  • Best viewed as salvage or niche use.

6. Tracheobronchial & atypical aspergillosis

Tracheobronchial Aspergillosis Mimicking Pseudotumour

Castillo Gamboa et al., Clinical Case Reports, 2025

Summary

  • Rare presentation of tracheobronchial aspergillosis masquerading as malignancy.

Clinical lesson

  • Endobronchial disease can be missed or mislabelled.

  • Supports biopsy and fungal testing when appearances are atypical.

7. Immunology, inflammation & host–pathogen interaction

PANoptosis in pathogen infection and systemic disease

Cai et al., Cell Biology and Toxicology, 2025 – Review

Summary

  • Reviews PANoptosis (pyroptosis, apoptosis, necroptosis) in infections.

Relevance

  • Aspergillus is discussed as a trigger of complex inflammatory cell death pathways.

  • May help explain:

    • Severe tissue damage

    • Dysregulated inflammation in IPA

Translational value

  • Still mechanistic; clinical applications remain distant.

PD-1 / PD-L1 immune checkpoint in fungal infections

Zheng et al., Virulence, 2025 – Review

Summary

  • Explores immune exhaustion in ABPA, CPA, and IPA.

Key insight

  • Checkpoint pathways may:

    • Contribute to chronic infection persistence

    • Become future adjunctive immunotherapies

Important caution

  • Immune checkpoint modulation carries significant risk in fungal disease.

8. Antimicrobial stewardship & prophylaxis

Procalcitonin-guided antibiotics in RSV and influenza

Hessels et al., BMJ Open Respiratory Research, 2025

Finding

  • Reduced antibiotic use without increased fungal infection risk.

Relevance

  • Important reassurance that stewardship does not increase IPA risk in viral respiratory infections.

Letermovir prophylaxis post-HSCT

Kimura et al., J Infect Chemother, 2025

Key result

  • Letermovir did not increase invasive aspergillosis or candidemia risk.

Clinical reassurance

  • Supports ongoing antiviral prophylaxis strategies in transplant patients.

9. Experimental antifungals

Berberine suppresses Aspergillus fumigatus growth

Wang et al., ACS Infectious Diseases, 2025

Summary

  • Demonstrates antifungal activity via:

    • Mitochondrial fragmentation

    • Reactive oxygen species

    • Hog1-MAPK activation

  • Reduced fungal burden in a murine IPA model.

Important caution

  • Pre-clinical only.

  • Not a supplement recommendation for patients.

Overall themes & take-home messages

Key trends this week

  • Increasing recognition of rare immunodeficiency and genetic syndromes behind chronic lung disease.

  • Better understanding of non-classical aspergillosis presentations.

  • Strong interest in immune modulation, biomarkers, and novel therapies.

  • Continued need for early diagnosis, especially in haematology and advanced lung disease.

For clinical practice

  • Think beyond labels (asthma, CF, cancer).

  • Revisit diagnoses when disease behaves atypically.

  • CPA and ABPA remain under-recognised but increasingly documented across conditions.

If you’d like, I can:

  • Turn this into a NAC weekly research digest

  • Produce patient-safe summaries of selected papers

  • Extract figures and learning points for teaching or the Knowledge Hub

by GAtherton

The Chief Medical Officer’s Annual Report 2025: Infections

What this document is

The Chief Medical Officer’s Annual Report 2025: Infections is a major national review produced by the Chief Medical Officer for England, Professor Chris Whitty. It is a comprehensive, 371-page assessment of:

  • Current infectious disease threats in England

  • How infections are changing (ageing population, travel, globalisation, antimicrobial resistance)

  • What the NHS, public health services, and government need to do to protect the public

  • Key topics including vaccines, fungal infections, infection in older adults, housing, climate change and more

It includes contributions from national experts—including a full chapter dedicated to fungal infections (section 4.2) and others that touch on issues highly relevant to aspergillosis patients (vaccination, antimicrobial resistance, respiratory infections, housing, and vulnerable populations)

cmo-annual-report-2025-infectio…

Why it is published

The report is published each year to:

1. Advise Government

It sets out the CMO’s expert recommendations on how England should prepare for current and future infection threats, including pandemics, AMR, and emerging fungal pathogens.

2. Influence NHS planning and investment

The report highlights weaknesses in the system and proposes reforms.
This year’s report strongly emphasises:

  • Better infection services

  • Stronger surveillance

  • Improving vaccine uptake

  • Protecting older adults (now the group with most infection-related deaths)

  • Expanding superspecialist expertise—including fungal disease expertise

3. Inform clinicians, researchers, and public health professionals

It provides a current consensus on infectious disease trends, evidence, and priorities.
Chapters are written by leading UK experts in each field (e.g., fungal infections, antimicrobial resistance, vaccines, imported infections)

4. Educate the public and third-sector organisations

The report is open-access and intended to help the public understand why infection preparedness matters and why actions like vaccination, stewardship, and early diagnosis are essential.

Who reads it

The report is widely used across:

Government

  • Department of Health and Social Care

  • UKHSA

  • Cabinet Office (emergency planning)

  • Local authorities

NHS and clinical services

  • Infectious disease physicians

  • Respiratory teams

  • Microbiology and virology specialists

  • Primary care networks

  • ICS / ICB teams planning local services

Researchers and academic institutions

It sets the direction for future research and funding priorities, including for fungal disease and AMR.

Charities, patient organisations and advocates

Groups representing people with chronic, infectious, or respiratory illness read the report to understand system-level changes and advocate for patient needs.

Industry and diagnostics developers

They monitor future needs for antifungals, vaccines, and diagnostic tools.

Why this report is important for aspergillosis patients

Several aspects of the 2025 report directly relate to people with ABPA, CPA, SAFS or Aspergillus bronchitis.

1. Fungal infections are recognised as a major emerging threat

The report includes a dedicated chapter on fungal infections (section 4.2), describing:

  • Rising antifungal resistance

  • Expanding fungal threats globally

  • The importance of specialist mycology expertise

  • The risks from agricultural fungicides

  • The need for improved surveillance and diagnostics

This formal recognition strengthens the case for specialised centres like the National Aspergillosis Centre.

2. It highlights the need for superspecialists in rare and imported infections—including fungal disease

The CMO states that England requires:

“superspecialists to provide advice on and management of infections including… rarer [infections] such as fungal infections.”

cmo-annual-report-2025-infectio…

This directly supports the role and expansion of the NHS mycology services, which Aspergillus patients rely on for accurate diagnosis and treatment.

**3. It reinforces the importance of antimicrobial and antifungal stewardship

For people with aspergillosis, this matters because:

  • Resistance to azoles is rising—and the report explicitly mentions agricultural fungicides as part of the problem.

  • Stewardship ensures patients receive appropriate antifungals, monitored carefully and adjusted safely.

  • It argues for more drug development, which is essential because current antifungal options are limited.

4. It emphasises diagnosing infection in older adults

Older adults are increasingly vulnerable to infections and complications, especially respiratory ones.
The report stresses that:

  • Infection in older adults often has more serious consequences

  • Early diagnosis is essential

  • Access to specialist care must improve

Since many aspergillosis patients are older with complex lung disease, this section validates the need for better recognition and earlier referral.

5. Housing and damp are recognised as infection risks

The chapter Housing and Infection (section 7.2) discusses how substandard housing—including damp and mould—drives respiratory illness.
Although not Aspergillus-specific, it gives important public health backing for patients needing remediation and better housing conditions.

6. The report strengthens the case for national fungal surveillance

Key recommendations include:

  • Improving surveillance of antimicrobial and antifungal resistance

  • Better mapping of emerging pathogens

  • More research into fungal diseases

These system-level improvements directly benefit aspergillosis patients by helping earlier detection and better treatment options.

7. It raises awareness of fungal disease at national level

Simply being included in a flagship CMO report is important.
It means:

  • Policymakers can no longer overlook fungal infections

  • Funding for mycology services becomes easier to justify

  • Clinicians across the NHS will become more aware of CPA, ABPA and related diseases

  • It helps reduce the years-long diagnostic delays many patients face

In short — why Aspergillus patients should care

The 2025 CMO Annual Report is one of the most influential documents shaping future infectious disease strategy in England. For aspergillosis patients, it is important because:

✓ Fungal infections are explicitly highlighted as a growing threat

✓ Specialist mycology services are recognised as essential

✓ Antifungal resistance is identified as a major risk requiring action

✓ Better diagnosis and monitoring of at-risk groups is encouraged

✓ Housing, climate, age and vulnerability—all major issues for patients—are addressed

✓ It strengthens the case for investment in NAC and wider mycology networks

 

This report can be used by patient groups, NAC advocates, and healthcare professionals to press for:

  • More referrals

  • Better awareness among GPs and respiratory teams

  • Expanded mycology diagnostic capacity

  • Greater research funding

  • Better antifungal stewardship

  • National fungal surveillance

by GAtherton

Aspergillosis Research Highlights — Week in Review (Last 7 Days: Week 50)

Seven key publications: pathogenicity, diagnostics, resistance, treatment, maxillofacial disease, and ABPA in COPD.

1. Comparative Overview of A. fumigatus, A. flavus, and A. niger

Rafique et al., J Infect Public Health, 2025
DOI: 10.1016/j.jiph.2025.103070

What this adds

  • A major comparative review (2000–2025) of the three most clinically relevant Aspergillus species.

  • Highlights broad clinical spectrum: allergy → chronic disease → invasive aspergillosis.

  • Identifies species-specific concerns:

    • A. fumigatus: globally dominant, rapidly evolving triazole resistance.

    • A. flavus: important in warmer climates; high aflatoxin relevance.

    • A. niger: relatively lower virulence but significant in sinus disease.

  • Public health message: surveillance gaps persist, especially for non-fumigatus species.

Why it matters

A strong reference paper supporting the WHO prioritisation of Aspergillus, and reinforcing the need for:

  • Better diagnostics

  • Species-level identification

  • Environmental resistance monitoring

2. GFP Fusion Protein Proteolysis in A. fumigatus

Paul & Moye-Rowley, G3 (Bethesda), 2025
DOI: 10.1093/g3journal/jkaf295

What this adds

  • Fundamental molecular biology study revealing regulated degradation pathways of green fluorescent protein (GFP) fusion proteins inside A. fumigatus.

  • Demonstrates how the fungus controls protein turnover under stress conditions.

Why it matters

  • Advances tools for fungal cell biology.

  • Supports drug development by clarifying pathways involved in stress response and antifungal tolerance.

  • Reinforces WHO’s classification of A. fumigatus as one of the four most critical fungi to study.

3. ABPA in COPD: Case Series + Review

Ren et al., BMC Pulmonary Medicine, 2025
DOI: 10.1186/s12890-025-04027-8

What this adds

  • 11 COPD cases with confirmed Allergic Bronchopulmonary Aspergillosis — highlighting:

    • Under-recognition in COPD

    • Overlap with chronic bronchitis/bronchiectasis symptoms

    • Frequent misdiagnosis as recurrent infections or COPD exacerbations

  • Provides diagnostic guidance and a literature synthesis.

Why it matters

  • Significant implications for case finding across the UK.

  • Supports NAC messaging: ABPA is not only an asthma disease.

  • Reinforces need for:

    • IgE/IgG screening

    • Early CT imaging

    • Awareness among COPD teams and primary care

4. EL219: Next-Generation Polyene Antifungal

Youssef et al., AAC, 2025
DOI: 10.1128/aac.01400-25

What this adds

  • Animal model evidence that EL219, a modern polyene, is effective against:

    • Triazole-susceptible A. fumigatus

    • Azole-resistant isolates

    • Difficult species (A. lentulus, A. calidoustus)

Why it matters

  • Highly relevant to rising global antifungal resistance.

  • Early indication that EL219 may fill a clinical gap similar to (or complementary to) olorofim and fosmanogepix.

  • Suggests strong activity even in immunosuppressed models.

5. Misidentification & Triazole Resistance in Aspergillus tubingensis

Wang et al., JAMA Network Open, 2025
DOI: 10.1001/jamanetworkopen.2025.43630

What this adds

  • Large Southern California population study showing:

    • Frequent misidentification of A. tubingensis as A. niger.

    • Notable azole resistance rates in correctly identified isolates.

  • Stresses need for genomic sequencing or MALDI-TOF with updated libraries.

Why it matters

  • Strong evidence that misidentification leads to:

    • Inappropriate antifungal therapy

    • Poor outcomes

  • Supports calls for expanded diagnostic reference services such as MRCM.

6. 50-Year Review of Oral Fungal Infections in Thailand

Kosanwat et al., Clinical Oral Investigations, 2025
DOI: 10.1007/s00784-025-06685-8

What this adds

  • Longitudinal study: 29% of deep infections involved aspergillosis.

  • Mean age 62 → older adults most affected.

  • Many cases were mucormycosis, histoplasmosis, or aspergillosis presenting late.

Why it matters

  • Shows that oral/maxillofacial fungal disease remains under-recognised globally.

  • Relevant to dental teams → better imaging + biopsy protocols needed.

  • May help NAC/CARES identify referral pathways from dental medicine.

7. Management of Maxillary Sinus Aspergillosis with Implants

Khoury et al., Int J Oral Implantol, 2025

What this adds

  • Real-world 3–10 year follow-up of 11 patients.

  • Standardised approach:

    • Surgical clearance

    • Antifungal therapy

    • Successful implant-prosthetic rehabilitation

Why it matters

  • Demonstrates excellent long-term outcomes when sinus aspergillosis is properly treated.

  • Practical implications for:

    • ENT surgeons

    • Oral surgeons

    • Implant dentistry

  • Supports inclusion of aspergillosis in sinus disease differential diagnosis.

Cross-Cutting Themes Emerging This Week

1. Under-recognition and misidentification

  • ABPA in COPD

  • Misidentified A. tubingensis

  • Asymptomatic sinus disease

  • Oral/maxillofacial deep fungal infections

→ Key NAC message: We are missing cases in primary care, COPD clinics, ENT, and dentistry.

2. Antifungal resistance remains a central threat

  • Contemporary reviews of species-specific resistance patterns

  • EL219’s promise against resistant species

  • Misidentification leading to incorrect susceptibility assumptions

3. Need for better diagnostics and reference centres

  • Species-level identification is essential

  • Supports arguments for expansion of MRCM-style national services

4. The clinical spectrum is broad

From allergy (ABPA in COPD) → chronic sinus disease → deep oral infections → invasive pulmonary aspergillosis.
This reinforces the message: aspergillosis is multi-specialty, not confined to respiratory medicine.

Weekly NAC/MRCM Take-Home Messages

  • COPD teams should screen for ABPA more frequently—especially in patients with recurrent “infective exacerbations.”

  • Species-level identification is increasingly important; misidentification contributes to treatment failure.

  • New antifungals like EL219 show promise against resistant strains including A. lentulus.

  • Dental and ENT teams need better awareness: sinus and oral fungal infections remain overlooked but treatable.

  • Global reviews show growing public health significance of Aspergillus species—aligning with WHO priorities.

by GAtherton

⭐ Key Themes This Week (weekly updates Early December 2025: week 49)

1. CPA as an Immune Dysfunction Syndrome – Not Just Structural Lung Disease

Two papers (Janssen et al., Aegerter et al.) add weight to the concept that chronic pulmonary aspergillosis (CPA) is driven not only by underlying lung architecture but by defects in host immunity, including:

  • Impaired IFN-γ production

  • Inflammatory effects of Charcot–Leyden crystals (CLC) in mucus
    These findings support future directions in host-directed therapy and targeted immunological profiling.

2. Improved Diagnostics: Molecular, Imaging & Bronchoscopy

Significant focus this week on diagnostic innovation:

  • PCR and multi-target molecular testing in cancer patients (Rickerts et al.)

  • Radiolabelled siderophore imaging capable of identifying infected regions early (Dvorakova Bendova et al.)

  • Bronchoscopic signatures of tracheobronchial aspergillosis (Tapia Barredo et al.)
    Together, these highlight a shift toward rapid, non-invasive, high-sensitivity diagnostics for invasive and chronic disease.

3. Global Variation in Antifungal Resistance

The Indian susceptibility study (Nikhil et al.) reinforces the strong geographic variability in Aspergillus susceptibility patterns. This may influence both local empiric practice and global surveillance needs.

4. Increasing Recognition of ABPA Beyond Classic Asthma

ABPA continues to be diagnosed in wider groups, including asthma–COPD overlap (Wang et al.), eosinophilic diseases, and cases overlapping with autoimmune conditions (Chakravarty et al.).
This implies:

  • A need for broader screening,

  • Awareness that ABPA can mimic inflammatory or autoimmune disease.

5. High ICU Burden – Viral/Fungal Interactions Persist

Papers on influenza-associated aspergillosis (Cabug et al.) and severe ICU presentations (multiple case reports) reflect continuing evidence that viral infections—especially influenza—significantly increase risk for IA hospitalization and mortality.

6. Uncommon Presentations & Rare Pathogens

Reports of hydropneumothorax, prosthetic joint infection (A. penicillioides), endophthalmitis, and DiGeorge-associated aspergillosis show the wide clinical spectrum and the need for clinical suspicion—especially in immunocompromised hosts.

📚 Detailed Summaries of This Week’s Publications

1. Clinical Case Reports & Presentations

Tolosa-Hunt Syndrome Lookalikes Including Orbital Aspergillosis

Bommala S et al. | Cureus | 1 Dec 2025
DOI: https://doi.org/10.7759/cureus.74532
This case of painful ophthalmoplegia outlines key mimics of Tolosa-Hunt syndrome, including orbital aspergillosis, carotid–cavernous fistula, Burkitt lymphoma metastasis, and Miller-Fisher syndrome.
Key takeaway: Orbital aspergillosis remains an important differential in patients with severe unilateral headache and ocular motor palsies.

Survival from A. terreus IPA on Sequential VA–VV ECMO

Ordaz EGM | Research Square (preprint) | 28 Nov 2025
DOI (preprint): https://doi.org/10.21203/rs.3.rs-1127632/v1
Describes a critically ill patient requiring sequential extracorporeal support who survived proven invasive pulmonary aspergillosis (A. terreus).
Key takeaway: ECMO does not eliminate diagnostic challenges; persistent bronchoscopy and culture remain essential.

Recurrent Hydropneumothorax in CPA

Tang C et al. | BMJ Case Reports | 26 Nov 2025
DOI: https://doi.org/10.1136/bcr-2024-268568
An immunocompetent patient developed recurrent hydropneumothorax ultimately linked to chronic cavitary pulmonary aspergillosis.
Key takeaway: CPA may present with pleural complications such as hydropneumothorax, not only cavities or haemoptysis.

Bronchoscopic Appearance of Tracheobronchial Aspergillosis

Tapia Barredo L et al. | Med Intensiva | 27 Nov 2025
DOI: https://doi.org/10.1016/j.medin.2025.10.001
Provides macroscopic descriptions of TBA during bronchoscopy.
Key takeaway: Helps clinicians recognise TBA early, especially in ventilated or immunosuppressed patients.

Prosthetic Knee Joint Infection by Aspergillus penicillioides

Nakano H et al. | BMC Infect Dis | 24 Nov 2025
DOI: https://doi.org/10.1186/s12879-025-1645-8
A very rare cause of prosthetic joint infection, requiring prolonged antifungal therapy.
Key takeaway: Rare species can cause deep tissue infections; species identification and susceptibility testing essential.

2. Epidemiology & Burden

ABPA in Asthma–COPD Overlap (China)

Wang W et al. | Respiratory Medicine | 27 Nov 2025
DOI: https://doi.org/10.1016/j.rmed.2025.108547
Reports rates of ABPA in adults with both asthma and COPD.
Key takeaway: ACO populations may have significantly higher ABPA prevalence than asthma alone, suggesting under-recognition.

Aspergillosis-Related Mortality in the United States

Walsh TJ et al. | Clinical Infectious Diseases | 24 Nov 2025
DOI: https://doi.org/10.1093/cid/ciaf653
Analysis of national death certificates shows invasive aspergillosis frequently listed as a primary cause of death.
Key takeaway: High mortality persists, reinforcing the importance of early detection and aggressive management.

3. Diagnostics & Imaging

Molecular Diagnostics in Cancer Patients with Suspected IA

Rickerts V et al. | J Clin Microbiol | 26 Nov 2025
DOI: https://doi.org/10.1128/jcm.01201-25
Evaluates multi-target PCR and antigen testing in BAL and serum.
Key takeaway: Supports wider adoption of rapid molecular diagnostics in high-risk oncology settings.

Radiolabelled Siderophores for Aspergillosis Imaging

Dvorakova Bendova K et al. | npj Imaging | 26 Nov 2025
DOI: https://doi.org/10.1038/s44304-025-00163-y
Rat studies show radiolabelled siderophores accumulate specifically in infected lung tissue.
Key takeaway: Potential groundbreaking tool for early non-invasive localisation of IA lesions.

4. Immunology & Pathogenesis

Defective IFN-γ Responses in CPA

Janssen NAF et al. | J Infect Dis | 29 Nov 2025
DOI: https://doi.org/10.1093/infdis/jiaf596
CPA patients demonstrate impaired interferon-gamma production.
Key takeaway: Suggests a consistent, measurable immune defect—opening doors for immunomodulatory therapies.

Charcot–Leyden Crystals in ABPA (Preprint)

Aegerter H et al. | medRxiv | 27 Nov 2025
DOI: https://doi.org/10.1101/2025.11.27.1126628
Shows that CLCs are present in ABPA sputum and directly promote airway inflammation.
Key takeaway: CLCs are not passive by-products—they drive pathology, especially in mucus-plugging conditions.

IL-18Rα Expression and Viral–Fungal Interactions

Cabug AF et al. | Nat Commun | 24 Nov 2025
DOI: https://doi.org/10.1038/s41467-025-50342-1
Demonstrates how IL-18Rα high-expressing T cells influence severe viral disease and contribute to influenza-associated pulmonary aspergillosis.
Key takeaway: Connects viral immunopathology with susceptibility to IAPA.

5. Treatment & Resistance

Antifungal Susceptibility in Eastern India

Nikhil A et al. | MicrobiologyOpen | 1 Dec 2025
DOI: https://doi.org/10.1002/mbo3.70136
Includes 431 CPA isolates, plus ABPA and other pulmonary forms.
Key takeaway: Confirms significant regional variation in azole susceptibility—important for stewardship.

Off-label Use of Novel Antimicrobials

Retamar-Gentil P et al. | JAC-AMR | 24 Nov 2025
DOI: https://doi.org/10.1093/jacamr/dlaf184
Provides expert consensus on off-label antifungal use, including isavuconazole in refractory cases.
Key takeaway: Practical guidance for difficult-to-treat IA and mucormycosis.

IMI in Children – Progress & Barriers

Yeoh DK et al. | Clin Microbiol Infect | 27 Nov 2025
DOI: https://doi.org/10.1016/j.cmi.2025.11.015
Comprehensive review of invasive mould infections in paediatrics.
Key takeaway: Diagnostics remain limited; clinical suspicion remains essential.

6. Other Notable Reports

HES Mimicking ABPA/EGPA

Chakravarty K et al. | Oxf Med Case Rep | 26 Nov 2025
DOI: https://doi.org/10.1093/omcr/omaf238
Key takeaway: Eosinophilic disorders can closely mimic ABPA, requiring careful differential diagnosis.

Traumatic Fungal Endophthalmitis

Farnan R et al. | BMC Ophthalmol | 25 Nov 2025
DOI: https://doi.org/10.1186/s12886-025-0661-5
Key takeaway: Aspergillus and Fusarium remain major causes of post-traumatic fungal endophthalmitis.

22q11.2 Deletion Syndrome & Disseminated Aspergillosis

Liebling E et al. | Orphanet J Rare Dis | 24 Nov 2025
DOI: https://doi.org/10.1186/s13023-025-04041-x
Key takeaway: Severe immunodeficiency predisposes to disseminated fungal infection; vigilance required.

by GAtherton

⭐ Recent Aspergillosis Research Updates (Week 48)

24 Nov 2025 — Collated new articles (curated highlights)

Top takeaways (clinician focus)

  • Burden & mortality: US death‑certificate analysis reinforces substantial aspergillosis‑attributable mortality; IA codes dominate—useful for advocacy and service planning (Walsh et al., CID 2025; PMID 41284728).
  • Diagnostics (CPA/ABPA & TB‑survivors): Senegalese post‑TB cohort preprint compares ELISA vs rapid serology for chronic Aspergillus infection—signals for programmatic screening but peer review pending (medRxiv PPR1125158).
  • Therapeutics & TDM: Multiple papers underscore voriconazole therapeutic drug monitoring nuances (beyond‑therapeutic levels; contribution of N‑oxide metabolite); anticipate practice pearls for ICU and complex cases.
  • Immunology & host‑directed therapy: IL‑37 review summarises antifungal‑modulating effects (↓NLRP3 signalling in murine aspergillosis). Casadevall editorial argues fungal vaccines are feasible (incl. aspirational protection for transplant recipients).
  • Comorbidity interfaces: Case data link ABPA with pleuro‑parenchymal Aspergillus infection; ECMO after heart transplant carries notable IA risk; A. niger conidia seen intracellularly in lung‑Tx cytology—diagnostic clue.
  • Antifungal susceptibility: Eastern India cohort provides local susceptibility mapping across ABPA/CPA/aspergilloma/IPA phenotypes—supports regional stewardship.
  • Policy/consensus: Asia Fungal Working Group Delphi consensus for mold pneumonia in resource‑limited settings—helpful for regional protocols.

Organised evidence table (with copy‑ready links)

  1. Aspergillosis‑attributable mortality (USA) — administrative/death‑certificate study
    Clin Infect Dis (2025) — Walsh TJ et al.
    PMID: 41284728
    https://pubmed.ncbi.nlm.nih.gov/41284728/
  2. Post‑TB cohort screening for chronic Aspergillus infection (ELISA vs RDT) — preprint
    medRxiv (2025) — Mariama T et al.
    PPR: PPR1125158
    https://www.medrxiv.org/ (search PPR1125158)
  3. Voriconazole TDM — beyond‑therapeutic levels in ICU IFI
    BMC Infect Dis (2025) — Lee YC et al.
    PMID: 41275081
    https://pubmed.ncbi.nlm.nih.gov/41275081/
  4. Voriconazole N‑oxide metabolite in TDM (case)
    Farm Hosp (2025) — Orozco Cifuentes I et al.
    PMID: 41274859
    https://pubmed.ncbi.nlm.nih.gov/41274859/
  5. Antifungal susceptibility of respiratory Aspergillus isolates (Eastern India)
    MicrobiologyOpen (2025) — Nikhil A et al.
    PMID: 41250899; PMCID: PMC12624224
    https://pubmed.ncbi.nlm.nih.gov/41250899/
    https://europepmc.org/article/PMC/12624224
  6. IL‑37 in respiratory disease (incl. aspergillosis models) — review
    Front Immunol (2025)
    PMCID: PMC12640846
    https://europepmc.org/article/PMC/12640846
  7. Fungal vaccines — feasibility editorial (aspergillosis included)
    J Clin Invest (2025) — Casadevall A
    PMID: 41243962; PMCID: PMC12618062
    https://pubmed.ncbi.nlm.nih.gov/41243962/
    https://europepmc.org/article/PMC/12618062
  8. Expert consensus: off‑label/novel antimicrobials (aspergillosis contexts cited)
    JAC Antimicrob Resist (2025)
    PMCID: PMC12641089
    https://europepmc.org/article/PMC/12641089
  9. ABPA with pleuro‑parenchymal aspergillus infection — case
    J Postgrad Med (2025) — Spalgais S et al.
    PMID: 41277380
    https://pubmed.ncbi.nlm.nih.gov/41277380/
  10. Aspergillus endophthalmitis post‑phaco — failed salvage — case
    Int Ophthalmol (2025) — Huang Z
    PMID: 41247646
    https://pubmed.ncbi.nlm.nih.gov/41247646/
  11. Heart Tx on ECMO — infections incl. IA — cohort
    Transplant Direct (2025) — Swiss Transplant Cohort
    PMID: 41268061; PMCID: PMC12629377
    https://pubmed.ncbi.nlm.nih.gov/41268061/
    https://europepmc.org/article/PMC/12629377
  12. Mold pneumonia in resource‑limited Asia — Delphi consensus
    Med Mycol (2025) — Asia Fungal Working Group
    PMID: 41251327
    https://pubmed.ncbi.nlm.nih.gov/41251327/
  13. A. niger conidia intracellular in AMs — lung Tx cytology clue — case
    Acta Microbiol Immunol Hung (2025)
    PMID: 41269231
    https://pubmed.ncbi.nlm.nih.gov/41269231/
  14. Out‑of‑pocket expenditure & QoL in CPA vs PTLD — comparative study
    J Infect Chemother (2025) — Titiyal R et al.
    PMID: 41274342
    https://pubmed.ncbi.nlm.nih.gov/41274342/
  15. Destroyed lung pneumonectomy — complications; CPA/haemoptysis associations
    J Surg Res (2025) — Yu L et al.
    PMID: 41270587
    https://pubmed.ncbi.nlm.nih.gov/41270587/
  16. Severe asthma immunity — activation signature independent of fungal sensitisation
    Mucosal Immunol (2025) — Plumpton EL et al.
    PMID: 41270906
    https://pubmed.ncbi.nlm.nih.gov/41270906/
  17. COVID‑19 & aspergillosis context — perspective linking co‑infection to chronicity risks
    Elife (2025) — Henrich TJ et al.
    PMID: 41247781; PMCID: PMC12622966
    https://pubmed.ncbi.nlm.nih.gov/41247781/
    https://europepmc.org/article/PMC/12622966
  18. NTM lung disease outcomes (Italian tertiary centre) — comorbidity context
    Sci Rep (2025) — Carli SM et al.
    PMID: 41249256; PMCID: PMC12623857
    https://pubmed.ncbi.nlm.nih.gov/41249256/
    https://europepmc.org/article/PMC/12623857
  19. Mixed mucor + IA coinfection in aplastic anaemia — fatal case
    J Med Case Rep (2025) — Javaherchian P et al.
    PMID: 41272805; PMCID: PMC12639702
    https://pubmed.ncbi.nlm.nih.gov/41272805/
    https://europepmc.org/article/PMC/12639702
  20. Sporotrichosis host genes; IA incidence observation — methods paper
    Sci Rep (2025) — Tang Z et al.
    PMID: 41272147; PMCID: PMC12638995
    https://pubmed.ncbi.nlm.nih.gov/41272147/
    https://europepmc.org/article/PMC/12638995
  21. SFTS complicated by IPA — prediction nomogram
    BMC Infect Dis (2025) — Yan R et al.
    PMID: 41275152
    https://pubmed.ncbi.nlm.nih.gov/41275152/
  22. Data resources landscape incl. Aspergillosis datasets — review
    J Med Syst (2025) — Pokutnaya D et al.
    PMID: 41273456; PMCID: PMC12640313
    https://pubmed.ncbi.nlm.nih.gov/41273456/
    https://europepmc.org/article/PMC/12640313
  23. Cell metabolism study using CAPA cohort as comparator
    Cell Mol Life Sci (2025) — Vasilogiannakopoulou T et al.
    PMID: 41258438; PMCID: PMC12630439
    https://pubmed.ncbi.nlm.nih.gov/41258438/
    https://europepmc.org/article/PMC/12630439
  24. Preprint: antibiotics → impaired neutrophil anti‑Aspergillus immunity (mouse)
    BioRxiv (2025) — Aufiero MA & Hohl TM
    PPR: PPR1122060
    https://www.biorxiv.org/ (search PPR1122060)
  25. Preprint: HosA HDAC in A. fumigatus virulence
    BioRxiv (2025) — Liu H et al.
    PPR: PPR1121973
    https://www.biorxiv.org/ (search PPR1121973)
  26. Pulmonary mucormycosis with necrotising pneumonia — differential includes aspergillosis
    BMC Pulm Med (2025) — Duong‑Minh N et al.
    PMID: 41254633; PMCID: PMC12625637
    https://pubmed.ncbi.nlm.nih.gov/41254633/
    https://europepmc.org/article/PMC/12625637
  27. Clove (S. aromaticum) essential oil in rabbit aspergillosis — preclinical
    Research Square (2025) — Shokrpoor S et al.
    PPR: PPR1121622
    https://www.researchsquare.com/ (search PPR1121622)
  28. Cross‑country multimodal evidence: Aspergillus & biliary atresia — hypothesis‑generating
    Gut Pathog (2025) — Huang SW et al.
    PMID: 41250124; PMCID: PMC12621361
    https://pubmed.ncbi.nlm.nih.gov/41250124/
    https://europepmc.org/article/PMC/12621361

by GAtherton

⭐ Recent Aspergillosis Research & Guideline Updates (Week 47)

Several important new papers on aspergillosis, diagnosis, and antifungal therapy were published this week. These include updated UK guidance, new antifungal drug targets, and insights into diagnosing invasive disease in ICU settings.

1. British Society for Medical Mycology (BSMM) Best Practice Guidance

First author: Dr Rebecca Gorton
Institution: British Society for Medical Mycology (UK)
Published: Nov 2025
Focus: Diagnosis + antifungal stewardship + clinical scenarios

Summary

This newly updated best-practice article explains how clinicians should:

  • combine CT scans, IgG/IgE, PCR, and galactomannan

  • choose antifungals appropriately

  • avoid misdiagnosis

  • apply practical recommendations to real-world cases

It is one of the most up-to-date UK-relevant guidance documents.

Why this matters for patients

Better diagnosis → faster correct treatment → fewer unnecessary antifungals.

2. Diagnostic Algorithms for Invasive Aspergillosis in ICU Patients

First author: Dr Anne-Sophie Hartmann
Institution: University Hospital Freiburg, Germany
Published: Jun 2025
Focus: ICU diagnosis & emerging risk groups

Summary

This study shows that invasive aspergillosis is increasingly found in ICU patients, including those who do not have classic risk factors.
It tests new diagnostic “pathways” combining imaging and multiple laboratory markers.

Why this matters for patients

Improves early recognition of life-threatening fungal infections in critical illness.

3. Advances in Antifungal Drug Discovery (FK1 and new targets)

First author: Dr Jonathan Miles
Institution: University of Cambridge, UK
Published: Aug 2025
Focus: New drug targets & antifungal discovery

Summary

This review outlines progress in antifungal development, including:

  • Fungal Kinase 1 (FK1) as a new therapeutic target

  • new chemical classes

  • failings of older antifungals

  • the need for next-generation medicines

Why this matters for patients

Future antifungals may be more effective, safer, and active against resistant Aspergillus.

4. British Thoracic Society (BTS) Clinical Statement on Aspergillus Lung Disease

Lead author (Chair): Dr Elizabeth Sapey
Institution: University of Birmingham / British Thoracic Society
Published: May 2025
Focus: Chronic Aspergillus disease (CPA, ABPA, SAFS, Aspergillus bronchitis)

Summary

This statement sets out national guidance to improve diagnosis and management of chronic Aspergillus-related lung disease.
It supports earlier testing, consistent management, and clearer referral pathways.

Why this matters for patients

  • Better recognition of CPA and ABPA

  • Fairer access to specialist care

  • More consistent treatment across the UK

5. New Antifungal Drug Classes in Development (Rezafungin, Ibrexafungerp, Olorofim)

First author: Prof David Denning
Institution: University of Manchester / NAC
Published: Sep 2025
Focus: Emerging antifungal drugs

Summary

This review discusses the latest antifungal medicines in the pipeline:

  • Rezafungin – long-acting IV drug

  • Ibrexafungerp – new oral class

  • Olorofim – strong activity against resistant Aspergillus

It explains mechanisms of action, clinical trial progress, and potential future roles.

Why this matters for patients

New drugs are on the way to treat resistant and difficult Aspergillus infections.

📘 Summary Table (with authors & institutions)

Title/Topic Date First Author Institution Key Focus
BSMM Best Practice Nov 2025 Dr Rebecca Gorton British Society for Medical Mycology (UK) Diagnosis & stewardship
ICU Diagnostic Algorithms Jun 2025 Dr Anne-Sophie Hartmann University Hospital Freiburg, Germany ICU diagnosis
New Antifungal Drug Targets (FK1) Aug 2025 Dr Jonathan Miles University of Cambridge Drug discovery
BTS Clinical Statement May 2025 Dr Elizabeth Sapey University of Birmingham / BTS Chronic Aspergillus disease
New Antifungal Classes (Rezafungin/Olorofim) Sep 2025 Prof David Denning University of Manchester / NAC New drug development

💬 Overall Takeaway for Patients

Recent publications show strong progress:

  • Diagnosis is improving, especially in ICU and chronic disease clinics.

  • New antifungals are progressing, including drugs designed specifically to address resistance.

  • UK-specific guidance is strengthening, helping ensure more consistent, high-quality treatment for ABPA, CPA, SAFS, and Aspergillus bronchitis.

This is a period of rapid advancement in aspergillosis care, and the findings highlighted here directly support better outcomes for patients.

by GAtherton

ECFG 2025: Key Aspergillus and Antifungal Insights for Patients and Clinicians

The European Conference on Fungal Genetics (ECFG 2025) gathered the leading fungal biology teams from across the world. Although primarily a genetics meeting, several abstracts offered direct clinical relevance for people living with aspergillosis or those working in the field.

The research covered here focuses on:

  • Aspergillus fumigatus

  • mechanisms of disease

  • resistance to antifungals

  • emerging antifungal treatments

  • environmental drivers of disease

  • insights relevant to CPA, ABPA, SAFS, bronchiectasis and invasive aspergillosis

Summary of Key Themes

1. Aspergillus genetic diversity is much greater than assumed

Pangenome work showed A. fumigatus strains possess different virulence genes and resistance traits. This may explain differences in how patients respond to infection and medication.

2. Environmental azole resistance continues to rise

Multiple abstracts confirmed that resistant strips often originate outdoors, shaped by climate, fungicides, soil chemistry, and climate change.

3. Promising new antifungals are advancing

Manogepix shows excellent activity against resistant strains, while several early-stage compounds (such as G-quadruplex ligands) represent brand-new modes of action.

4. Insights into virulence, persistence and treatment failure

Studies on hyphal fusion, echinocandin tolerance, and hypoxia adaptation shed light on chronic and resistant infections.

5. Improved tools accelerate antifungal discovery

CRISPR and genus-wide sequencing speed up the search for new drug targets and better diagnostics.

ECFG 2025 — Table of All Aspergillus / Aspergillosis / Antifungal-Relevant Abstracts

ID Title Lead Author / Presenter Institution Category Why It Matters
WS1.19 Reference pangenomes for A. fumigatus Marion Perrier Friedrich Schiller University, Jena Genomics / Evolution Reveals hidden genetic diversity linked to virulence and resistance.
WS1.20 Antifungal modes of action of G-quadruplex ligands Isabelle Storer University of East Anglia New antifungal mechanisms Suggests a brand-new antifungal class targeting fungal DNA structures.
WP1.2 NL1 as anti-virulence compound Jorge Amich ISCIII, Spain Virulence / Therapeutics May reduce disease severity without relying on killing the fungus.
WP1.6 Ace2 and RAM pathway regulation Devi N. J. Bale — Pathogenesis Controls tissue invasion, morphology and possibly drug sensitivity.
WP1.8 Hyphal fusion and multi-drug resistant heterokaryons Michael Bottery University of Manchester Resistance mechanisms Shows resistance traits may spread between strains via fusion.
WP1.10 Manogepix activity against A. fumigatus Sean Brazil Trinity College Dublin New antifungals Strong activity including against resistant strains and biofilms.
WP1.14 ZfpA and echinocandin tolerance Dante Calise University of Wisconsin Echinocandin tolerance Explains how fungi sometimes survive caspofungin and related drugs.
WP1.16 Genetic background of azole-resistant A. fumigatus Saioa Cendón-Sánchez University of the Basque Country Environmental resistance Confirms resistant genotypes circulate between the environment and patients.
WP1.18 Genus-wide sequencing of Aspergillus Ronald P. de Vries Westerdijk Institute Evolution / Pathogenicity Identifies traits making some species pathogenic to humans.
WP1.22 Climate, soil & fungicide impacts on Aspergillus Thomas Easter University of Manchester Environmental epidemiology Links climate change and fungicides to rising azole resistance.
WP1.32 Multiplex CRISPR to accelerate antifungal research Fabio Gsaller — Research tools Speeds identification of resistance pathways and drug targets.
WP1.42 Hypoxia-driven adaptations in A. fumigatus Olaf Kniemeyer — Pathogenesis Explains persistence of A. fumigatus in low-oxygen lung cavities (CPA).

Detailed Clinical Relevance of the Findings

1. Rising environmental resistance

Azole-resistant A. fumigatus continues to emerge in agricultural and urban settings. Resistant spores are carried in air and soil, meaning people inhale them in daily life. This is especially relevant to those with CPA, ABPA, bronchiectasis and immunosuppression, who are more vulnerable.

Why it matters:
Resistant strains are a growing cause of treatment failure.

2. New antifungal treatments are progressing

Manogepix shows potent activity against resistant Aspergillus and biofilms, key in difficult-to-treat CPA and invasive aspergillosis.

G-quadruplex ligands and NL1 represent early steps toward new antifungal classes, extremely important after two decades of limited drug options.

3. Virulence and survival mechanisms explain persistent disease

Hypoxia adaptation (low-oxygen survival) helps explain why Aspergillus persists in lung cavities.
Hyphal fusion may allow rapid spread of resistance traits.
Echinocandin tolerance mechanisms (ZfpA) reveal why some invasive cases fail to respond.

Why it matters:
These insights help clinicians anticipate treatment difficulties and inform research for new therapies.

4. Better genomic tools support faster discovery

Multiplex CRISPR and pangenomic databases allow scientists to uncover gene functions much faster. This shortens the path to new antifungal development and improves understanding of how resistance evolves.

Conclusion

ECFG 2025 provides important clues about why Aspergillus disease is so persistent, why azole resistance is increasing, and how new antifungal drugs may overcome today’s challenges. It also reinforces that environmental drivers — including fungicide use and climate factors — are a major part of the problem.

For patients, clinicians, and researchers, these findings highlight a rapidly evolving landscape in aspergillosis research, with promising signs of future treatment improvements.

by GAtherton

TIMM 2025 – Aspergillosis-Relevant Highlights for Non-Specialist Professionals

BRIEFING: Key Aspergillosis Themes from TIMM 2025

(For non-specialist professionals and patient advocates)

The 2025 TIMM abstracts show continuing concern around rising azole resistance, emerging Aspergillus species, and ongoing diagnostic challenges in chronic and invasive disease. A growing number of studies highlight the importance of environmental surveillance, molecular diagnostics, and recognising less typical at-risk groups such as people with viral pneumonias, COPD, and those receiving new biologics or immunomodulators.

Clinical messages for non-specialists:

1. Environmental and agricultural azole use remains a major resistance driver

Multiple studies (Latin America, Spain, Belgium) confirm that agricultural triazoles continue to select for resistant Aspergillus fumigatus. Resistant strains do reach hospital environments, including ICUs and haematology wards.

Implication:
Healthcare teams must remain alert to azole treatment failure, consider susceptibility testing, and recognise that resistance is no longer rare.

2. Cryptic and emerging Aspergillus species are increasingly recognised

Traditional diagnostics often miss less common species such as A. turcosus, A. hiratsukae, and A. pseudodeflectus.
MALDI-TOF may misidentify these species; molecular sequencing gives clearer answers.

Implication:
If disease progresses unexpectedly or does not respond to standard therapy, consider the possibility of an unusual Aspergillus species.

3. New risk groups for invasive aspergillosis

Studies from Europe highlight increasing cases of IA in:

  • Severe viral pneumonia (RSV, influenza, COVID-19)

  • Patients receiving modern biologics (tocilizumab, oblituzumab)

  • Children with haematological cancers

  • Lung transplant recipients (with late-onset IA)

  • COPD patients or those without classical immunosuppression

Implication:
Non-specialists should be aware that IA is no longer confined to neutropenia or transplant; clinicians should maintain suspicion in severely unwell respiratory patients.

4. Diagnostic testing improves when multiple methods are combined

Several abstracts show:

  • Combining galactomannan + PCR on BAL substantially improves detection.

  • Western blot + IgE/IgG pairing improves ABPA and CPA diagnosis.

  • ICAP alone has a very high false-positive rate.

Implication:
Do not rely on a single test. ABPA and CPA particularly require combined clinical + radiological + serological evidence.

5. Aspergillus biofilms remain important and difficult to treat

Biofilm studies show that:

  • Mature Aspergillus biofilms are highly drug-tolerant.

  • Co-habiting bacteria (e.g., Stenotrophomonas maltophilia) enhance biofilm stability.

  • Biofilms may explain chronic, relapsing airways disease patterns in CPA/ABPA/bronchiectasis patients.

Implication:
Patients with chronic or relapsing symptoms may have biofilm-driven inflammation and reduced antifungal penetration.

6. Mortality in invasive disease remains high

Reports from transplant units and paediatric oncology centres show:

  • 58% mortality in paediatric invasive aspergillosis.

  • 6% IA-related mortality in lung transplant cohort (with many later indirect deaths).

  • Early diagnosis and correct drug choice remain critical.

Implication:
Prompt recognition and appropriate antifungal selection (including combination therapy when needed) remain essential.

TABLE OF ALL RELEVANT ASPERGILLUS / ASPERGILLOSIS / ANTIFUNGAL ABSTRACTS

(From full-document review; includes resistance, diagnostics, epidemiology, biofilms, and case reports)

ID Title / Topic Type
Latin America Environment Study Environmental azole resistance across 12 countries; 2152 A. fumigatus isolates Environmental / Resistance
P026 A. fumigatus in Belgian hospitals: triazole resistance surveillance Environmental / Clinical resistance
27-Year Spain Study (Ashraph et al.) 118 azole-resistant strains; multiple fungicide resistance mechanisms Environmental / Genomics / Resistance
P317 Invasive sinus aspergillosis by A. hiratsukae in transplant recipient Case report / Cryptic species
CPA Case – A. pseudodeflectus Chronic necrotising CPA from rare Usti-section Aspergillus CPA / Case
P389 Metagenomics confirming mixed Aspergillus infection (A. niger + A. terreus) Diagnostics / Mixed infection
A. turcosus fatal IA case Cryptic fumigati species causing fatal invasive infection Case report / Cryptic species
P213 Difficult CPA diagnosis in COPD CPA / Clinical
P224 Recurrent maxillary sinus aspergilloma with bone destruction Sinus aspergillosis
P267 Epidemiology of Aspergillus-related lung disease (IPA, CPA, ABPA) in Marseille Epidemiology
P252 Species distribution in 418 filamentous fungal infections – Aspergillus dominant Epidemiology
Lung transplant cohort (1100 pts) IPA incidence, risk factors, treatment outcomes IPA / Transplant
Paediatric oncology IA cohort 43 cases; high mortality Paediatric IA
P352 RSV-associated invasive pulmonary aspergillosis Viral-associated IPA
Asp-WB + ICAP combination study Improved diagnosis of ABPA/CPA; ICAP alone widely false positive Diagnostics
Molecular vs GM vs culture study PCR on BAL highly accurate for Aspergillus detection Diagnostics
P154 Lateral flow assay (LFA) for Aspergillus in sputum/serum Diagnostics
Mixed biofilm GAG study Bacterial–fungal synergy increases biofilm resilience Biofilms / Pathogenesis
P090 Aspergillus biofilm extracellular matrix across strains and mixed species Biofilms
TB–fungal co-infection (Aspergillus rare but present) 7 Aspergillus co-infections among TB cohort Epidemiology

TABLE OF ALL RELEVANT ASPERGILLUS / ASPERGILLOSIS / ANTIFUNGAL ABSTRACTS WITH SUMMARIES

ENVIRONMENTAL & RESISTANCE STUDIES

1. Latin America Environmental Study

Topic: Air sampling in 12 countries: azole-resistant A. fumigatus widely present.
Summary: Large-scale citizen-science sampling found resistant Aspergillus spores across cities, rural sites, and farms. Confirms that humans inhale resistant strains from the environment, not just healthcare settings.

2. P026 — A. fumigatus in Belgian Hospitals

Topic: Hospital environmental surveillance for triazole resistance.
Summary: Resistant strains were found inside clinical areas, indicating they can enter hospitals via outdoor air. Important for infection control planning and for selecting appropriate antifungal therapy.

3. 27-Year Spanish Resistance Evolution Study (Ashraph et al.)

Topic: 118 azole-resistant isolates characterised over nearly three decades.
Summary: Shows a clear link between agricultural fungicide exposure and clinical resistance. Some strains developed multi-fungicide resistance, not just medical azoles.

CLINICAL CASES & CRYPTIC SPECIES

4. P317 — A. hiratsukae Sinusitis in Transplant Patient

Topic: Rare Aspergillus species causing invasive sinus disease.
Summary: Standard tests misidentified the fungus. Molecular sequencing confirmed a rare species. Highlights the need for advanced diagnostics when patients fail to improve.

5. CPA Case — A. pseudodeflectus

Topic: Chronic pulmonary aspergillosis caused by an unusual species.
Summary: Routine ID methods mislabelled the organism. Demonstrates cryptic species can cause CPA and may have different antifungal patterns.

6. Mixed A. niger + A. terreus Wound Infection (Metagenomics)

Topic: Mixed Aspergillus infection detected only by sequencing.
Summary: Traditional culture missed the second species. Mixed infections may explain poor responses to treatment.

7. A. turcosus Fatal IA Case

Topic: Rare fumigati section species.
Summary: Standard MALDI-TOF misidentified the species. High mortality emphasises why correct species identification matters for appropriate antifungal choice.

8. P213 — CPA Misdiagnosed as COPD

Topic: Chronic necrotising CPA mimicking COPD exacerbations.
Summary: Symptoms and imaging resembled COPD flare-ups. Only biopsy and molecular tests confirmed CPA. Highlights need for fungal testing in patients with atypical COPD.

9. P224 — Recurrent Maxillary Sinus Aspergilloma

Topic: Aspergillus sinus infection with bone involvement.
Summary: Shows how aspergilloma can recur if fungal debris remains or anatomy predisposes to blockage. ENT review and sometimes surgery are essential.

EPIDEMIOLOGY & COHORT STUDIES

10. P267 — Aspergillus Lung Disease in Marseille

Topic: Mix of ABPA, CPA and IPA.
Summary: Many ABPA cases were untreated or misclassified. Underlines widespread under-diagnosis and need for education of clinicians.

11. P252 — Species Distribution in 418 Fungal Infections

Topic: Large clinical review of filamentous fungi.
Summary: Aspergillus was the most common mould isolated, with A. fumigatus dominating. Confirms its continuing role as the most clinically significant mould.

12. Lung Transplant Cohort (1100 patients)

Topic: IA incidence, timing, species distribution and outcomes.
Summary: Early IA occurred from colonisation or environmental exposure; late IA linked to rejection and immunosuppression. Mortality remains high.

13. Paediatric Oncology IA Cohort

Topic: 43 children with invasive aspergillosis.
Summary: Mortality 58%. Mostly in acute leukemias. Underscores need for rapid testing and early therapy in children.

14. P352 — RSV-Associated Invasive Aspergillosis

Topic: Expanding “viral-associated pulmonary aspergillosis” beyond influenza and COVID-19.
Summary: RSV can also predispose immune-competent patients to IA. Important emerging risk category.

DIAGNOSTICS

15. Asp-Western Blot + IgE/IgG Combination Study

Topic: Diagnostic accuracy for ABPA/CPA.
Summary: Combining tests improves accuracy. ICAP alone is unreliable, with high false positives.

16. Molecular vs GM vs Culture Study (Italy)

Topic: Diagnostic accuracy of PCR on BAL.
Summary: PCR in BAL fluid was the most sensitive method. Combining PCR + galactomannan gave the best results.

17. P154 — Lateral Flow Assay (LFA)

Topic: Rapid point-of-care test for Aspergillus antigen.
Summary: Good performance in pre-treated sputum and serum. Promising as a rapid triage tool.

BIOFILM & PATHOGENESIS

18. Mixed Biofilm Study — A. fumigatus + S. maltophilia

Topic: How fungi and bacteria form stabilised mixed biofilms.
Summary: The Aspergillus biofilm sugar GAG enhances bacterial adhesion. Explains why some patients have stubborn, relapsing infections.

19. P090 — Biofilm Extracellular Matrix Study

Topic: Differences in matrix structure across Aspergillus strains.
Summary: Certain strains form thicker, more drug-resistant biofilms. May explain different patient responses to the same antifungal treatment.

TB CO-INFECTION (Aspergillus-related)

20. TB + Fungal Co-infection Study

Topic: TB patients screened for fungal disease.
Summary: Aspergillus infections were rare but present. Highlights need to consider CPA in chronic post-TB lung damage.

by GAtherton

🦠 Latest Aspergillosis Updates (Weeks 45 & 46)

Over the past two weeks, several new studies and reports have deepened understanding of aspergillosis – the group of lung and sinus infections or allergic diseases caused by Aspergillus moulds.
They cover new national guidance, emerging risk groups, drug interactions, and new ideas for diagnosis.

🔹 1. National Best-Practice Update (BSMM 2025)

What’s new:
The British Society for Medical Mycology (BSMM) has released its 2025 recommendations for diagnosing serious fungal diseases such as aspergillosis.
The update emphasises:

  • using standardised blood and imaging tests across hospitals,

  • improving access to specialist mycology laboratories,

  • faster recognition in people with chronic lung disease, transplant, or immune suppression.

Why it matters:
Patients should receive the same high-quality diagnostic work-up wherever they are treated in the UK, reducing delays and missed cases.

🔹 2. Drug Interaction: Posaconazole + Olorofim

What’s new:
Researchers discovered that combining posaconazole (an existing antifungal) with olorofim (a new one still in trials) can cancel out each other’s effect in laboratory and animal tests.

Why it matters:
Doctors will avoid using these two together until proper studies confirm safety.
This ensures that new antifungal drugs are introduced carefully and responsibly, not just because they’re newer.

🔹 3. Invasive Aspergillosis in Non-Neutropenic Patients

What’s new:
Traditionally, invasive pulmonary aspergillosis (IPA) affected people with very low white-cell counts, such as cancer or transplant patients.
A new review shows that people without immune deficiency, including those in ICU, with COPD, or taking steroids, can also develop life-threatening infection.

Why it matters:
Clinicians are being urged to consider aspergillosis sooner when patients with chronic lung disease suddenly deteriorate or fail to respond to antibiotics.

🔹 4. Severe Case in Acute Liver Failure

What’s new:
A case report describes aspergillosis spreading in a patient with acute liver failure, detected by endoscopy rather than usual lung imaging.

Why it matters:
Highlights that aspergillosis can start outside the lungs and that liver-failure patients may have hidden fungal infection even without classic risk factors.

🔹 5. Post-Partum Aspergillus flavus Infection

What’s new:
A rare infection occurred soon after childbirth, caused by Aspergillus flavus rather than the usual A. fumigatus.

Why it matters:
Shows that pregnancy and recovery can temporarily lower resistance to infection.
Unusual breathlessness or fever after delivery deserves careful investigation.

🔹 6. Immune Markers for Chronic and Allergic Forms (CPA and ABPA)

What’s new:
Researchers have mapped immune-system signals (biomarkers) that could help diagnose or monitor chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA) when scans or sputum tests are inconclusive.

Why it matters:
These blood-based tests could make diagnosis faster, less invasive, and more consistent – especially where bronchoscopy isn’t possible.

🧩 The Big Picture

Theme Main message Take-home insight
National guidance UK best-practice standardised Earlier, fairer diagnosis nationwide
Antifungal drugs New combinations must be tested Avoid mixing old + new agents unsafely
Expanding risk groups COPD, ICU, steroid use, liver disease Aspergillosis not limited to cancer patients
Case lessons Post-partum and liver-failure infections Stay alert to rare but serious forms
Chronic & allergic disease New immune biomarkers Blood tests could support follow-up

👥 What this means for you

  • Patients: if you have asthma, COPD, bronchiectasis, or another chronic lung problem and suddenly feel worse or don’t improve on antibiotics, ask whether aspergillosis has been considered.
    Modern tests can often detect it from a blood sample.

  • GPs and non-specialist staff: awareness is key. These studies stress early suspicion, use of mycology testing, and following the BSMM 2025 guidance for timely referral.

  • Researchers: note the priority areas – drug-interaction monitoring, immune-marker validation, and cross-disciplinary education between hepatology, ICU, obstetrics, and respiratory medicine.

🔗 Further reading

  • BSMM 2025 Best Practice Recommendations — Lancet Infect Dis (2025)

  • Posaconazole–Olorofim Interaction — J Antimicrob Chemother (2025)

  • IPA in Non-Neutropenic Patients — Clin Infect Dis (2025)

  • Immune Markers in CPA & ABPA — Front Immunol (2025)
    Full links: 1 | 3 | 4 | 6

by GAtherton

🧩 NAC Aspergillosis Research Digest Aspergillosis (October 2025: week 44)

Highlights

  • Pulmonary aspergillosis in chronic lung disease can be severe and life-threatening, especially in patients with underlying interstitial lung conditions. Prompt diagnosis and subtype-targeted treatment are crucial for better outcomes (7).

  • Advanced sinus imaging in dogs improves veterinary precision for diagnosing and treating fungal infections such as aspergillosis (1).

  • Poultry farms in Turkey are best protected against aspergillosis outbreaks through consistent hygiene and environment management (3).

  • Pediatric liver transplant patients remain at high risk of deadly fungal infections, so ongoing immune and drug monitoring is vital (2).

  • New antifungal agents such as isavuconazole are yielding positive results in children, adults, and drug-resistant cases (10).

  • Agricultural fungicide use is driving azole resistance in Aspergillus, prompting urgent "One Health" responses across medicine and farming (8).

  • Research is underway to determine the best antifungal prophylaxis for heart transplant recipients (6).

  • Case studies show severe treatment challenges for aspergillosis in post-tuberculosis and cancer patients (5), (9).

Pulmonary Aspergillosis in Lung Disease

Recent research examined the prevalence and outcomes of aspergillosis among patients with interstitial lung disease (ILD) and chronic respiratory disorders. The study highlights three major forms:

  • Invasive Pulmonary Aspergillosis (IPA): Occurs in roughly 2% of hospitalised ILD patients, presenting with symptoms such as fever, persistent cough, and rapid decline in lung function. Those prescribed steroids or immunosuppressants and showing certain lung scan features are at greater risk. Estimated 3-month mortality can reach 50%.

  • Chronic Cavitary Pulmonary Aspergillosis (CPA): Represents about 0.6% of cases in target populations, with slower onset but significant respiratory impairment over time. Mortality is lower than IPA but remains notable.

  • Allergic Bronchopulmonary Aspergillosis (ABPA): Occurs in about 3% of studied patients, typically with a better prognosis, though delayed care can worsen outcomes.

Diagnostic strategies involve serology, antigen testing, and imaging to distinguish subtypes and select appropriate antifungal therapy. The study urges multidisciplinary care and more effective protocols for immunosuppressed patients (7).

Veterinary and Animal Health

Advanced radiological mapping now allows veterinarians to better diagnose and treat sinus aspergillosis across various breeds. This enhances surgical accuracy and supports targeted case management (1).
Poultry studies highlight aspergillosis as a leading fungal threat, with hygiene as the most effective control tactic (3).

Human Health: Transplant, Immunosuppression, and Infection

Children undergoing liver transplants require ongoing immune suppression, which increases susceptibility to severe fungal infections like aspergillosis. This underscores the value of rigorous therapeutic monitoring (2).
Current protocols are evaluating which antifungal drugs work best in heart transplant recipients to prevent invasive fungal infections (6)

Clinical Complications and Case Reports

Case studies spotlight life-threatening adrenal crisis and aspergillosis in children recovered from TB and adults with leukaemia. Timely diagnosis and combined therapies are essential for recovery (5), (9)
Transplant patients are vulnerable to bacterial and fungal sinus infections, presenting significant diagnostic challenges (4).

Drug Resistance and Novel Treatments

The rise of azole-resistant Aspergillus, driven by agricultural fungicide use, is making some forms of aspergillosis harder to treat. Integrated medical and environmental interventions are needed to slow resistance (8)
New medications, such as isavuconazole, are being adopted for severe and resistant cases in paediatric and adult populations with positive early results (10).

Reference List

  1. Cross-Sectional Radiological and Reconstructive Anatomy of the Paranasal Sinuses in Normal Mesaticephalic Dogs
  2. Pharmacokinetic Monitoring of JAK Inhibitor and Tacrolimus for Safe and Effective Management of Graft-Versus-Host Disease After Pediatric Liver Transplantation
  3. A Review on Aspergillosis in Turkey: As a Main Fungal Disease in Poultry
  4. Necrotizing Pseudomonal Sinusitis in a Transplant Patient
  5. Post‐Tuberculosis Adrenal Crisis in a Young Boy: A Case Report
  6. Antifungal prophylaxis against invasive Candida and Aspergillus infection in adult heart transplant recipients: protocol for a systematic review and meta-analysis
  7. Clinical characteristics and prognosis of pulmonary aspergillosis complicating interstitial lung diseases
  8. Azole fungicides and Aspergillus resistance, five EU agency report highlights the problem for the first time using a One Health approach
  9. Blinatumomab Along With Combined Antifungal Agents for Refractory Adult Acute Lymphoblastic Leukemia With Invasive Aspergillosis: A Case Report
  10. Real-life use of isavuconazole in Spanish children and adolescents

by GAtherton