Executive overview (what stands out this fortnight)
Key signals
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Immune dysregulation—not just classic immunosuppression—continues to emerge as a central driver of invasive aspergillosis.
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Allergic bronchopulmonary aspergillosis (Allergic Bronchopulmonary Aspergillosis) is appearing in atypical and early phenotypes, including absence of bronchiectasis.
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Antifungal toxicity and pharmacokinetic variability remain clinically important.
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Paediatric invasive aspergillosis evidence is improving.
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Environmental and One Health studies continue to inform exposure risk.
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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.
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