This is a big but very important question, especially for understanding who’s at higher risk of aspergillosis — including invasive aspergillosis (IA), chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), and aspergilloma.

Here’s a breakdown of the diseases and conditions linked to higher risk of aspergillosis, categorized by underlying mechanism:

🧬 1. Immunosuppression-Related Conditions

These are major risk factors for invasive aspergillosis:

  • Hematologic malignancies (e.g., leukemia, lymphoma, multiple myeloma)

  • Hematopoietic stem cell transplantation (HSCT)

  • Solid organ transplantation (especially lung, liver, heart)

  • Prolonged neutropenia (e.g. after chemotherapy)

  • Chronic granulomatous disease (CGD)

  • Severe aplastic anemia

  • Primary immunodeficiencies (e.g., CARD9 deficiency)

  • AIDS (late-stage, esp. with neutropenia or co-infections)

🫁 2. Pre-existing Lung Disease

Especially relevant to chronic pulmonary aspergillosis (CPA), aspergilloma, and ABPA:

  • Tuberculosis (TB) – especially cavitary or healed TB

  • Non-tuberculous mycobacterial (NTM) infection

  • Chronic obstructive pulmonary disease (COPD)

  • Asthma (moderate-severe or steroid-dependent)

  • Cystic fibrosis (CF)

  • Bronchiectasis (including post-infectious or idiopathic)

  • Sarcoidosis (esp. fibrocavitary)

  • Pneumoconiosis (e.g. silicosis)

  • Old healed fungal infections (e.g., histoplasmosis)

  • Post-COVID lung damage (e.g., fibrosis or cavitation)

💊 3. Medication or Treatment-Induced Immunosuppression

  • High-dose corticosteroids (especially prolonged use)

  • TNF-alpha inhibitors (e.g., infliximab, etanercept)

  • Calcineurin inhibitors (e.g., cyclosporine, tacrolimus)

  • Chemotherapy

  • JAK inhibitors (e.g., tofacitinib, ruxolitinib)

  • Anti-IL-5, IL-4, IL-13 monoclonal antibodies (possible ABPA risk modifiers)

🧠 4. ICU or Hospital-Acquired Risk

  • Severe COVID-19 pneumonia (→ COVID-associated pulmonary aspergillosis, CAPA)

  • Severe influenza (→ Influenza-associated pulmonary aspergillosis, IAPA)

  • ARDS (acute respiratory distress syndrome)

  • Mechanical ventilation

  • Broad-spectrum antibiotics

  • Renal replacement therapy / dialysis

🧬 5. Genetic/Allergic Conditions

  • Atopy (strong personal or family history)

  • Allergic bronchopulmonary aspergillosis (ABPA) risk is higher in:

    • Asthma

    • Cystic fibrosis

  • HLA associations (e.g. HLA-DR2, DR5 in ABPA)

🦠 6. Other Conditions with Fungal Susceptibility

  • Diabetes mellitus (especially poorly controlled)

  • Liver cirrhosis (linked to immune dysregulation)

  • Chronic kidney disease (esp. end-stage and dialysis patients)

  • Malnutrition or cachexia

  • Post-surgical states (e.g. after lung surgery, esp. with bronchopleural fistula)

🕊️ Reassurance for Patients: Understanding Aspergillosis Risk

If you’ve been told you’re at higher risk of aspergillosis, it’s completely natural to feel concerned. But it’s important to know that risk doesn’t mean certainty — and that many people live full, healthy lives even with underlying conditions linked to this infection.

Here are a few key points to help you feel more at ease:

🌿 1. Risk Isn’t the Same as Diagnosis

Being “at risk” means doctors will keep a closer watch for early signs — not that you will get the infection. Many people with risk factors never develop aspergillosis at all.

🛡️ 2. Monitoring & Prevention Are Powerful

Your healthcare team is trained to spot the earliest signs of infection, and tools like chest scans, blood tests, and symptom checks mean infections can often be detected early — when they’re most treatable.

💊 3. Treatments Are Effective and Improving

From antifungal medications to inhaled therapies and new biologic drugs, we have more tools than ever to manage all forms of aspergillosis — often with minimal impact on day-to-day life.

🧠 4. You’re Not Alone

Millions of people around the world live with asthma, COPD, or other chronic conditions. Support groups, clinics, and community resources are there to help you feel supported and empowered.

🌞 5. Focus on What You Can Control

Healthy lifestyle choices, regular medical checkups, avoiding dusty environments, and good hygiene all reduce your chances of exposure. You have real power to protect your health.

❤️ In Short:

Risk awareness is a tool for empowerment — not a cause for fear.
With vigilance, care, and support, most people do very well.

Full list:

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We can estimate the level of the increased risk in many cases – ie. by how much is the risk of getting aspergillosis increased over people who do not have the named risk factor?

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