Aspergillus fumigatus and Aspergillosis in 2019.

Aspergillus fumigatus is a saprotrophic fungus; its primary habitat is the soil. In its ecological niche, the fungus has learned how to adapt and proliferate in hostile environments. This capacity has helped the fungus to resist and survive against human host defenses and, further, to be responsible for one of the most devastating lung infections in terms of morbidity and mortality. In this review, we will provide (i) a description of the biological cycle of A. fumigatus; (ii) a historical perspective of the spectrum of aspergillus disease and the current epidemiological status of these infections; (iii) an analysis of the modes of immune response against Aspergillus in immunocompetent and immunocompromised patients; (iv) an understanding of the pathways responsible for fungal virulence and their host molecular targets, with a specific focus on the cell wall; (v) the current status of the diagnosis of different clinical syndromes; and (vi) an overview of the available antifungal armamentarium and the therapeutic strategies in the clinical context. In addition, the emergence of new concepts, such as nutritional immunity and the integration and rewiring of multiple fungal metabolic activities occurring during lung invasion, has helped us to redefine the opportunistic pathogenesis of A. fumigatus.

Passive surveillance for azole-resistant Aspergillus fumigatus, United States, 2011-2013.

Emergence of Aspergillus fumigatus strains containing mutations that lead to azole resistance has become a serious public health threat in many countries. Nucleotide polymorphisms leading to amino acid substitutions in the lanosterol demethylase gene (cyp51A) are associated with reduced susceptibility to azole drugs. The most widely recognized mutation is a lysine to histidine substitution at aa 98 (L98H) and a duplication of the untranscribed promoter region, together known as TR34/L98H. This mechanism of resistance has been reported in Europe, Asia, and the Middle East, and is associated with resistance to all azole drugs and subsequent treatment failures. To determine whether isolates with this mutation are spreading into the United States, we conducted a passive surveillance-based study of 1,026 clinical isolates of A. fumigatus from 22 US states during 2011-2013. No isolates harboring the TR34/L98H mutation were detected, and MICs of itraconazole were generally low.

Aspergilosis cerebral: reporte de caso / Brain aspergillosis: a case report

En los últimos años la incidencia por infecciones de hongos del genero Aspergillus han aumentado de forma significativa como consecuencia del incremento de pacientes con estados de inmunodepresión, fundamentalmente por la alta incidencia de SIDA y por el mayor empleo de tratamientos inmunosupresores. Las aspergilosis son infecciones infrecuentes en el sistema nervioso central, constituyendo el 4 por ciento de las enfermedades invasoras, tratándose de una entidad grave, con un pobre pronóstico (mortalidad mayor del 95 por ciento). Se presenta un caso clínico de un paciente masculino de 48 años, con miocardiopatia dilatada terminal que fue sometido a transplante cardiaco, tratamiento inmunosupresor y profilaxis antimicrobiana. Después de su alta (23 días post cirugía), regresa con compromiso del sensorio y focalidad neurológica, por lo que se practica RNM que evidenció lesión microangiopatica, con edema y realce periférico anular. Cultivos microbiológicos negativos y LCR dentro de lo normal. Posteriormente (10 días después del ingreso) empeora su condición neurológica e imagenológica, por lo que se realizó biopsia estereotáxica obteniéndose exámenes directos negativos e histología sin evidencia de microorganismos, sin embargo, en los cultivos se obtuvo Aspergillus fumigatus. Se inició tratamiento con Voriconazol con buena respuesta inicial, pero posteriormente empeora su condición neurológica y general, con signos y síntomas de rechazo del transplante cardiaco, falleciendo a los 62 días postransplante.

In recent years the incidence of fungal infections of the genera Aspergillus have increased significantly as a result of the increase in patients with immunocompromised states, primarily by the high incidence of AIDS and the increased use of immunosuppressive treatments. The aspergillosis infections are rare in the central nervous system, constituting 4 por ciento of invasive disease, in the case of a serious entity with a poor prognosis (mortality greater than 95 por ciento). We report a case of a 48-year-old male patient with terminal dilated cardiomyopathy underwent heart transplantation, immunosuppressive therapy and antimicrobial prophylaxis. After his high (23 days post-surgery), is back with commitment and focal neurologic consciousness, so that is practiced MRI showed microangiopathic injury, edema and peripheral enhancement cancel. Microbiological cultures and negative CSF within normal. Later (10 days after admission) her neurological condition worsened and imagery, so stereotactic biopsy was obtained and histology tests negative without direct evidence of microorganisms, however the culture was positive to Aspergillus fumigatus. Voriconazole treatment started with good initial response, but later his condition worsened neurological and general signs and symptoms of heart transplant rejection, died 62 days postranplantation.

[Early description of a pulmonary aspergillosis 1847 from Greifswald]. / Frühe Beschreibung einer pulmonalen Aspergillose 1847 aus Greifswald.

In 1847 the student of medicine Theodor Sluyter (1817-1895) from Greifswald published his thesis in Berlin including the first well-documented case of human pulmonary aspergillosis. In 1856 Rudolf Virchow (1821-1902) classified the depicted fungi as an Aspergillus species. Possibly Carl Ferdinand Eichstedt (1816-1892) carried out the autopsy. He is known by the first description of a fungus as the cause of pityriasis versicolor in 1846. Further involved scientists from Greifswald were Wilhelm Baum (1799-1883), Theodor Litzmann (1815-1890) and the botanist Johann Konrad Schauer (1813-1848). Their curricula vitae are given in further details as well the curriculum of T. Sluyter.

An early report of growth of an Aspergillus species on the wall of a lung cavity.

A report by Bristowe in 1854 of a vegetable fungus growing in a lung cavity and identified as an Aspergillus was almost certainly one of the earliest reports of A fumigatus colonisation.

Aspergilose Pulmonar

Os autores apresentam,neste trabalho de revisão bibliográfica sobre aspergilose pulmonar,os principais aspectos da doença,de valor no diagnóstico,prognóstico e tratamento,chamando a atenção para estudos mais recentes dos componentes imunológicos