Aspergillus and Health

Abstract

Among the filamentous fungi described as etiological agents of infection, Aspergillus is the most frequent agent of invasive mould disease, and it is associated with high mortality [...]

Fungi in a One Health Perspective

“…The filamentous fungus more frequently isolated from patients with invasive fungal infections is Aspergillus, accounting for about 300,000 cases of invasive aspergillosis per year worldwide [14], with a high mortality rate of 45% to >99%, depending on if the patient is treated or not [14,39,60,68,69]. Furthermore, also worldwide, Aspergillus species cause around 3,000,000 cases of chronic pulmonary aspergillosis, and more than 1 million of deaths per year [14,39,60,68]. Some pulmonary pathologies are related to occupational exposure to Aspergillus conidia that cause Aspergillus-induced allergic and asthmatic lung diseases [68].…”

“…Furthermore, also worldwide, Aspergillus species cause around 3,000,000 cases of chronic pulmonary aspergillosis, and more than 1 million of deaths per year [14,39,60,68]. Some pulmonary pathologies are related to occupational exposure to Aspergillus conidia that cause Aspergillus-induced allergic and asthmatic lung diseases [68]. An example of occupational disease caused by Aspergillus is an onion farmer that developed hypersensitive pneumonitis caused by the inhalation of A. niger while cleaning up onion peels with air compressors [70].…”

“…A. fumigatus sensu stricto, due to its small conidia, high thermotolerance, rapid growth, and optimal temperature of 37 • C, can affect both the upper and the lower respiratory tract. The damage caused is due to the fungus itself and also due to the host's inflammatory response, causing a range of health issues that can include an allergic reaction, colonization or semi-invasive disease, or even acute invasive aspergillosis, depending on the immune status of the host [59,62,68]. Although invasive aspergillosis may be rare in immunocompetent individuals, in immunocompromised people it is a major cause of morbidity and mortality [59,62,69].…”

“…However, the treatment of aspergillosis has been a concern since the appearance of A. fumigatus resistant to azoles, causing a rise in mortality rates (47-88%) [62]. The use of triazole prophylaxis, treatments with azoles, and azole agricultural fungicides cause the development of acquired resistance in A. fumigatus isolates, leading to new challenges in the therapeutic management of these infections [35,36,38,68]. As the availability of antifungal drugs to treat fungal infections is limited, the rise in resistance rates may result in treatment failure and, consequently, in higher mortality rates [39].…”

“…There are two predominant mutations in A. fumigatus found in azole-naïve patients-TR34/L98H and TR46/Y121F/T298A (detected in the cyp51A gene)-which are also detected in A. fumigatus isolates found in the environment [39]. Other Aspergillus species a are also important pathogens, such as A. terreus, which causes aspergillosis with a high frequency in Austria and that has been reported as resistant to several antifungals, especially to amphotericin B [68]. Furthermore, A. flavus, A. nidulans, A. sydowii, and A. alabamensis are less susceptible to amphotericin B, while A. niger, A. tubingensis, and A. calidoustus are less susceptible to azoles [73].…”