Chronic Pulmonary Aspergillosis—Where Are We? and Where Are We Going?

Hayes, Gemma; Frazer, Lilyann Novak

doi:10.3390/jof2020018

Cited by 60 publications

(90 citation statements)

References 226 publications

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“…Furthermore, we found poor immune homeostasis with immune response inclined towards inflammatory signals, as shown by high CD4:CD8 ratio among these patients. Our findings are in keeping with the currently budding concept that mild immunological suppression and genetic polymorphisms are important factors leading to the development of CPA [ 12 , 23 ]. Severe immunosuppression in the form of chronic granulomatous disease (CGD) and profound neutropenia is well known to predispose to invasive pulmonary aspergillosis [ 28 ] and so is T H 2 biased immune mediated pathological inflammation in ABPA [ 29 ].…”

Section: Discussionsupporting

confidence: 90%

“…The other underlying diseases complicated by CPA include: bronchiectasis, chronic obstructive pulmonary disease (COPD), ABPA, fibrocystic pulmonary sarcoidosis, hyperimmunoglobulin E syndrome, rheumatoid arthritis, and ankylosing spondylitis [ 10 , 11 ]. With all these respiratory co-morbidities, it is not surprising that the estimated global burden of CPA is nearly three million worldwide [ 9 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Innate and Adaptive Immune Defects in Chronic Pulmonary Aspergillosis

Bongomin

Harris²,

Foden³

et al. 2017

JoF

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We evaluated the expression of biomarkers of innate and adaptive immune response in correlation with underlying conditions in 144 patients with chronic pulmonary aspergillosis (CPA). Patients with complete medical and radiological records, white cell counts, and a complete panel of CD3, CD4, CD8, CD19, and CD56 lymphocyte subsets were included. Eighty-four (58%) patients had lymphopenia. Six (4%) patients had lymphopenia in all five CD variables. There were 62 (43%) patients with low CD56 and 62 (43%) patients with low CD19. Ten (7%) patients had isolated CD19 lymphopenia, 18 (13%) had isolated CD56 lymphopenia, and 15 (10%) had combined CD19 and CD56 lymphopenia only. Forty-eight (33%) patients had low CD3 and 46 (32%) had low CD8 counts. Twenty-five (17%) patients had low CD4, 15 (10%) of whom had absolute CD4 counts <200/μL. Multivariable logistic regression showed associations between: low CD19 and pulmonary sarcoidosis (Odds Ratio (OR), 5.53; 95% Confidence Interval (CI), 1.43–21.33; p = 0.013), and emphysema (OR, 4.58; 95% CI; 1.36–15.38; p = 0.014), low CD56 and no bronchiectasis (OR, 0.27; 95% CI, 0.10–0.77; p = 0.014), low CD3 and both multicavitary CPA disease (OR, 2.95; 95% CI, 1.30–6.72; p = 0.010) and pulmonary sarcoidosis (OR, 4.94; 95% CI, 1.39–17.57; p = 0.014). Several subtle immune defects are found in CPA.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Innate and Adaptive Immune Defects in Chronic Pulmonary Aspergillosis

Bongomin

Harris²,

Foden³

et al. 2017

JoF

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“…Contrary to the countries where TB is endemic, COPD has been reported to be the most common risk factor of CPA in other countries [3][4][5]. Prior cardiothoracic surgery has also been reported to increase the risk of CPA [4, 16,17]. In addition to TB, we also found COPD and previous cardiothoracic surgery as underlying conditions of CPA in our study population.…”

Section: Discussionmentioning

confidence: 41%

Underlying Conditions and Clinical Spectrum of Chronic Pulmonary Aspergillosis (CPA): An Experience from a Tertiary Care Hospital in Karachi, Pakistan

Iqbal

Irfan

Mushtaq

et al. 2020

JoF

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The incidence of chronic pulmonary aspergillosis (CPA) is especially increasing in high tuberculosis (TB) burden countries. Despite a high estimated CPA burden in Pakistan, actual data on CPA are not available. The aim of the current study is to determine the underlying conditions and clinical spectrum of CPA at a tertiary care hospital in Karachi, Pakistan. This is a retrospective chart review study in patients admitted with CPA from January 2012 to December 2017. A total of 67 patients were identified during the study period. Mean age of CPA patients was 45.9 ± 15 years, 44 (65.7%) were male and 19 (28.4%) had diabetes. The most common type of CPA was simple aspergilloma (49.2%) followed by chronic cavitary pulmonary aspergillosis (CCPA) (44.7%). TB was the underlying cause of CPA in 58 (86.6%) patients followed by bronchiectasis caused by allergic bronchopulmonary aspergillosis (ABPA) 8 (11.9%). Aspergillus flavus was identified in 17 (47.2%), followed by A. fumigatus in 13 (36.1%) CPA patients. Isolation of multiple Aspergillus species was found in 10 (25.6%) patients. Itraconazole was given in 27 (40.3%) patients and a combination therapy of itraconazole and surgery was given in 21 (31.34%) patients. We found aspergilloma and CCPA as the most prevalent forms of CPA in our setting. Further large prospective studies using Aspergillus specific immunoglobulin G (IgG) antibodies testing are required for better understanding of CPA in Pakistan.

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“…Others develop as chronic infections that cause sustained damage to organs. Pulmonary aspergillosis is the most common of these diseases, causing a wide range of respiratory problems (Tekaia & Latgé, ; Fedorova et al, ; Kousha, Tadi & Soubani, ; Kosmidis & Denning, ; Hayes & Novak‐Frazer, ). Finally, some of these fungi are highly virulent and grow rapidly through soft tissues, which can lead to severe mutilation and organ damage.…”

Section: Fungi and Animalsmentioning

confidence: 99%

Fungal evolution: major ecological adaptations and evolutionary transitions

2019

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Fungi are a highly diverse group of heterotrophic eukaryotes characterized by the absence of phagotrophy and the presence of a chitinous cell wall. While unicellular fungi are far from rare, part of the evolutionary success of the group resides in their ability to grow indefinitely as a cylindrical multinucleated cell (hypha). Armed with these morphological traits and with an extremely high metabolical diversity, fungi have conquered numerous ecological niches and have shaped a whole world of interactions with other living organisms. Herein we survey the main evolutionary and ecological processes that have guided fungal diversity. We will first review the ecology and evolution of the zoosporic lineages and the process of terrestrialization, as one of the major evolutionary transitions in this kingdom. Several plausible scenarios have been proposed for fungal terrestralization and we here propose a new scenario, which considers icy environments as a transitory niche between water and emerged land. We then focus on exploring the main ecological relationships of Fungi with other organisms (other fungi, protozoans, animals and plants), as well as the origin of adaptations to certain specialized ecological niches within the group (lichens, black fungi and yeasts). Throughout this review we use an evolutionary and comparative-genomics perspective to understand fungal ecological diversity. Finally, we highlight the importance of genome-enabled inferences to envision plausible narratives and scenarios for important transitions.

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Chronic Pulmonary Aspergillosis—Where Are We? and Where Are We Going?

Cited by 60 publications

References 226 publications

Innate and Adaptive Immune Defects in Chronic Pulmonary Aspergillosis

Innate and Adaptive Immune Defects in Chronic Pulmonary Aspergillosis

Underlying Conditions and Clinical Spectrum of Chronic Pulmonary Aspergillosis (CPA): An Experience from a Tertiary Care Hospital in Karachi, Pakistan

Fungal evolution: major ecological adaptations and evolutionary transitions

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