Aspergillosis

Epidemiology, Diagnosis, and Treatment

Jose Cadenaa, George R. Thompson IIIb,c,*,

Thomas F. Patterson, MDa

KEYWORDS
 Aspergillosis  Invasive pulmonary aspergillosis  Resistance
 Chronic cavitary aspergillosis  Aspergilloma

KEY POINTS
 Novel risk factors for invasive aspergillosis continue to emerge.
 Non–culture-based methods are important adjuncts to diagnosis.
 Azole resistance has emerged in Aspergillus fumigatus.
 Voriconazole is recommended for most patients; liposomal amphotericin B is an alterna-
tive in some patients, especially with concerns of antifungal resistance.
 Isavuconazole and posaconazole offer efficacy with reduced toxicity compared with
voriconazole.

INTRODUCTION

Aspergillosis refers to a spectrum of illness that is dependent on host factors and the
immunologic response. Noninvasive forms include allergic bronchopulmonary asper-
gillosis (ABPA) and allergic fungal rhinosinusitis, whereas more invasive diseases
include chronic pulmonary aspergillosis and invasive pulmonary aspergillosis (IPA).1,2
Following inhalation or inoculation with Aspergillus conidia (eg spores), infection
may develop locally or disseminate to contiguous or distant sites, particularly in those
receiving immunosuppressive therapy or who are neutropenic following bone marrow
transplantation or receipt of chemotherapy.
Infection-related mortality remains high, particularly in those with structural or
immunologic defects that are irreversible. More recently, small molecule agents,
including ibrutinib, have been noted to predispose to disseminated infection and
have emerged as new risk factors for invasive infection. Antifungal resistance

a
Department of Medicine, Division of Infectious Diseases, University of Texas Health Science
Center at San Antonio, 7703 Floyd Curl Drive – MSC 7881, San Antonio, TX 78229-3900, USA;
b
Department of Internal Medicine, Division of Infectious Diseases, University of California –
Davis Health; c Department of Medical Microbiology and Immunology, University of California
– Davis Health
* Corresponding author. Department of Medicine, Division of Infectious Diseases, 4150 V
Street; Suite G500, University of California-Davis Medical Center, Sacramento, CA 95817.
E-mail address: patterson@uthscsa.edu

Infect Dis Clin N Am 35 (2021) 415–434

https://doi.org/10.1016/j.idc.2021.03.008 id.theclinics.com
0891-5520/21/Published by Elsevier Inc.