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. 2022 Nov 29;31(166):220114.
doi: 10.1183/16000617.0114-2022. Print 2022 Dec 31.

Pulmonary aspergillosis: diagnosis and treatment

Frederic Lamoth  1   2 , Thierry Calandra  3
Affiliations

Pulmonary aspergillosis: diagnosis and treatment

Frederic Lamoth et al. Eur Respir Rev. .

Abstract

Aspergillus species are the most frequent cause of fungal infections of the lungs with a broad spectrum of clinical presentations including invasive pulmonary aspergillosis (IPA) and chronic pulmonary aspergillosis (CPA). IPA affects immunocompromised populations, which are increasing in number and diversity with the advent of novel anti-cancer therapies. Moreover, IPA has emerged as a complication of severe influenza and coronavirus disease 2019 in apparently immunocompetent hosts. CPA mainly affects patients with pre-existing lung lesions and is recognised increasingly frequently among patients with long-term survival following cure of tuberculosis or lung cancer. The diagnosis of pulmonary aspergillosis is complex as it relies on the presence of clinical, radiological and microbiological criteria, which differ according to the type of pulmonary aspergillosis (IPA or CPA) and the type of patient population. The management of pulmonary aspergillosis is complicated by the limited number of treatment options, drug interactions, adverse events and the emergence of antifungal resistance.

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Conflict of interest statement

Conflict of interest: F. Lamoth has research funding from Gilead, MSD, Pfizer and Novartis, and has participated in Advisory boards for Gilead, MSD and Pfizer. All contracts were made with and fees paid to his institution (CHUV). Conflict of interest: T. Calandra has participated in advisory boards or consulted for Menarini, Shinogi, Cytosorbent, ThermoFisher and GE Healthcare for projects unrelated to the submitted work and on data safety monitoring boards for Cidara and Novartis. All contracts were made with and fees paid to his institution (CHUV).

Figures

FIGURE 1
FIGURE 1
Schematic representation of the diagnostic classification of invasive pulmonary aspergillosis (IPA) according to the European Organization for Research and Treatment of Cancer and Mycoses Study Group Education and Research Consortium. Possible IPA must include at least one host criterion and one clinical criterion. Probable IPA must include at least one host criterion, one clinical criterion and one mycological criterion. Proven IPA is defined independently from the presence or absence of host/clinical/mycological criteria. For details, see reference [9]. BAL: bronchoalveolar lavage; CT: computed tomography; PCR: specific polymerase chain reaction for Aspergillus species.
FIGURE 2
FIGURE 2
Diagnostic approach of invasive pulmonary aspergillosis (IPA) in high-risk haematologic cancer patients. AF: antifungal; BAL: bronchoalveolar lavage; CT: computed tomography; EORTC/MSGERC: European Organization for Research and Treatment of Cancer and Mycoses Study Group Education and Research Consortium; GM: galactomannan; GVHD: graft versus host disease; HSCT: haematopoietic stem cell transplantation; IA: invasive aspergillosis; MRI: magnetic resonance imaging; ODI: optical density index; PCR: specific polymerase chain reaction for Aspergillus species.
See this image and copyright information in PMC

Comment in

  • doi: 10.1183/16000617.0150-2022

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