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. 2024 Jun 27;62(6):myad129.
doi: 10.1093/mmy/myad129.

Aspergillus fumigatus-a systematic review to inform the World Health Organization priority list of fungal pathogens

C Orla Morrissey  1 , Hannah Y Kim  2   3   4 , Tra-My N Duong  2 , Eric Moran  5 , Ana Alastruey-Izquierdo  6 , David W Denning  7   8 , John R Perfect  9 , Marcio Nucci  10 , Arunaloke Chakrabarti  11 , Volker Rickerts  12 , Tom M Chiller  13 , Retno Wahyuningsih  14   15 , Raph L Hamers  16   17 , Alessandro Cassini  18   19 , Valeria Gigante  20 , Hatim Sati  20 , Jan-Willem Alffenaar  2   3   4 , Justin Beardsley  2   21
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Aspergillus fumigatus-a systematic review to inform the World Health Organization priority list of fungal pathogens

C Orla Morrissey et al. Med Mycol. .

Abstract

Recognizing the growing global burden of fungal infections, the World Health Organization established a process to develop a priority list of fungal pathogens (FPPL). In this systematic review, we aimed to evaluate the epidemiology and impact of invasive infections caused by Aspergillus fumigatus to inform the first FPPL. The pre-specified criteria of mortality, inpatient care, complications and sequelae, antifungal susceptibility, risk factors, preventability, annual incidence, global distribution, and emergence were used to search for relevant articles between 1 January 2016 and 10 June 2021. Overall, 49 studies were eligible for inclusion. Azole antifungal susceptibility varied according to geographical regions. Voriconazole susceptibility rates of 22.2% were reported from the Netherlands, whereas in Brazil, Korea, India, China, and the UK, voriconazole susceptibility rates were 76%, 94.7%, 96.9%, 98.6%, and 99.7%, respectively. Cross-resistance was common with 85%, 92.8%, and 100% of voriconazole-resistant A. fumigatus isolates also resistant to itraconazole, posaconazole, and isavuconazole, respectively. The incidence of invasive aspergillosis (IA) in patients with acute leukemia was estimated at 5.84/100 patients. Six-week mortality rates in IA cases ranged from 31% to 36%. Azole resistance and hematological malignancy were poor prognostic factors. Twelve-week mortality rates were significantly higher in voriconazole-resistant than in voriconazole-susceptible IA cases (12/22 [54.5%] vs. 27/88 [30.7%]; P = .035), and hematology patients with IA had significantly higher mortality rates compared with solid-malignancy cases who had IA (65/217 [30%] vs. 14/78 [18%]; P = .04). Carefully designed surveillance studies linking laboratory and clinical data are required to better inform future FPPL.

Keywords: Aspergillus fumigatus; epidemiology; incidence; invasive aspergillosis; invasive fungal disease; mortality; risk factors; susceptibility.

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Conflict of interest statement

Dr. David Denning and his family hold Founder shares in F2G Ltd, a University of Manchester spin-out antifungal discovery company. All the other authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Flow diagram for selection of studies included in the systematic review of Aspergillus fumigatus based on: the PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
See this image and copyright information in PMC

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