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Review
. 2025 Jul 27;11(8):555.
doi: 10.3390/jof11080555.

Emerging Risk Factors for Invasive Pulmonary Aspergillosis: A Narrative Review

Ahmed Elkhapery  1 , Mariam Fatima  2 , Ayman O Soubani  3
Affiliations
Review

Emerging Risk Factors for Invasive Pulmonary Aspergillosis: A Narrative Review

Ahmed Elkhapery et al. J Fungi (Basel). .

Abstract

Aspergillus can cause a spectrum of diseases depending on the immune status and predisposing conditions. Invasive pulmonary aspergillosis (IPA) is classically seen in patients with severe immunocompromise, such as patients with hematologic malignancies, transplant recipients, and chronic corticosteroid use at high doses. Recently, IPA cases in patients without these classic risk factors, including those associated with severe respiratory viral infections, chronic obstructive pulmonary disease, liver failure, and critical illness, are being increasingly recognized. Delayed recognition and missed diagnoses contribute to increased mortality in these patient populations. Maintaining a high index of suspicion and implementation of systematic screening protocols in high-risk patients may help reduce missed or delayed diagnoses and improve patient outcomes. This review describes the pathophysiology, incidence, risk factors, outcomes, and diagnostic and treatment considerations in IPA in patients with emerging risk factors.

Keywords: diagnosis; invasive pulmonary aspergillosis; management; risk factors.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Risk factors for invasive aspergillosis in the ICU. The figure stratifies the risk factors into high, intermediate, and low risk. Neutropenia, hematologic malignancy, and allogeneic hematopoietic stem cell transplant (HSCT) confer the highest risk for invasive aspergillosis in the ICU. The figure also provides an insight into the relative risk of emerging risk factors for IPA.
Figure 2
Figure 2
Chest CT image of a patient with COVID-19 pneumonia who required prolonged mechanical ventilation. His chest CT revealed fibrotic changes with right cavitary lesions. Bronchoscopy with bronchoalveolar lavage resulted in positive cultures for Aspergillus fumigatus, and galactomannan was elevated to 7.6 ODI. The patient was diagnosed with IPA and was started on voriconazole. He was eventually extubated and discharged home.
Figure 3
Figure 3
An algorithm for the diagnosis and management of IPA in critically ill patients. HSCT: Hematopoietic Stem Cell Transplant. COVID-19: Coronavirus Disease of 2019. COPD: Chronic Obstructive Pulmonary Disease. CT: Computed Tomography. BAL: Broncho-Alveolar Lavage. ODI: Optical Density Index. IPA: Invasive Pulmonary Aspergillosis. ITBA: Invasive Tracheobronchial Aspergillosis.
See this image and copyright information in PMC

References

    1. Latge J.P., Chamilos G. Aspergillus fumigatus and Aspergillosis in 2019. Clin. Microbiol. Rev. 2019;33:e00140-18. doi: 10.1128/CMR.00140-18. - DOI - PMC - PubMed
    1. Falvey D.G., Streifel A.J. Ten-year air sample analysis of Aspergillus prevalence in a university hospital. J. Hosp. Infect. 2007;67:35–41. doi: 10.1016/j.jhin.2007.06.008. - DOI - PubMed
    1. Morris G., Kokki M.H., Anderson K., Richardson M.D. Sampling of Aspergillus spores in air. J. Hosp. Infect. 2000;44:81–92. doi: 10.1053/jhin.1999.0688. - DOI - PubMed
    1. Rankin N.E. Disseminated aspergillosis and moniliasis associated with agranulocytosis and antibiotic therapy. BMJ. 1953;1:918–919. doi: 10.1136/bmj.1.4816.918. - DOI - PMC - PubMed
    1. Taplitz R.A., Kennedy E.B., Bow E.J., Crews J., Gleason C., Hawley D.K., Langston A.A., Nastoupil L.J., Rajotte M., Rolston K.V., et al. Antimicrobial Prophylaxis for Adult Patients with Cancer-Related Immunosuppression: ASCO and IDSA Clinical Practice Guideline Update. J. Clin. Oncol. 2018;36:3043–3054. doi: 10.1200/JCO.18.00374. - DOI - PubMed

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