The emergence ofAspergillusspecies in chronic respiratory disease.
Chronic lung disease is recognized as an important risk factor for developing pulmonary aspergillosis. The development of specific aspergillus-associated syndromes depends on host immunity and underlying lung disease. In the setting of asthma, hypersensitivity toAspergilluscan lead to allergic bronchopulmonary aspergillosis (ABPA) or severe asthma with fungal sensitization (SAFS). Chronic use of systemic or inhaled corticosteroids coupled with recurrent antibiotic use for exacerbations prevalent in chronic obstructive pulmonary disease (COPD) predisposes to chronic pulmonary aspergillosis (CPA). Prior pulmonary tuberculosis is a risk factor for CPA, a syndrome with a wide range of presentations including a simple aspergilloma, chronic cavities, necrosis or fibrosis. Accumulating evidence suggests that the presence of or colonization byAspergillusin the setting of chronic lung disease can worsen clinical course and outcomes even in the absence of overt pulmonary aspergillosis. We propose that understanding the complex interplay between host and fungi may provide key insights into the pathogenesis ofAspergillus-associated pulmonary syndromes in the setting of chronic lung disease, and provide novel therapeutic approaches to improve its identification and management.
Department of Respiratory and Critical Care Medicine, Singapore General Hospital.
Anthony Ca
AC
Yii
Department of Respiratory and Critical Care Medicine, Singapore General Hospital ,and Duke-National University Singapore Graduate Medical School, Singapore.
Mariko S
MS
Koh
Department of Respiratory and Critical Care Medicine, Singapore General Hospital and Duke-National University Singapore Graduate Medical School, Singapore.
Therese S
TS
Lapperre
Department of Respiratory and Critical Care Medicine, Singapore General Hospital ,and Duke-National University Singapore Graduate Medical School, Singapore.
Gan L
GL
Tan
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, schotirmall@ntu.edu.sg.
Sanjay H
SH
Chotirmall
D000818:Animals; D001230:Aspergillus / Q000302:isolation & purification*; D021821:Communicable Diseases, Emerging / Q000382:microbiology*; D006801:Humans; D015995:Prevalence; D055732:Pulmonary Aspergillosis / Q000382:microbiology*; D012307:Risk Factors