NORD's
Washington Office
 Read about events on Capitol Hill, funding for rare-disease research, and other topics of interest from NORD's office in Washington, DC.
|
|
|
Aspergillosis
Aspergillosis is a fungal
infection caused by a species of mold that is found all over the world and
known to thrive in soil and decomposing vegetation independent of an animal
host. Ancient lineages can trace it back to approximately one billion years.
Aspergillosis encompasses a
spectrum of disease related to host factors and the acute invasive form is
rapidly progressive that occurs in highly immunocompromised individuals and
can be fatal, while the chronic forms of pulmonary aspergillosis is typical
in patients without severe immune impairment and is slow progressing i.e.
over months to years and may require prolonged antifungal therapy.
Patients with a pre-exisiting
condition that has caused a cavity in the lung may develop Aspergilloma,
which is a fungal mass that develops in this cavity. For individuals with a
compromised immune system, aspergillus spieces can also induce an allergic
response that can present itself as sinusitis and asthma.
Invasive form of
aspergillosis is common among patients who undergo solid organ transplants
especially the lung and affects the sinuses and pulmonary tract indicating
that inhalation is the most common route of entry of aspergillus spores,
while other entry sites such as gastrointestinal tract and skin occur on
rare occasions.
Diagnosis of invasive
apsergillosis is challenging due to the nature of its non specific
presentation of symptoms and the lack of availability of a definitive test.
Voriconazole is recommended as the primary treatment of Invasive
aspergillosis and in case of patients resistant to Voriconazole, Lipid
amphotericin B formulation is recommended.
Prevention of invasive
apergillosis primarily relies on environmental infection control via
reduction in mold exposure and prophylaxix geared towards the high-risk
individuals. Knowledge of innate and T-cell immunity against aspergillus may
pave the way for new strategies including vaccine development. Understanding
the host genetic factors may contribute towards developing an understanding
the risk of invasive aspergillosis during periods of immunosuppresion in
selecting donors, targeted anti-fungal prophylaxis and new therapeutic
development.
ASPERGILLOSIS: Brahm H. Segal
MD., NEJM 2009;360:1870-84
|
