Recent Advances in the Therapy Against Invasive Aspergillosis

Abstract

The members of the genus Aspergillus are opportunistic fungi that cause disease almost exclusively in patients with chronic lung pathology or depressed immune defenses. Aspergillus disease has a variety of clinical manifestations, ranging from allergic responses occurring in the absence of fungal growth or airway colonization to invasion and destruction of lung parenchyma with or without dissemination to other organs (Denning and Stevens, 1990; Greenberger, 2002; Marr et al., 2002; Muller et al., 2002). Over the past decades, the incidence of invasive aspergillosis has increased dramatically as a result of an expansion of the population of immunocompromised patients. At particular risk for invasive aspergillosis are those patients with persistent and profound neutropenia as a result of aggressive anticancer chemotherapy, hematopoietic stem cell transplant, or aplastic anemia (Gerson et al., 1984; Weinberger et al., 1992; Walsh et al., 1994; Perea and Patterson, 2002). In addition, congenital or acquired qualitative defects of the phagocytic cells have also been associated with the development of invasive aspergillosis: examples are patients with chronic granulomatous disease, Job syndrome, or those receiving prolonged courses of immunosuppressive agents such as corticosteroids. Aspergillosis is uncommon in patients with AIDS but when present it is associated with short survival after diagnosis (Shetty et al., 1997; Holding et al., 2000).