Aspergillus Bronchitis

There is a proposal for a seperately identifiable clinical entity where patients have clear signs of respiratory infection (cough, voluminous sputum, recurrent chest infections) and have a positive culture or PCR results for the presence of Aspergillus in their airways. Many have bronchiectasis and high MRC dyspnea scores. Most have high IgG and precipitans to Aspergillus. Despite all this these patients did not fulfill the criteria for allergic, chronic or invasive aspergillosis but do respond strongly to antifungal treatment.

This paper proposes that these observations constitute a group of patients that can be diagnosed as having Aspergillus bronchitis.

Another noteworthy publication in December is a major review of pathogenic fungal diseases entitled ‘Hidden Killers, Human Fungal Infections’. This review takes a worldwide perspective of most of the major fungal infections that occur globally, making the point that many of these diseases are not widely appreciated to be the major killers that they are. There is good awareness of the more superficial infections such as athletes foot, ringworm and nail infections but did you know that the former affects 20% of the world population while the latter affects up to 50% of the population of the world amongst those aged over 70!? This review contains many such surprising statistics for a range of fungal infections.

Most readers will be aware that Aspergillus infections are usually caused by inhaling spores and that we all generally inhale spores all of the time as spores of this genus (and a few others e.g. Penicillium) are present in our air all of the time. We also know that these spores can only grow if an individual is immunocompromised and/or has some lung damage that allows spores to gain a foothold in otherwise healthy tissue. But did you know that there are 200 000 recorded cases of Invasive Aspergillosis (IA) every year worldwide? The majority of these affect people who have leukemia or emphysema (COPD) and mortality rates are >50% and higher if diagnosis is delayed. More at risk groups are emerging e.g. TB.

Worryingly for research funding most victims of aspergillosis will be recorded as deaths due to cancer or smoking respectively (and 50-60% are not recorded as IA at all so the true numbers of infections are more likely to be approaching 400 000 per year), leading to a lack of awareness that reduces research funding.

If we were able to quickly and accurately diagnose aspergillosis we could save many more lives. The only way to discover and develop better diagnostic technology is to dedicate funding for the research. For this to happen much more awareness of serious fungal infections is needed!