# Aspergillosis: An Update on Epidemiology, Risk Factors, Diagnosis, Susceptibility, and Treatment

## TL;DR

This paper reviews recent developments in understanding and treating aspergillosis, a widespread fungal infection, focusing on new risk factors, diagnostic tools, and treatments.

## Contribution

The paper provides an updated review of aspergillosis epidemiology, risk factors, diagnostics, and treatment options over the last five years.

## Key findings

- A. terreus is increasingly causing aspergillosis, alongside less common species.
- New risk factors include COPD (OR 1.88) and interstitial lung disease (OR 3.71).
- Isavuconazole is a better treatment alternative compared to voriconazole.

## Abstract

Aspergillosis is one of the most common fungal infections worldwide, caused by various species belonging to the genus Aspergillus, affecting both immunocompetent and immunocompromised individuals. The objective of this review was to provide an update on the last five years regarding various aspects of this mycosis, including epidemiology, risk factors, diagnosis, susceptibility, and treatment. The results showed that aspergillosis is distributed throughout the world. Furthermore, A. terreus was found to be an increasing causative agent in cases of aspergillosis, along with other less common species. Regarding clinical forms, particularly in the case of Allergic Bronchopulmonary Aspergillosis (ABPA), it is necessary to consider patients with structural lung impairment (Chronic Obstructive Pulmonary Disease (COPD) and Interstitial Lung Diseases). Meanwhile, newly identified risk factors for the development of aspergillosis include chronic obstructive pulmonary disease (odds ratio 1.88) and interstitial lung disease (OR 3.71). Furthermore, the main diagnostic methodologies for aspergillosis were polymerase chain reaction (PCR), matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF), and next-generation sequencing (NGS). Additionally, the usefulness of isavuconazole compared to voriconazole was demonstrated, representing a better alternative for the treatment of aspergillosis, while novel antifungals such as olorofim and fosmanogepix show excellent results in the management of aspergillosis. Due to the discovery of new risk factors, coupled with antifungal resistance in Aspergillus spp. and the wide variety of diagnostic tools, individualized assessment of aspergillosis cases is necessary for the appropriate management of this mycosis.