Invasive Pulmonary Aspergillosis in Other Patient Populations

Invasive pulmonary aspergillosis (IPA) is increasingly reported in patients with non-classic host factors, including those with liver and lung diseases, solid malignancies, human immunodeficiency virus (HIV) infections, and individuals taking immunomodulatory drugs. The presentation of IPA in these patients is often non-specific, with consolidations, cavities, and ground-glass opacities often observed on chest CT. Diagnosing IPA can be challenging, as Aspergillus species are frequent airway colonizers in many of these patients, and diagnostic assays, such as the Aspergillus galactomannan, have not been well-validated in this demographic. Prompt recognition and appropriate antifungal treatment are essential for improving outcomes in patients with IPA. Voriconazole is the first-line treatment, though careful drug-level monitoring may be necessary in cases of end-organ impairment or potential drug interactions. Other azoles like isavuconazole or itraconazole, intravenous amphotericin B, or surgery may be alternatives. While primary prophylaxis against IPA is not universally recommended for these patient groups, mitigating risk factors such as the overuse of antibiotics, cigarette and cannabis use, and minimizing environmental exposure to Aspergillus may be important strategies to prevent IPA.