Extrapulmonary Manifestations of Aspergillosis

Extrapulmonary aspergillosis can often result from inhalation of Aspergillus species through the sinuses, penetrating through the ears, or from disseminated infection originating from the lungs. Risk factors include high-dose glucocorticoids, prolonged neutropenia, immunosuppression, advanced HIV, COVID-19 infection, and traumatic injuries, especially post-war or natural disasters. Sites of infection can range from neuroaspergillosis, cardiac involvement, sinusitis, otitis, ocular involvement, skin and soft tissue infections (SSTIs), osteomyelitis, peritonitis, to renal involvement. Diagnosis relies on culture, histopathology, and biomarker detection. Voriconazole is the treatment of choice. However, when significant drug–drug interaction (DDI) is a concern, newer azoles can be considered. When azole resistance is present, alternative antifungal agents, most notably amphotericin B, is the recommended choice. For severe and refractory cases, combination therapy of antifungal agents could be beneficial. Surgical debridement, combined with medical management, serves as the cornerstone of treatment particularly in central nervous system (CNS) infection, sinuses involvement, and endocarditis. However, numerous cases prove challenging to manage and are associated with high mortality rates. There is an urgent need for advanced research and the development of innovative treatments to improve the prognosis for affected individuals.