Recent Advances in the Management of Aspergillosis

Aspergillus spp. is a ubiquitous filamentous mold, encompassing a wide spectrum ranging from saprophytic colonization and allergic syndrome, localized or disseminated depending upon the interplay between host immune response and virulence of pathogen, and degree of immunosuppression and hyperactivity. The risk factors for invasive aspergillosis include inherited or acquired neutrophil defects, hematological malignancies, solid-organ malignancies with profound neutropenia, hematopoietic stem cell transplant, solid-organ transplants, prolonged or high-dose corticosteroids or immunosuppressants, advance acquired immunodeficiency syndromes, reactive airway disease, chronic lung disease, diabetes mellitus (DM), acute or chronic liver disease, and rheumatological conditions; Influenza and COVID-19 are new risk factors associated with high mortality. With the increasing complexities of infections, host immune status, drug, and emerging antifungal resistance, the management of Aspergillus spp. infections is becoming a challenge. Therapeutic drug monitoring, combination therapy, and alternative antifungal agents as salvage therapy are the emerging strategies. Consequently, novel antifungal agents with newer targets and structural modifications of existing agents are in the pipeline. In this chapter, we will discuss the recent concepts and newer agents in the management of Aspergillus spp. infections.