Aspergillosis
Author:
Segal BH
Date: 6 May 2009
Abstract:
Filamentous fungi (molds) are ancient lineages that have existed for approximately 1 billion years and thrive in soil and decomposing vegetation independent of an animal host. Thus, the evolution from primitive immune systems that rely principally on antimicrobial peptides, such as those in insects, to the complex immune system in mammals occurred with continued exposure to fungi. The immune system, therefore, must not only recognize inhaled molds and control their growth but also restrain injurious inflammation and allergy.We regularly inhale the spores of aspergillus species, yet fungal disease is uncommon. Aspergillus-related diseases are associated with a spectrum of disorders of immunity. Invasive aspergillosis, the focus of this review, is typically a disease of highly immunocompromised persons and is a leading cause of infection-related death in patients with acute leukemia and recipients of allogeneic hematopoietic stem-cell transplants. At the other end of the immunologic spectrum, allergic forms of aspergillosis, such as allergic bronchopulmonary aspergillosis, result from a poorly controlled inflammatory response to hyphae colonizing the sinopulmonary tract. Important advances have been made in fungal diagnostics and in the antifungal armamentarium. In addition, new insights have been gained regarding host defense against aspergillus species and the immunopathogenesis of aspergillus related diseases that may pave the way to new prevention and therapeutic strategies.
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