CLINICAL MICROBIOLOGY REVIEWS, 0893-8512/99/$04.0010 Apr. 1999, p. 310–350 Vol. 12, No. 2 Copyright © 1999, American Society for Microbiology. All Rights Reserved. Aspergillus fumigatus and Aspergillosis JEAN-PAUL LATGE ´ * Laboratoire des Aspergillus, Institut Pasteur, 75015 Paris, France INTRODUCTION .......................................................................................................................................................310 TAXONOMY OF A. FUMIGATUS ...........................................................................................................................311 Species Identification .............................................................................................................................................311 Culture and morphological characteristics .....................................................................................................311 Biochemical and molecular characterizations used in species determination ...........................................311 Molecular Analyses in Strain Typing ..................................................................................................................312 CLINICAL SYMPTOMS AND DIAGNOSIS OF RESPIRATORY ASPERGILLOSIS ....................................314 Allergic Bronchopulmonary Aspergillosis ...........................................................................................................314 Aspergilloma ............................................................................................................................................................314 Invasive Aspergillosis .............................................................................................................................................314 ANTIGENS AND LABORATORY DIAGNOSIS ....................................................................................................316 Antigens ....................................................................................................................................................................316 Serodiagnosis in the Immunocompetent Patient................................................................................................318 Serodiagnosis in the Immunocompromised Host...............................................................................................318 Circulating antigens ...........................................................................................................................................318 Detection of DNA in specimens ........................................................................................................................320 ARE THERE VIRULENCE FACTORS IN A. FUMIGATUS? ..............................................................................320 Strategies..................................................................................................................................................................320 Animal Models ........................................................................................................................................................321 Putative Virulence Factors ....................................................................................................................................323 Adhesins ...............................................................................................................................................................323 Pigments ...............................................................................................................................................................323 Toxic Molecules ...................................................................................................................................................323 Enzymes................................................................................................................................................................324 HOST DEFENSE MECHANISMS AGAINST A. FUMIGATUS...........................................................................326 Innate Immunity .....................................................................................................................................................326 Anatomical barriers ............................................................................................................................................326 Humoral components .........................................................................................................................................326 Phagocytic cells ...................................................................................................................................................326 (i) Macrophages ..............................................................................................................................................327 (ii) Neutrophils ...............................................................................................................................................327 (iii) Platelets ....................................................................................................................................................327 Acquired Immunity .................................................................................................................................................327 T-cell immunity ...................................................................................................................................................327 Protective immunity............................................................................................................................................329 Role of Immunosuppression in the Development of Invasive Aspergillosis ...................................................329 Immunosuppressive drugs .................................................................................................................................329 Immunosuppressive molecules of fungal origin .............................................................................................330 MOLECULAR EPIDEMIOLOGY AND PROPHYLAXIS OF INVASIVE ASPERGILLOGIS........................330 TREATMENT OF ASPERGILLOSIS ......................................................................................................................332 Amphotericin B .......................................................................................................................................................332 Itraconazole .............................................................................................................................................................333 Outcome and Trends ..............................................................................................................................................333 CONCLUSION............................................................................................................................................................335 ACKNOWLEDGMENTS ...........................................................................................................................................335 REFERENCES ............................................................................................................................................................335 INTRODUCTION Aspergillus fumigatus is a saprophytic fungus that plays an essential role in recycling environmental carbon and nitrogen (235, 506, 676). Its natural ecological niche is the soil, wherein it survives and grows on organic debris. Although this species is not the most prevalent fungus in the world, it is one of the most ubiquitous of those with airborne conidia (443, 444, 466). It sporulates abundantly, with every conidial head producing thousands of conidia. The conidia released into the atmo- sphere have a diameter small enough (2 to 3 mm) to reach the lung alveoli (518, 577). A. fumigatus does not have an elaborate mechanism for releasing its conidia into the air; dissemination simply relies on disturbances of the environment and strong air * Mailing address: Laboratoire des Aspergillus, Institut Pasteur, 25 rue du Docteur Roux, 75724 Paris Cedex 15, France. Phone: 01 40 61 35 18. Fax: 01 40 61 34 19. E-mail: [email protected]. 310 Downloaded from https://journals.asm.org/journal/cmr on 19 July 2023 by 2402:800:62f0:7703:ed25:bb89:cb90:4629.
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