Given the importance that invasive aspergillosis has acquired in public health, the diagnosis, treatment and prevention of the different forms of this disease, including invasive pulmonary aspergillosis, sinus aspergillosis, disseminated aspergillosis and various types of invasive aspergillosis of single organ
Aspergillosis consists of a set of diseases derived from a fungal infection caused by fungi of the species Aspergillus spp. Although the different forms of the disease derive from different fungal subspecies, patients suffering from aspergillosis are usually infected with the fungus Aspergillus fumigatus .
Aspergillus fumigatus is a saprophytic fungus that, opportunistically, can be incorporated into the respiratory tract of the human being causing many diseases. Generally it lives in the ground or in the vegetation in a putefraction state. However, it can disperse through the air in the form of spores, which makes its presence ubiquitous.
The inhalation of these spores by the human being is what triggers the infection, but for this they have to give very specific conditions. As a general rule, patients who are affected by an infection of this type have neutropenia , that is, a decrease in the number of neutrophils and macrophages. These cells are key in the immune system to defend against these types of infections.
Under normal conditions, a person who has inhaled spores of this fungal species will not develop the infection. This is because upon reaching the alveoli the macrophages will end up with the corresponding spores preventing the fungus from developing inside the body. When these defenses fail, the disease develops.
In recent years there has been an increase in the number of infections derived from the presence of fungi of this species. This is probably due to the increased use of corticosteroids and immunosuppressive treatments.
The symptoms derived from this disease are very diverse. However, in general, patients have the following symptoms:
The treatment of aspergillosis is crucial. In fact, invasive aspergillosis , which is mainly caused by Aspergillus fumigatus , is a serious infectious disease. If not treated properly it can trigger acute pneumonia . In these cases, the chances of death are very high.
Treatment of aspergillosis
As a general rule, a patient who does not have a compromised immune system (usually as a result of treatment with immunosuppressive drugs or certain types of chemotherapy) will not develop this disease .
In patients who constitute a risk group , for example, those who have just undergone an organ transplant, which are treated with immunosuppressants throughout their lives, they are given preventively amphotericin B in order to mitigate the possible fungal infections.
Amphotericin B is an antibiotic, antifungal and, in some cases, antiparasitic, broad spectrum whose mechanism of action consists in inhibiting the synthesis of glucan, an essential molecule for the life of numerous microorganisms, among them the fungi of the Aspergillus species .
When the infection is already effective, the doctor usually opts for other drugs or the combination of several in the most serious cases. This is because each patient responds in a completely different way to the treatment of this type of infection: in one patient Amphotericin B can be very effective while in another it can even worsen the infection.
The treatment of aspergillosis with imidazole derivatives is quite frequent, especially treatment with voriconazole (Vfend®) in cases of Aspergillus infections.
These are molecules that have a free imidazole ring in their structure, as well as several aromatic rings capable of interfering in the synthesis of ergosterol, one of the precursors of cholesterol . That is, a drug capable of preventing the fungus from synthesizing an essential molecule for its survival.
In the most serious cases, it may be possible to opt for the extirpation of the affected tissues . However, surgery in this type of patients is not usually recommended due to their compromised state of health. In addition, the removal of the affected tissue can severely compromise the correct pulmonary function , and the remedy may be worse than the disease.
In conclusion, the key to overcoming this type of infection is early detection in order to avoid more invasive forms of the disease. On the other hand, the treatment of aspergillosis may be effective only if the patient adequately follows the doctor’s guidelines.