Levels of evidence supporting clinical practice guidelines on invasive aspergillosis. Tejada et al., 2020.
This paper is the first study analysing the quality of evidence supporting invasive aspergillosis guidelines. In evaluating the level of evidence (LOE) supporting recommendations in clinical practice guidelines (CPGs) of invasive aspergillosis (IA) it reports that among 238 strong recommendations, only 57 (24.0%) were supported by LOE A (multiple randomized controlled trial (RCT) or meta-analysis). When comparing recent CPGs with previous versions, the proportion of recommendations supported by LOE A did not significantly increase over time. The authors conclude that IA is a condition with an urgent unmet clinical need for more high-quality randomized trials.
Impact of high baseline Aspergillus-specific IgG levels on weight and quality-of-life outcomes of patients with chronic pulmonary aspergillosis. Bongomin et al., 2020.
This retrospective study evaluates the impact of quantitative baseline Aspergillus-specific immunoglobulin G (IgG) serum levels on weight changes of patients with chronic pulmonary aspergillosis (CPA) under antifungal treatment. A very high Aspergillus IgG may confer a higher likelihood of weight gain as a key, objective marker of clinical response, if patients can tolerate 12 months of antifungal therapy.
Surgical resection is one treatment modality for chronic pulmonary aspergillosis (CPA), and sometimes a preoperative presumption of lung cancer turns out to be CPA. This study audits surgical experience with regard to risk factors for relapse, and the value of postoperative monitoring of Aspergillus-immunogolubulin G (IgG) titres. It concludes that surgery in selected patients with CPA can have favourable outcomes. Relapse is common after surgical treatment of CPA but can be minimized with antifungal therapy, emphasizing the importance of an accurate diagnosis prior to surgery.
Wiesner et al. show a secreted fungal protease allergen of humans induces inflammation in mice with hallmarks of allergic asthma. The protease damages junctions of bronchiolar epithelial club cells, which the mechanosensor and gated calcium channel TRPV4 detects. Calcineurin mediates the calcium signaling and cellular alarms initiating lung allergic inflammation.
Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes. Dave et al., 2020.
This retrospective, interventional, multicentric case series describes the clinical presentations, management and factors determining outcomes of Aspergillus endophthalmitis, an eye infection. It reports trauma and intraocular surgery as common causes. The common infecting fungi are Fusarium and Aspergillus species for exogenous endophthalmitis, the latter having high ocular morbidity and poor outcome.
