Increasing rates of serious fungal infections in non immunocompromised humans.
For many decades it has been known that many types of fungi such as Aspergillus, Candida, and Cryptococcus can cause life threatening fungal infections in people with compromised immune systems such as those with cancer, HIV+, and those on immunosuppressive drugs for bone/organ transplants or autoimmune conditions.
Rates of Invasive Fungal Diseases Increasing
In recent years, it has become apparent that increasing numbers of humans without classically compromised immune systems are developing life threatening fungal infections. A recent review and recent study have documented the recent increases in life threatening infections involving Aspergillus and Cryptococcus 1, 2.
Invasive Aspergillus Infections More Common Than Generally Realized
It is estimated that at least 5 to 7% of invasive pulmonary Aspergillosis cases occur in non immunocompromised hosts 1. About 1 to 2% of Intensive Care Unit (ICU) patients have positive Aspergillus samples, with an estimated 0.35% to 0.56% of ICU patients developing invasive Aspergillosis1. Autopsy studies suggest invasive pulmonary Aspergillosis infection is underestimated, with about 1 to 3.5% of deceased patients having invasive Aspergillosis and invasive aspergillus being found in about 12.5% of patients who died of acute respiratory distress syndrome (ARDS) 1.
Factors which Increase Aspergillosis Risk
Many factors can increase risk of invasive Aspergillus infections besides the usual risk factors of cancer, HIV+, and immunosuppressive drugs. Recent research has indicated that such factors as steroid use, pulmonary diseases, respiratory infections like influenza virus or Pseudomonas, malnutrition, and liver failure 1. Medical professionals should have a high suspicion for Aspergillus infections in immunocompromised patients. Tools helpful to diagnose Aspergillosis include chest imagining, biopsies, and serum tests for PCR Aspergillus analysis, galactomannan, and 1-3 β-D-Glucan 1.
Invasive Cryptococcus Rates Increasing
Cryptococcus is a mold (yeast) which often affects HIV+ positive people and can cause life threatening lung and brain infections. In recent years, more patients without immunocompromised conditions are developing life threatening Cryptococcus infections 2. A study at the Peking Union Medical College Hospital between 1998 and 2017 reported that 40 out of 99 patients who had invasive pulmonary cryptococcis did not have any obvious immunocompromising factors 2. A history of frequent alcohol consumption was associated with a higher rate of invasive Cryptococcus infections in immunocompetent patients 2.
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Research and References
1. Tudesq JJ, Peyrony O, Lemiale V, Azoulay E. Invasive Pulmonary Aspergillosis in Nonimmunocompromised Hosts. Seminars in respiratory and critical care medicine. 2019;40(4):540-547.
2. Hou X, Kou L, Han X, Zhu R, Song L, Liu T. Pulmonary cryptococcosis characteristics in immunocompetent patients-A 20-year clinical retrospective analysis in China. Mycoses. 2019;62(10):937-944.