Sometimes Aspergillus species are opportunistic pathogens causing frank mycosis. These mycoses are collectively called invasive aspergillosis and are usually classified by the portal of entry. Invasive pulmonary aspergillosis is typically manifested as acute pneumonia. Nonpulmonary portals of entry include the eye, paranasal sinus, or gastrointestinal tract or may be associated with vascular surgery and drug addiction. Invasive aspergillosis is largely a disease of a compromised host. Those at high risk include patients with diabetes, drug addicts, chronically ill patients, transplant patients receiving immunosuppressive drugs, and cancer patients receiving chemotherapy. Occupational exposure is also a factor. Historically, the earliest reports of aspergillosis were among wig cleaners and pigeon fanciers.
Aspergillus fumigatus and A. flavus are the most common species associated with invasive and noninvasive as-pergillosis. It is hypothesized that these species possess special virulence factors that facilitate their role as opportunistic pathogens.
Invasive disease is treated with antifungal chemotherapy, but existing antimycotic drugs have toxic side effects, and the therapeutic outcome is often poor. As the use of immunosuppressive drugs increases in modern medicine, invasive aspergillosis is becoming more common. There is an important need for effective systemic antifungal drugs. Several pharmaceutical companies have active drug discovery programs in this area.
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