Chronic pulmonary aspergillosis in Taiwan: Disease burden, diagnosis, treatment, and outcomes

Aspergillus is a common filamentous fungus found in various natural environments, with spores frequently inhaled by humans. While healthy individuals typically resist infection, immunocompromised individuals and those with pre-existing lung diseases are at higher risk for aspergillosis. Chronic pulmonary aspergillosis (CPA) often develops in individuals with conditions like tuberculosis and chronic obstructive pulmonary disease. Recent studies in Taiwan reveal a significant incidence of CPA among elderly patients with these underlying conditions. The most common clinical manifestations include cavitation, nodules, and consolidation in the lungs. Aspergillus-specific IgG antibodies have emerged as key diagnostic markers, with varying optimal cut-off values across different regions. Studies indicate a strong correlation between high IgG levels and severe CPA, alongside associations with specific radiographic features. Additionally, elevated inflammatory markers such as IL-1β and TNF-α are linked to poor outcomes, emphasizing the need for early detection and intervention. The preferred treatment regimen consists of itraconazole, voriconazole, posaconazole, and isavuconazole, with itraconazole and voriconazole being the most extensively documented in the context of CPA. Overall, this review underscores the importance of localized diagnostic validation and comprehensive studies to improve the understanding and treatment of CPA in Taiwan.