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曲霉病:发病机制、耐药性及新兴治疗方法的全面综述

Aspergillosis: A comprehensive review of pathogenesis, drug resistance, and emerging therapeutics.

作者信息

Singh Amanpreet, Singh Jeewanjot, Kumar Sandeep

机构信息

Department of Pharmaceutics, Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College of Pharmacy, Bela, Ropar, 140111, Punjab, India.

Department of Pharmacology, Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College of Pharmacy, Bela, Ropar, 140111, Punjab, India.

出版信息

J Food Drug Anal. 2025 Jun 13;33(2):75-96. doi: 10.38212/2224-6614.3547.

Abstract

Aspergillosis stands as a primary opportunistic fungal infection which mainly results from Aspergillus fumigatus events that have gained more importance because of its multiple infection patterns and developing antifungal resistance. Healthcare providers identify two main ends of the aspergillosis spectrum which include allergic responses and invasive systemic infections that affect mainly immunocompromised subjects. This review presents a detailed summary for understanding the epidemiology of aspergillosis along with its risk factors as well as pathogenesis and host immune response and diagnostic difficulties. The analysis puts significant weight on increasing azole and echinocandin resistance that has become worse because of agricultural and environmental azole exposure and the development of multidrug-resistant strains. The mechanisms of action and restrictions together with resistance profiles differentiate different antifungal treatments like azoles and echinocandins in addition to polyenes from each other. The potential therapeutic benefits of using combination therapy with drug delivery targeting systems and developing new antifungal agents including rezafungin and ibrexafungerp are assessed. The review emphasizes relevant interactions between drugs when used together with food elements which affect antifungal safety and effectiveness specifically in patients with complex healthcare needs. The review analyzes newly developed diagnostic methods including PCR-based tests and biomarkers for their capability of improving fast and precise detection. The review presents immunomodulatory therapies as well as host-directed strategies which represent a set of emerging approaches. The clinical presentation of aspergillosis varies widely which case studies help doctors to understand better. Comprehensive management of aspergillosis necessitates cooperative medical care and precise medicinal interventions alongside continuous diagnostics improvements to achieve solutions for the worldwide health issue.

摘要

曲霉病是一种主要的机会性真菌感染,主要由烟曲霉引起。由于其多种感染模式和不断发展的抗真菌耐药性,烟曲霉感染变得更加重要。医疗保健提供者确定了曲霉病谱的两个主要端点,包括过敏反应和侵袭性全身感染,主要影响免疫功能低下的患者。本综述详细总结了曲霉病的流行病学、危险因素、发病机制、宿主免疫反应以及诊断困难。分析着重指出,由于农业和环境中唑类药物的暴露以及多重耐药菌株的出现,唑类和棘白菌素耐药性不断增加,情况日益恶化。除了多烯类药物外,唑类和棘白菌素等不同抗真菌治疗药物的作用机制、限制因素以及耐药情况各不相同。评估了使用联合治疗与药物递送靶向系统以及开发包括瑞扎芬净和依布列净在内的新型抗真菌药物的潜在治疗益处。该综述强调了药物与食物成分一起使用时的相关相互作用,这尤其会影响有复杂医疗需求患者的抗真菌安全性和有效性。该综述分析了新开发的诊断方法,包括基于PCR的检测方法和生物标志物,因其具有提高快速精确检测的能力。该综述介绍了免疫调节疗法以及宿主导向策略,这些都是一系列新兴方法。曲霉病的临床表现差异很大,病例研究有助于医生更好地理解。曲霉病的综合管理需要合作医疗护理、精确的药物干预以及持续改进诊断,以解决这一全球健康问题。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a605/12213175/7b6b269a09a8/jfda-33-02-075f1.jpg

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