S10.4b Pathophysiology, diagnosis, and management of chronic pulmonary Aspergillosis

Abstract

S10.4 Emerging antifungal resistant fungi, September 24, 2022, 10:30 AM – 12:00 PM Chronic pulmonary Aspergillosis (CPA) is a complex disease that is difficult to diagnose and resistant to treatment. Many cases are missed and have unfortunate outcomes in clinical settings. Although CPA has long been classified into several types based on pathological findings, it is not always possible to make a pathological diagnosis in all cases, so a clinical diagnosis is often made. In addition, many have an underlying respiratory disease and complications by infections caused by other microorganisms, making treatment further difficult. The diagnosis of CPA requires clinical symptoms and findings, radiological, serological, pathological, and microbiological approaches, and standardization of these diagnostic criteria is challenging. The mainstay of treatment is outpatient oral therapy with azoles, and indications and therapeutic evidence for echinocandins, and polyenes are limited. The development of novel antifungals with different mechanisms of action from conventional agents is also awaited. Azole-resistance of Aspergillus caused by long-term treatment is also an issue. It has been reported that resistant strains have been found in CPA patients treated with long-term azole therapy, mutations in the cyp51A and others have also been identified and longer exposure to azoles are correlated with higher MIC values of them. This presentation will focus on epidemiology, pathogenesis, diagnosis, and management including drug resistance in CPA patients.