Because aspergillosis is not a reportable infection in the United States, the exact number of cases is difficult to determine. Milder, allergic forms of aspergillosis are more common than the invasive form of the infection.
Allergic bronchopulmonary aspergillosis (ABPA) likely affects between 1 and 15% of cystic fibrosis patients.1 One study calculated that 2.5% of adults who have asthma also have ABPA, which is approximately 4.8 million people worldwide.2 Of these 4.8 million people who have ABPA, an estimated 400,000 also have chronic pulmonary aspergillosis (CPA).2 Another 1.2 million people are estimated to have CPA after having tuberculosis,3 and over 70,000 people are estimated to have CPA as a complication of sarcoidosis.4
Invasive aspergillosis is uncommon and occurs primarily in immunocompromised people. The first population-based incidence estimates for invasive aspergillosis were obtained from laboratory surveillance conducted in the San Francisco Bay Area during 1992-1993 and suggested a yearly rate of 1 to 2 cases of aspergillosis per 100,000 population.5 However, the epidemiology of invasive Aspergillus infections has likely shifted since this time due to the increasing number of solid organ and stem cell transplant recipients and newer immunosuppressive agents. The number of hospitalizations related to invasive aspergillosis in the United States increased an average of 3% per year during 2000- 2013. 6 Nearly 15,000 aspergillosis-associated hospitalizations occurred in the United States in 2014, at an estimated cost of $1.2 billion.7
Prospective surveillance among transplant recipients performed during 2001-2006 found that invasive aspergillosis was the most common type of fungal infection among stem cell transplant recipients8 and was the second-most common type of fungal infection among solid organ transplant recipients.9 In a broad US healthcare network of intensive care unit autopsy studies, aspergillosis was one of the top four most common diagnoses that likely lead to death.10
Although most cases of aspergillosis are sporadic (not part of an outbreak), outbreaks of invasive aspergillosis occasionally occur in hospitalized patients. Invasive aspergillosis outbreaks are often found to be associated with hospital construction or renovation, which can increase the amount of airborne Aspergillus, resulting in respiratory infections or surgical site infections in high-risk patients.12,13 Outbreaks of primary cutaneous aspergillosis and central nervous system aspergillosis in association with the use of contaminated medical devices have also been described.14, 15 The incubation period for aspergillosis is unclear and likely varies depending on the dose of Aspergillus and the host immune response.
Allergic forms of aspergillosis such as allergic bronchopulmonary aspergillosis (ABPA) and allergic Aspergillus sinusitis are generally not life-threatening.
In contrast, although invasive aspergillosis is uncommon, it is a serious infection and can be a major cause of mortality in immunocompromised patients. For example, a large prospective study found that the one-year survival for people who had invasive aspergillosis was 59% among solid organ transplant recipients10 and 25% among stem cell transplant recipients.8 In a systematic review of intensive care unit autopsy studies, aspergillosis was one of the top four most common diagnoses that likely lead to death.11
- Stevens DA, Moss RB, Kurup VP, Knutsen AP, Greenberger P, Judson MA, et al. Allergic bronchopulmonary aspergillosis in cystic fibrosis–state of the art: Cystic Fibrosis Foundation Consensus Conference. Clin Infect Dis. 2003 Oct 1;37 Suppl 3:S225-64.
- Denning DW, Pleuvry A, Cole DC. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol. 2013 May;51(4):361-70.
- Denning DW, Pleuvry A, Cole DC. Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ. 2011 Dec 1;89(12):864-72.
- Denning DW, Pleuvry A, Cole DC. Global burden of chronic pulmonary aspergillosis complicating sarcoidosis. Eur Respir J. 2013 Mar;41(3):621-6.
- Rees JR, Pinner RW, Hajjeh RA, Brandt ME, Reingold AL. The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992-1993: results of population-based laboratory active surveillance. Clin Infect Dis. 1998 Nov;27(5):1138-47.
- Vallabhaneni S, Benedict K, Derado G, Mody RK. Trends in Hospitalizations Related to Invasive Aspergillosis and Mucormycosis in the United States, 2000-2013. Open Forum Infect Dis. 2017 Winter;4(1):ofw268.
- Benedict K, Jackson BR, Chiller T, Beer KD. Estimation of direct healthcare costs of fungal diseases in the United States. Clin Infect Dis. 2018 Sep 10.
- Kontoyiannis DP, Marr KA, Park BJ, Alexander BD, Anaissie EJ, Walsh TJ, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis. 2010 Apr 15;50(8):1091-100.
- Pappas PG, Alexander BD, Andes DR, Hadley S, Kauffman CA, Freifeld A, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis. 2010 Apr 15;50(8):1101-11.
- Webb BJ, Ferraro JP, Rea S, Kaufusi S, Goodman BE, Spalding J. Epidemiology and Clinical Features of Invasive Fungal Infection in a US Health Care Network. Open Forum Infect Dis 2018 Jul 31;5(8):ofy187.
- Winters B, et al. Diagnostic errors in the intensive care unit: a systematic review of autopsy studies. BMJ Qual Saf. 2012 Nov;21(11):894-902.
- Weber DJ et al. Preventing healthcare-associated Aspergillus infections: a review of recent CDC/HICPAC recommendations. Med Mycol 2009; 47S1: S199-209
- Vonberg RP, Gastmeier P. Nosocomial aspergillosis in outbreak settings. J Hosp Infect. 2006 Jul;63(3):246-54.
- Allo MD, Miller J, Townsend T, Tan C. Primary cutaneous aspergillosis associated with Hickman intravenous catheters. N Engl J Med. 1987 Oct 29;317(18):1105-8.
- Gunaratne PS, Wijeyaratne CN, Seneviratne HR. Aspergillus meningitis in Sri Lanka–a post-tsunami effect? N Engl J Med. 2007 Feb 15;356(7):754-6.