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The basics

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. One study calculated that 2.5% of adults who have asthma also have ABPA, which is approximately 4.8 million people worldwide. Of these 4.8 million people who have ABPA, an estimated 400,000 also have chronic pulmonary aspergillosis (CPA). Another 1.2 million people are estimated to have CPA after having tuberculosis, and over 70,000 people are estimated to have CPA as a complication of sarcoidosis.

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. 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. Nearly 15,000 aspergillosis-associated hospitalizations occurred in the United States in 2014, at an estimated cost of $1.2 billion.

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 recipients and was the second-most common type of fungal infection among solid organ transplant recipients. 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.

Aspergillosis outbreaks

Most cases of aspergillosis are sporadic and are not part of an outbreak. Invasive aspergillosis outbreaks often occur with hospital construction or renovation, which can increase the amount of airborne Aspergillus. Outbreaks can also result from the use of contaminated medical devices.

Deaths due to aspergillosis

Although invasive aspergillosis is not common, it is a serious infection and can cause death 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 recipients and 25% among stem cell transplant recipients. 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.

Allergic bronchopulmonary aspergillosis (ABPA) and allergic Aspergillus sinusitis are generally not life-threatening.