Emergence of Aspergillus terreus as a Notable Fungal Pathogen of Human and Animal Health

Dhwani Upadhyay¹, Prasad Andhare¹ and Mahendra Pal^2,

¹Department of Life Sciences, School of Sciences, GSFC University, Vadodara, Gujarat, India

²Narayan Consultancy of Veterinary Public Health and Microbiology, Bharuch, Gujarat, India

Cite this paper:
Dhwani Upadhyay, Prasad Andhare and Mahendra Pal. Emergence of Aspergillus terreus as a Notable Fungal Pathogen of Human and Animal Health. American Journal of Microbiological Research. 2025; 13(3):38-44. doi: 10.12691/ajmr-13-3-1

Abstract

Aspergillus terreus, historically considered an environmental saprophyte, is now known to be an important opportunistic pathogen in human and veterinary medicine. Its increasing occurrence, particularly in immunocompromised individuals, emphasises its clinical relevance. Importantly, A. terreus demonstrates inherent resistance to the key antifungal, amphotericin B, which further complicates treatment options and is associated with increased morbidity and mortality. The virulence of the pathogen is enhanced by its production of various mycotoxins, another type of secondary metabolite that may alter host–pathogen interactions, and statins. Here, we review the current understanding of the taxonomy, ecology, and pathogenicity of A. terreus and its specific morphologic characteristics and resistance profiles. We explored their transmission dynamics, highlighting their environmental reservoirs and possible zoonotic routes. Infections caused by this fungus can cause a variety of clinical manifestations, from superficial to invasive diseases; therefore, a high index of suspicion is required to make a diagnosis. The phenotypic diversity of the organism along with traditional identification methods is a challenge for diagnosis." Therapeutically, the resistance of A. terreus to amphotericin B requires alternative antifungal regimens, with voriconazole and posaconazole demonstrating variable activity. This review further discusses breakthroughs in diagnostic modalities and therapeutic approaches with the potential to improve patient outcomes. We also highlight preventive strategies, such as environmental control and infection surveillance, to reduce the risk of A. terreus infection. This review intends to bring together the current knowledge and offer valuable insights related to the emerging pathogen A. terreus and its clinical importance.

Keywords:
Antifungal resistance Aspergillus terreus Emerging fungal pathogen Invasive aspergillosis Public health

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References:

[1]	Samson, R.A., Visagie, C.M., Houbraken, J., Hong, S.B., Hubka, V., Klaassen, C.H., Perrone, G., Seifert, K.A., Susca, A., Tanney, J.B. and Varga, J. “Phylogeny, identification and nomenclature of the genus Aspergillus”. Studies in Mycology, 78 (1).141-173, 2014.
[2]	Lass‐Flörl, C. “The changing face of epidemiology of invasive fungal disease in Europe”. Mycoses, 52 (3). 197-205, 2009.
[3]	Sabino, R. “Aspergillus and health”. Microorganisms, 10 (3). 538, 2022.
[4]	Ijadpanahsaravi, M., Teertstra, W. R., & Wösten, H. A. “Inter-and intra-species heterogeneity in germination of Aspergillus conidia”. Antonie Van Leeuwenhoek, 115 (9). 1151-1164, 2022.
[5]	Steenwyk, J.L., Balamurugan, C., Raja, H.A., Gonçalves, C., Li, N., Martin, F., Berman, J., Oberlies, N.H., Gibbons, J.G., Goldman, G.H. and Geiser, D.M., “Phylogenomics reveals extensive misidentification of fungal strains from the genus Aspergillus”. Microbiology Spectrum, 12 (4). 03980-23, 2024.
[6]	Pal M., and Torres-Rodriquez J. M. “Aspergillus flavus as cause of
[7]	pulmonary aspergillosis in an occupational worker”. Revista
[8]	Iberoamericana de Micologia. 7. 487-488, 1990.
[9]	Pal M., Tesfaye S., and Mekonnen G. A. “Aspergillosis: An important fatal mycotic disease of chicks”. International Journal of Livestock Research, 2. 69-73, 2012.
[10]	Dave P., Raj M., and Pal M. “Etiologic significance of Aspergillus terreus in primary cutaneous mycosis of an agricultural worker”. Molecular Microbiology Research, 5 (2). 1-4, 2015.
[11]	Garcia-Rubio, R., de Oliveira, H.C., Rivera, J. and Trevijano-Contador, N. “The fungal cell wall: Candida, Cryptococcus, and Aspergillus species”. Frontiers in Microbiology, 10. 2993, 2020.
[12]	Balajee, S.A., Nickle, D., Varga, J. and Marr, K.A. “Molecular studies reveal frequent misidentification of Aspergillus fumigatus by morphotyping”. Eukaryotic Cell, 5(10). pp.1705-1712, 2006.
[13]	De Carolis, E., Posteraro, B., Lass-Flörl, C., Vella, A., Florio, A.R., Torelli, R., Girmenia, C., Colozza, C., Tortorano, A.M., Sanguinetti, M. and Fadda, G. “Species identification of Aspergillus, Fusarium and Mucorales with direct surface analysis by matrix-assisted laser desorption ionization time-of-flight mass spectrometry”. Clinical Microbiology and Infection, 18 (5). 475-484, 2012.
[14]	Chabi, M.L., Goracci, A., Roche, N., Paugam, A., Lupo, A. and Revel, M.P. “Pulmonary aspergillosis”. Diagnostic and interventional imaging, 96(5). pp. 435-442, 2015.
[15]	Lass-Flörl, C., Dietl, A.M., Kontoyiannis, D.P. and Brock, M. “Aspergillus terreus species complex”. Clinical Microbiology Reviews, 34 (4). pp. e00311-20, 2021.
[16]	Lass‐Flörl, C., Griff, K., Mayr, A., Petzer, A., Gastl, G., Bonatti, H., Freund, M., Kropshofer, G., Dierich, M.P. and Nachbaur, D. “Epidemiology and outcome of infections due to Aspergillus terreus: 10‐year single centre experience”. British Journal of Haematology, 131(2).201-207, 2005.
[17]	Baddley, J.W., Pappas, P.G., Smith, A.C. and Moser, S.A. “Epidemiology of Aspergillus terreus at a university hospital”. Journal of Clinical Microbiology, 41 (12).5525-5529, 2003.
[18]	Kabay, M.J., Robinson, W.F., Huxtable, C.R.R. and McAleer, R. “The pathology of disseminated Aspergillus terreus infection in dogs”. Veterinary Pathology, 22(6). 540-547, 1985.
[19]	de Melo, W.C.M.A., Scorzoni, L., Rossi, S.A., Costa-Orlandi, C.B. and Yonashiro, M. “Update on Fungal Disease: From Establish Infection to Clinical Manifestation”. Journal of Biotechnology and Biomaterials, 7 (273) p.2., 2017.
[20]	Hachem, R.Y., Kontoyiannis, D.P., Boktour, M.R., Afif, C., Cooksley, C., Bodey, G.P., Chatzinikolaou, I., Perego, C., Kantarjian, H.M. and Raad, I.I. “Aspergillus terreus: an emerging amphotericin B–resistant opportunistic mold in patients with hematologic malignancies”. Cancer, 101(7). pp. 1594-1600, 2004.
[21]	Alastruey-Izquierdo, A., Mellado, E., Peláez, T., Pemán, J., Zapico, S., Alvarez, M., Rodríguez-Tudela, J.L., Cuenca-Estrella, M. and FILPOP Study Group. “Population-based survey of filamentous fungi and antifungal resistance in Spain (FILPOP Study). Antimicrobial Agents and Chemotherapy, 57(7). 3380-3387, 2013.
[22]	Lass-Flörl, C., Rath, P.M., Niederwieser, D., Kofler, G., Würzner, R., Krezy, A. and Dierich, M.P. “Aspergillus terreus infections in haematological malignancies: molecular epidemiology suggests association with in-hospital plants”. Journal of Hospital Infection, 46 (1). 31-35, 2000.
[23]	Seyedmousavi, S., Guillot, J., Arné, P., De Hoog, G.S., Mouton, J.W., Melchers, W.J. and Verweij, P.E. “Aspergillus and aspergilloses in wild and domestic animals: a global health concern with parallels to human disease”. Medical Mycology, 53(8). 765-797, 2015.
[24]	Lass-Flörl C, Rath PM, Niederwieser D, Kofler G, Würzner R, Krezy A, Dierich MP. “Aspergillus terreus infections in haematological malignancies: molecular epidemiology suggests association with in-hospital plants”. Journal of Hospital Infection, 1;46 (1). 31-5, 2000.
[25]	Kousha M, Tadi R, Soubani AO. “Pulmonary aspergillosis: a clinical review”. European Respiratory Review, 20(121).156-74, 2011.
[26]	Baddley JW, Marr KA, Andes DR, Walsh TJ, Kauffman CA, Kontoyiannis DP, Ito JI, Balajee SA, Pappas PG, Moser SA. “Patterns of susceptibility of Aspergillus isolates recovered from patients enrolled in the Transplant-Associated Infection Surveillance Network”. Journal of Clinical Microbiology, 47(10). 3271-5, 2009.
[27]	Perfect JR. “Fungal diagnosis: how do we do it and can we do better?”. Current Medical Research and Opinion, 1 (29). 3-11, 2013.
[28]	Pal M. “Disseminated Aspergillus terreus infection in a caged pigeon”. Mycopathologia, 119. 137-9, 1992.
[29]	Sharman MJ, Mansfield CS. “Sinonasal aspergillosis in dogs: a review”. Journal of Small Animal Practice, 53(8). 434-44, 2012.
[30]	Heilmann RM, Nabity MB, Bryan LK, Cook AK, Scott K. “Mucocutaneous nasal histoplasmosis in an immunocompetent dog”. BMC Veterinary Research, 17(1). 192, 2021.
[31]	Nucci M, Queiroz-Telles F, Tobón AM, Restrepo A, Colombo AL. “Epidemiology of opportunistic fungal infections in Latin America”. Clinical Infectious Diseases, 51(5). 561-70, 2010.
[32]	Dave P, Mahendra R, Pal M. “Etiologic significance of Aspergillus terreus in primary cutaneous mycosis of an agricultural worker”. Molecular Microbiology Research, 17 (5). 2015.
[33]	Hope WW, Walsh TJ, Denning DW. “Laboratory diagnosis of invasive aspergillosis”. The Lancet Infectious Diseases, 5 (10). 609-22, 2005.
[34]	Upton A, Kirby KA, Carpenter P, Boeckh M, Marr KA. “Invasive aspergillosis following hematopoietic cell transplantation: outcomes and prognostic factors associated with mortality”. Clinical Infectious Diseases, 44 (4). 531-40, 2004.
[35]	Pfeiffer CD, Fine JP, Safdar N. “Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis”. Clinical Infectious Diseases, 42 (10).1417-727, 2006.
[36]	De Carolis E, Vella A, Vaccaro L, Torelli R, Spanu T, Fiori B, Posteraro B, Sanguinetti M. “Application of MALDI-TOF mass spectrometry in clinical diagnostic microbiology”. Journal of Infection in Developing Countries, 8 (09). 1081-8, 2014.
[37]	Vashist SK, Luong JH, Vashist SK, Luong JH. ‘An overview of point-of-care technologies enabling next-generation healthcare monitoring and management”. Springer International Publishing; 2019.
[38]	Blum G, Perkhofer S, Haas H, Schrettl M, Würzner R, Dierich MP, Lass-Flörl C. “Potential basis for amphotericin B resistance in Aspergillus terreus”. Antimicrobial Agents and Chemotherapy. 52(4). 1553-5, 2008.
[39]	Bastos RW, Valero C, Silva LP, Schoen T, Drott M, Brauer V, Silva-Rocha R, Lind A, Steenwyk JL, Rokas A, Rodrigues F. “Functional characterization of clinical isolates of the opportunistic fungal pathogen Aspergillus nidulans. Msphere, 5 (2). 10-128, 2019.
[40]	Tan K, Kim J, Lee Y, Kim W, Lee D, Lee Y. “ROS defense mechanisms and amphotericin B resistance in Aspergillus terreus”. Front Microbiol, 10. 1185, 2019.
[41]	Herbrecht R, Patterson TF, Slavin MA, Marchetti O, Maertens J, Johnson EM, Schlamm HT, Donnelly JP, Pappas PG. “Application of the 2008 definitions for invasive fungal diseases to the trial comparing voriconazole versus amphotericin B for therapy of invasive aspergillosis: a collaborative study of the Mycoses Study Group (MSG 05) and the European Organization for Research and Treatment of Cancer Infectious Diseases Group”. Clinical Infectious Diseases, 60 (5). 713-20-2015.
[42]	Copley MS, Waldron M, Athans V, Welch SC, Brizendine KD, Cober E, Siebenaller C. “Itraconazole vs. posaconazole for antifungal prophylaxis in patients with acute myeloid leukemia undergoing intensive chemotherapy: a retrospective study”. International Journal of Antimicrobial Agents, 55 (3).105886, 2020.
[43]	Devanlay C, Tavernier-Tardy E, Bourmaud A, Falk A, Raberin H, Menguy S, Guyotat D, Magné N, Cornillon J. “Impact of fluconazole versus posaconazole prophylaxis on the incidence of fungal infections in patients receiving induction chemotherapy for acute myeloid leukemia”. Biomedical Journal, 38 (3). 2015.
[44]	Cornet M, Levy V, Fleury L, Lortholary J, Barquins S, Coureul MH, Deliere E, Zittoun R, Brücker G, Bouvet A. “Efficacy of prevention by high-efficiency particulate air filtration or laminar airflow against Aspergillus airborne contamination during hospital renovation”. Infection Control and Hospital Epidemiology, 20 (7). 508-13, 1999.
[45]	Ghodsi S, Nikaeen M, Aboutalebian S, Mohammadi R, Mirhendi H. “Prevalence of fungi and their antifungal and disinfectant resistance in hospital environments: insights into combating nosocomial mycoses”. Antimicrobial Resistance and Infection Control, 14(1). 37, 2025.
[46]	Mareković I. “What’s new in prevention of invasive fungal diseases during hospital construction and renovation work: an overview”. Journal of Fungi, 9(2):151, 2023.
[47]	Barrs VR, Talbot JJ. “Feline aspergillosis”. Veterinary Clinics: Small Animal Practice, 44 (1). 51-73, 2014.
[48]	Johnson L, editor. “Canine and Feline Respiratory Medicine, An Issue of Veterinary Clinics of North America: Small Animal Practice”. Elsevier Health Sciences, 28. 2020.
[49]	Weatherly C, Carag J, Zohdy S, Morrison M. “The mental health impacts of human-ecosystem-animal relationships: A systematic scoping review of Eco-, Planetary, and One Health approaches”. One Health. 17. 100621, 2023.