The genus Aspergillus contains about 180 validly described saprophytic species. Nearly 10 percent of these species can cause a wide spectrum of infectious disease including life threatening invasive aspergillosis, colonization of the sinus and respiratory organs as well as allergic diseases. Cases of life threatening invasive aspergillosis have been steadily rising throughout the world. While prophylactic antifungal drugs have reduced the mortality due to invasive aspergillosis in immunosuppressed and immunodeficient patients, the overall case fatality rate remains well above 50% making it one of the most difficult microbial diseases to manage. A. fumigatus is by far the most common cause of invasive aspergillosis regardless of the underlying conditions of patients. Old concepts regarding the identification of Aspergillus species have strictly been based on morphological characteristics which have often been problematic due to their variability. The new classification concept employs phenotypic characteristics with multigene DNA sequences. The new method allowed differentiation of genetically distinct but morphologically similar sister species of A. fumigatus. The recently described A. lentinus is one such example which had previously been identified as A. fumigatus. Clinical diagnosis of invasive aspergillosis without waiting for isolation of culture has also made significant progress during the past 10 years. This lecture will focus on recent developments in the diagnosis of aspergillosis and the biological characteristics of A. fumigatus which renders it to be the primary cause of invasive aspergillosis.
Aspergillosis* ; Aspergillus* ; Base Sequence ; Classification ; Colon ; Communicable Diseases ; Diagnosis ; Humans ; Lentinula ; Mortality ; Population Characteristics ; Siblings

BACKGROUND/AIMS: Since patients with human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) have favorable outcomes after treatment, treatment de-escalation for these patients is being actively investigated. However, not all HPV-positive HNSCCs are curable, and some patients have a poor prognosis. The purpose of this study was to identify poor prognostic factors in patients with HPV-positive HNSCC. METHODS: Patients who received a diagnosis of HNSCC and tested positive for HPV from 2000 to 2015 at a single hospital site (n = 152) were included in this retrospective analysis. HPV typing was conducted using the HPV DNA chip assay or liquid bead microarray system. Expression of p16 in the tumors was assessed by immunohistochemistry. To determine candidate factors associated with overall survival (OS), univariate and multivariable Cox regression analyses were performed. RESULTS: A total of 152 patients with HPV-positive HNSCC were included in this study; 82.2% were male, 43.4% were current or former smokers, and 84.2% had oropharyngeal cancer. By univariate analysis, old age, performance status ≥ 1, non-oropharyngeal location, advanced T classification (T3–4), and HPV genotype 18 were significantly associated with poor OS. By multivariable analysis, performance status ≥ 1 and non-oropharyngeal location were independently associated with shorter OS (hazard ratio [HR], 4.36, p = 0.015; HR, 11.83, p = 0.002, respectively). Furthermore, HPV genotype 18 positivity was also an independent poor prognostic factor of OS (HR, 10.87, p < 0.001). CONCLUSIONS Non-oropharyngeal cancer, poor performance status, and HPV genotype 18 were independent poor prognostic factors in patients with HPV-positive HNSCC. Patients with these risk factors might not be candidates for de-escalation treatment.