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Invasive pulmonary aspergillosis (IPA) is a severe opportunistic fungal infection that predominantly affects immunocompromised individuals, including those with hematologic malignancies, organ transplants, and, more recently, patients with post-COVID-19 immune dysregulation. Despite advancements in medical mycology, IPA continues to pose significant diagnostic and therapeutic challenges, contributing to high global morbidity and mortality. Diagnostic accuracy remains limited due to nonspecific clinical manifestations and the suboptimal performance of conventional tools such as bronchoalveolar lavage culture and galactomannan testing. However, recent innovations including polymerase chain reaction-based molecular assays, lateral flow devices, and immuno-positron emission tomography/magnetic resonance imaging offer improved sensitivity, specificity, and speed. Therapeutically, triazoles remain the cornerstone of IPA management, complemented by echinocandins and liposomal amphotericin B in refractory cases. The role of combination therapy and antifungal susceptibility testing is growing in response to rising azole resistance. Additionally, novel antifungal agents and immunotherapeutic approaches are currently under clinical investigation. Effective management of IPA requires a timely, multidisciplinary approach that combines advanced diagnostics with personalized antifungal strategies. Continued research is essential to standardize molecular techniques, refine immunotherapy, and expand access to next-generation antifungals to reduce the global burden of this life-threatening infection. This review aims to synthesize current evidence on the diagnosis and treatment of IPA, critically evaluate the strengths and limitations of existing diagnostic and therapeutic approaches, and explore emerging strategies to enhance clinical outcomes in the context of rising antifungal resistance.
Allergic bronchopulmonary aspergillosis (ABPA) is a severe asthma endotype arising from dysregulated immune responses to Aspergillus fumigatus in susceptible individuals. ABPA is characterized by exaggerated type 2 immune responses, markedly elevated serum total IgE and A. fumigatus-specific IgE and IgG levels, peripheral blood eosinophilia, and imaging abnormalities, including bronchiectasis and mucus impaction. Genetic predisposition involving HLA genotypes and immune-related polymorphisms contributes to disease susceptibility. The 2024 International Society of Human and Animal Mycology guidelines provide standardized criteria that integrate clinical, immunological, and radiological parameters to identify ABPA and distinguish it from overlapping diagnoses. Management employs a dual approach: anti-inflammatory therapy with systemic corticosteroids targets dysregulated immunity, while antifungal therapy with triazoles reduces airway fungal burden. The relapsing-remitting disease course necessitates systematic monitoring using clinical assessment, total IgE levels, and serial imaging to detect relapses, distinguish them from asthma exacerbations or infections, and optimize treatment intensity. Despite substantial progress in understanding the pathobiology of ABPA, high-quality evidence for optimal management strategies remains limited. Future research should focus on precision medicine approaches, novel biomarkers, and inhaled antifungal therapies to improve outcomes in this severe asthma phenotype. This review provides clinicians with comprehensive information on the pathobiology, diagnosis, classification, and evidence-based management strategies for ABPA, aiming to improve outcomes for patients with this severe asthma endotype.
Prolonged exposure to microgravity profoundly influences ocular physiology, giving rise to spaceflight-associated neuro-ocular syndrome (SANS), a significant concern for astronauts on long-duration missions. This review consolidates current evidence on ocular adaptations to spaceflight, encompassing pathophysiological mechanisms, diagnostic advances, related ocular conditions, and emerging countermeasures. Literature published between 2000 and 2025 was systematically examined across PubMed, Scopus, and Web of Science, integrating both peer-reviewed studies and technical reports from the National Aeronautics and Space Administration and the European Space Agency. Findings indicate that ocular changes consistent with SANS affect approximately one-third of astronauts, with higher prevalence during missions exceeding six months. Hallmark features include optic disc edema, posterior globe flattening, and mild hyperopic shifts, attributed to cephalad fluid shifts, altered cerebrospinal fluid dynamics, venous congestion, and impaired glymphatic flow. Besides SANS, microgravity predisposes astronauts to dry eye disease, immune-related infections, and radiation-induced cataracts. Recent advances in in-flight optical coherence tomography, optical coherence tomography angiography, and ultrasound have enhanced early detection, while countermeasures such as lower body negative pressure, artificial gravity, and artificial intelligence-driven ocular monitoring show promise. Understanding ocular adaptations to space not only mitigates mission risks but also enriches terrestrial knowledge of intracranial pressure regulation and neuro-ophthalmic health.
Extracorporeal carbon dioxide removal (ECCO₂R) has emerged as a supportive therapy for patients with acute respiratory failure, particularly when refractory hypercapnia and respiratory acidosis persist despite standard management. This narrative review summarizes the physiological rationale, current evidence, and clinical applications of ECCO₂R in modern critical care practice. ECCO₂R removes carbon dioxide directly from the bloodstream, thereby facilitating lung-protective ventilation strategies and potentially reducing ventilator-induced lung injury. The technique has been primarily evaluated in patients with acute respiratory distress syndrome (ARDS) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD). In these settings, ECCO₂R may enable the use of lower tidal volumes and reduced airway pressures, and in selected patients, it may decrease the need for invasive mechanical ventilation. Although ECCO₂R has been shown to improve carbon dioxide clearance, correct respiratory acidosis, and optimize ventilatory parameters, randomized trials have not demonstrated a definitive mortality benefit. Its clinical application is also limited by device-related complications, including bleeding, thrombosis, and hemolysis. Furthermore, outcomes are influenced by technical factors such as cannula configuration, blood flow rate, membrane efficiency, and anticoagulation strategy. Ongoing technological advancements and well-designed clinical trials are needed to better define the role of ECCO₂R in contemporary critical care practice.
