Distribution of Aspergillus species and risk factors for aspergillosis in mainland China: a systematic review

Background: Aspergillus, a widespread fungus in the natural environment, poses a significant threat to human health by entering the human body via the airways and causing a disease called aspergillosis. This study comprehensively analyzed data on aspergillosis in published articles from mainland China to investigate the prevalence of Aspergillus, and risk factors, mortality rate, and underlying condition associated with aspergillosis. Methods: Published articles were retrieved from Google Scholar, PubMed, and Science Direct online search engines. In the 101 analyzed studies, 3558 Aspergillus isolates were meticulously collected and classified. GraphPad Prism 8 was used to statistically examine the epidemiology and clinical characteristics of aspergillosis. Results: Aspergillus fumigatus was prominently reported ( n = 2679, 75.14%), followed by A. flavus ( n = 437, 12.25%), A. niger ( n = 219, 6.14%), and A. terreus ( n = 119, 3.33%). Of a total of 9810 patients, 7513 probable cases accounted for the highest number, followed by confirmed cases ( n = 1956) and possible cases ( n = 341). In patients, cough emerged as the most common complaint ( n = 1819, 18.54%), followed by asthma ( n = 1029, 10.48%) and fever (1024, 10.44%). Of total studies, invasive pulmonary aspergillosis (IPA) was reported in 47 (45.53%) studies, exhibiting an increased prevalence in Beijing ( n = 12, 25.53%), Guangdong ( n = 7, 14.89%), and Shanghai ( n = 6, 12.76%). Chronic pulmonary aspergillosis (CPA) was reported in 14 (13.86%) studies. Among the total of 14 studies, the occurrence of CPA was 5 (35.71%) in Beijing and 3 (21.42%) in Shanghai. Allergic bronchopulmonary aspergillosis (ABPA), was reported at a lower frequency ( n = 8, 7.92%), Guangdong recorded a relatively high number ( n = 3, 37.5%), followed by Beijing ( n = 2, 25.0%), and Shanghai ( n = 1, 12.5%). Percentage of death reported: IPA had the highest rate ( n = 447, 68.87%), followed by CPA ( n = 181, 27.88%) and ABPA ( n = 14, 2.15%). Among the aspergillosis patients, 6220 had underlying conditions, including chronic lung disease ( n = 3765, 60.53%), previous tuberculosis ( n = 416, 6.68%), and organ transplant or organ failure ( n = 648, 10.41%). Aspergillosis was also found in patients using corticosteroid therapy ( n = 622, 10.0%). Conclusion: This review sheds light on the prevalence patterns of Aspergillus species, risk factors of aspergillosis, and gaps in surveillance that could be helpful for the control and treatment of aspergillosis and guide the researchers in future studies. Registration: This systematic review was prospectively registered on PROSPERO: Registration ID CRD42023476870.