From the lungs and beyond: host-fungal interactions in disseminated aspergillosis.

Invasive aspergillosis most commonly manifests as pulmonary disease. However, in a subset of patients, the fungus disseminates from the lungs to secondary sites of infection. Disseminated disease is associated with markedly worse clinical outcomes than pulmonary infections, underscoring the importance of understanding the biological mechanisms through which Aspergillus can escape from the pulmonary environment. Here, we review the molecular and cellular events that facilitate dissemination of Aspergillus fumigatus, with a focus on interactions at the host-pathogen interface within the vasculature. Additionally, we examine how fungal morphogenesis, adhesion to endothelial surfaces, and penetration of vascular barriers contribute to hematogenous spread. Finally, we highlight areas of open investigation to focus future research efforts.