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.