Aspergillosis

Publication Date: July 25, 2016

Key Points

Key Points

Aspergillus species continue to be an important cause of life-threatening infection in immunocompromised patients. This at-risk population is comprised of patients with prolonged neutropenia, allogeneic hematopoietic stem cell transplant (HSCT), solid-organ transplantation (SOT), inherited or acquired immunodeficiencies, corticosteroid use, and others.

Additionally, chronic and allergic syndromes due to Aspergillus are recognized to affect an even greater number of additional patients.

New agents and formulations along with recent studies of the use of older agents are now available for treating patients with these infections, and new diagnostic tools have increased the ability to diagnose these infections in a timely manner.

Epidemiology and Risk Factors

Epidemiology and Risk...

...italized allogeneic HSCT recipients should...


...autions can be reasonably applied to other...


...tals in which a protected environment is...


...IDSA recommends reasonable precautions t...


...and transplant centers should perform regular surv...


Prophylaxis

...rophylaxi...

...mmends prophylaxis with posaconazole, ( S ,...

...onazole, ( S , M)70...

...fungin ( W , L)705...

...onged neutropenia for those who are...

...xis with caspofungin is also probably effectiv...

...ith itraconazole is effective, but t...

...ld not be co-administered with other agents...


...s. Host Disease (GVHD)...

...commends prophylaxis with posaconazole fo...

...axis with other mold-active azoles is al...

...axis with itraconazole is limited by tolerability...

...he IDSA recommends continuation of antifungal p...


...Transplant

...recommends antifungal prophylaxis with eit...

...c voriconazole or itraconazole is sugge...

...e IDSA recommends reinitiating antifungal p...


...Solid Organ Transplant...

...IDSA recommends prophylactic strategies in s...


Diagnosis

Diagnos...

...lecular tools are more widely used in clinical lab...


...search in the area continues, the IDSA recom...


Galactomannan (GM) and (1→3)-β-D-glucan

...d bronchoalveolar lavage (BAL) GM is recommen...

...is NOT recommended for routine blood...

...ended for screening in solid organ transplant rec...

Serum assays for (1→3)-β-D-glucan...


...iographic Diagnos...

...mends performing a chest computed tomographic (...

...ne use of contrast during a chest CT scan for a s...

...is recommended when a nodule or a mass is...

...e IDSA suggests a follow-up chest CT-sc...


...choscopy...

...ommends performing a bronchoscopy with BAL i...

...morbidities such as severe hypoxemia, bleeding, an...

...he yield of BAL is low for peripher...

...ecommends the use of a standardized...


Treatment

Treatment

...Agents for Aspergillosis...

...tericin B (AmB)...

...deoxycholate and its lipid derivatives are...

...d formulations of AmB may be considered as prop...

...hinocandi...

...ns are effective in salvage therapy (either...

...azoles...

...s are preferred agents for treatment...

...patients receiving triazole-based therap...

...rate amount of data for itraconazole...

...tudies are needed to address wheth...

...ans should obtain serum trough drug...

...ination Therapy

...f polyenes or azoles with echinocan...

...ptibility Testi...

...antifungal susceptibility testing of isolates...


...herapy for Invasive Disease...

...monary Aspergillosis (IPA)...

...ends primary treatment with voricona...

...initiation of antifungal therapy in patie...

...therapies include liposomal AmB, ( S ,...

...conazole, ( S , M)70...

...lipid formulations of AmB. ( W , L...

...fungal therapy with voriconazole and an ec...

...y with an echinocandin is NOT recommended. ( S , M...

...ins (micafungin or caspofungin) can be used in...

...ecommends that treatment of IPA be cont...

...patients with successfully treated IPA...

...Aspergillosis (IA)...

...ing doses of, or eliminating altogether, im...

...stimulating factors (CSFs) may be considere...

...nulocyte transfusions can be considered...

...binant interferon-γ is recommended as...

...for aspergillosis should be consid...

...n absolute contraindication to additional chemot...

...out when to proceed with additional chemother...

...or Progressive Disease...

...he IDSA recommends an individualized approach...

...e context of salvage therapy, an addition...

...patients currently receiving an antifungal and ex...

...ge therapy, agents include lipid formulations of A...

...markers to Assess Re...

...monitoring of serum GM can be used in...

...ucan has not been extensively studied in IA...


...iatric Aspergillosis...

Treatment of aspergillosis in children uses the...


...and Nontransplant Recipients...

...ophytic forms of tracheobronchial asper...

...ludes bronchoscopic removal of mucoid impactio...

...active triazole agents are recommended...

...entric granulomatosis is treated in the same...

...e forms of TBA are treated with a...

...lso recommends minimization or reversal...

...transplant recipients, the IDSA re...


...lmonary Aspergillosis...

...NS...

...commends voriconazole as primary t...

...ormulations of AmB are reserved for t...

...ophthalmitis

...recommends that Aspergillus endophthalmiti...

...eratit...

The IDSA recommends that clinicians trea...

...asal Sinuses...

...nds that both surgery and either systemic...

...ditis, Pericarditis, and Myoc...

...endocarditis, the IDSA recommends early surgical...

...riconazole or a lipid formulation of AmB...

...owing surgical replacement of an infect...

...elitis and Septic Arthritis...

...intervention is recommended, where...

...utaneo...

...aneous lesions may reflect disseminate...

...f aspergillosis in burns or massive soft tissu...

Peritoniti...

The IDSA recommends prompt peritoneal dialysis cat...

...astrointestinal, and Hepatic...

...s voriconazole and surgical consultation in att...

...gests antifungal therapy with voriconazole or...

...enal

...ts a combined approach of medical and...

...ar Infections

...ive Aspergillus otitis externa, also calle...

...ommends that clinicians treat IA of th...

...s in the Non-transplant Population...

...suggests the diagnosis of Aspergillus bronchit...

...DSA suggests treatment with oral itra...


...eakthrough Infe...

...s an individualized approach that tak...


...mpirical and Pre-emptive Str...

...tifungal therapy is recommended for high-r...

...fungal options include a lipid formulation of AmB,...

...inocandin (caspofungin or micafungin)...

...riconazole. ( S , M...

...ifungal therapy is recommended for high-...

...mpirical antifungal therapy is NOT recom...

...use of serum or BAL fungal biomarkers...

...initiation of antifungal therapy in patients wit...

...suspected or documented breakthrough...

...ng transplant recipients not on anti-mold...

...x months after lung transplantation and in th...


...ronic and Saprophytic...

...he diagnosis of CCPA requires: ( S...

...uggests an individualized approach...


...nic Cavitary Pulmonary Aspergillosi...

...he diagnosis of CCPA requires: ( S , M) 3...

...m Aspergillus PCR testing is more se...

...with CCPA without pulmonary symptoms, weight lo...

...nts with CCPA and either pulmonary or general...

...ral itraconazole and voriconazole are...

...azole is a useful third-line agent for thos...

...be managed with oral tranexamic acid, (...

...ronchial artery embolization ( S...

...ifungal therapy to prevent recurrenc...

...failing these measures may require...

...avenous micafungin, ( W , L)705...

...pofungin, ( W , L)70...

...ericin B ( W , L)705...

...cal resection is an option for some patients wit...

...ose with progressive disease, long...


...pergilloma

...tic patients with a single aspergillo...

...with symptoms, especially significant hemoptysi...

.../post-operative antifungal therapy is...


...ergic Syndromes...

...Bronchopulmonary Aspergillosis

...ed Aspergillus IgE and total IgE ar...

...ts treating symptomatic asthmatic p...

...ystic fibrosis (CF) patients with frequent ex...

...gic Aspergillus Rhinosinus...

...he IDSA recommends establishing the diagnosis o...

...he IDSA recommends polypectomy and sinus wash...

...commends the use of topical nasal steroids to r...

...IDSA suggests oral antifungal therap...


...le 1. Summary of Recommendations for the...


...2. Clinical Scenarios Where Antifungal Therapeuti...


...able 3. Commonly Encountered Drug-Drug Interactio...