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

...ology and Risk Factors...

...zed allogeneic HSCT recipients should be p...


...ons can be reasonably applied to ot...


...n which a protected environment is not...


...DSA recommends reasonable precautions to reduc...


...eukemia and transplant centers should perform...


Prophylaxis

...phylaxis...

...ecommends prophylaxis with posaconazole, ( S...

...onazole, ( S , M)705...

...afungin ( W , L)70...

...prolonged neutropenia for those who are...

...xis with caspofungin is also probably eff...

...ylaxis with itraconazole is effective, but t...

...es should not be co-administered with other ag...


...t vs. Host Disease (GVHD)...

The IDSA recommends prophylaxis with posacona...

...ith other mold-active azoles is also effective....

...phylaxis with itraconazole is limite...

...e IDSA recommends continuation of...


...ng Transplant...

The IDSA recommends antifungal prophylaxis with e...

...ic voriconazole or itraconazole is su...

...ecommends reinitiating antifungal prophylaxis f...


...lung Solid Organ Transpl...

...e IDSA recommends prophylactic strategi...


Diagnosis

Diagno...

Until molecular tools are more widely used...


As research in the area continues, the IDSA r...


...alactomannan (GM) and (1→3)-β-D-gl...

...oalveolar lavage (BAL) GM is recommended...

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

...ecommended for screening in solid...

...assays for (1→3)-β-D-glucan are recomm...


...iographic Diagnosis

...nds performing a chest computed tomographi...

...of contrast during a chest CT scan...

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

...gests a follow-up chest CT-scan to...


...hoscopy...

...commends performing a bronchoscopy with BA...

...ant comorbidities such as severe hypoxemia...

...d of BAL is low for peripheral nodular les...

The IDSA recommends the use of a stan...


Treatment

...eatment...

...tifungal Agents for Aspe...

...photericin B (Am...

...te and its lipid derivatives are appropriate opt...

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

Echinocandins

...ocandins are effective in salvage th...

...azoles...

...riazoles are preferred agents for treatme...

...nts receiving triazole-based therapy for I...

...e amount of data for itraconazole, vor...

...are needed to address whether TDM is helpf...

...ld obtain serum trough drug levels for...

...nation Therap...

...nations of polyenes or azoles with echinocan...

...ptibility Testing...

...ne antifungal susceptibility testing of isolate...


Recommended Therapy for Inva...

...vasive Pulmonary Aspergill...

...recommends primary treatment with vo...

...rly initiation of antifungal therapy...

...ernative therapies include liposomal...

...conazole, ( S , M)705...

...other lipid formulations of AmB. ( W , L)705...

...on antifungal therapy with voriconazole...

...rimary therapy with an echinocandin is...

...ocandins (micafungin or caspofungin) can be used i...

...IDSA recommends that treatment of IPA...

...patients with successfully treated IPA who r...

...Aspergillosis (IA)...

...doses of, or eliminating altogether, immu...

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

...ansfusions can be considered for neut...

...ombinant interferon-γ is recommended as proph...

...spergillosis should be considered for...

...not an absolute contraindication to additional ch...

...s about when to proceed with additional...

...or Progressive Disease...

...mends an individualized approach that ta...

...ext of salvage therapy, an additional...

...tients currently receiving an antifunga...

...rapy, agents include lipid formulation...

...kers to Assess Response...

...ial monitoring of serum GM can be used in the a...

...-D-glucan has not been extensively studied in IA...


Pediatric Aspergil...

...reatment of aspergillosis in children uses...


...nt and Nontransplant Recip...

...forms of tracheobronchial aspergillosis...

Treatment includes bronchoscopic remo...

...old-active triazole agents are recommend...

...ic granulomatosis is treated in the same...

...orms of TBA are treated with a mold-active tri...

...ecommends minimization or reversal of un...

...nt recipients, the IDSA recommends...


...onary Aspergillosis...

...NS

The IDSA recommends voriconazole as primar...

...formulations of AmB are reserved for t...

...ndophthalmit...

...IDSA recommends that Aspergillus...

Keratiti...

...recommends that clinicians treat Aspergillu...

...ranasal Sinuses

...mends that both surgery and either...

...carditis, Pericarditis, and Myocarditi...

...us endocarditis, the IDSA recommends early sur...

...r a lipid formulation of AmB is re...

...ollowing surgical replacement of an infec...

...tis and Septic Arthriti...

...ention is recommended, where feasible, for man...

Cutaneous

...us lesions may reflect disseminated...

...cases of aspergillosis in burns or massive so...

...itonitis...

...mmends prompt peritoneal dialysis catheter re...

...astrointestinal, and Hepatic...

...gests voriconazole and surgical consultatio...

...SA suggests antifungal therapy with voriconazol...

...enal...

...IDSA suggests a combined approach of medic...

...ar Infections...

...Aspergillus otitis externa, also called otomycosis...

...SA recommends that clinicians treat IA of the...

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

...ts the diagnosis of Aspergillus bronchitis in...

...he IDSA suggests treatment with oral itraconazol...


...reakthrough Infecti...

...DSA suggests an individualized approach that t...


...pirical and Pre-emptive St...

...fungal therapy is recommended for hi...

...l options include a lipid formulation...

...n (caspofungin or micafungin), ( S , H)705...

...riconazole. ( S , M)705

...ical antifungal therapy is recommended f...

...ungal therapy is NOT recommended for pati...

...rum or BAL fungal biomarkers such as GM...

...n of antifungal therapy in patients wit...

...ment of suspected or documented bre...

...ant recipients not on anti-mold prophylaxis,...

Six months after lung transplantation and in...


...and Saprophytic Syndro...

...agnosis of CCPA requires: ( S , M)...

...DSA suggests an individualized approach that...


...nic Cavitary Pulmonary Aspergillosis (...

...gnosis of CCPA requires: ( S , M) 3...

...ergillus PCR testing is more sensitive than...

...nts with CCPA without pulmonary sym...

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

...traconazole and voriconazole are the preferred...

...aconazole is a useful third-line agen...

Hemoptysis may be managed with oral tranexa...

...tery embolization ( S , M)705...

...ngal therapy to prevent recurrence....

...ents failing these measures may require surg...

...us micafungin, ( W , L)70...

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

...tericin B ( W , L)70...

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

...progressive disease, long term, even lif...


...spergillom...

...matic patients with a single asper...

Patients with symptoms, especially significan...

...ri/post-operative antifungal thera...


...llergic Syndr...

...c Bronchopulmonary Aspergillosis...

...Aspergillus IgE and total IgE are recomme...

...s treating symptomatic asthmatic patients wi...

...tic fibrosis (CF) patients with frequent...

...Aspergillus Rhinosinusitis...

...recommends establishing the diagnosis of all...

...IDSA recommends polypectomy and sinus washou...

...ends the use of topical nasal steroids to reduce s...

...DSA suggests oral antifungal thera...


...of Recommendations for the Treatment of A...


...e 2. Clinical Scenarios Where Antifu...


...y Encountered Drug-Drug Interaction...