Aspergillosis
Key Points
Key Points
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
...demiology and Risk Fa...
...ized allogeneic HSCT recipients should...
These precautions can be reasonably ap...
...pitals in which a protected environment is not...
...e IDSA recommends reasonable precauti...
...transplant centers should perform re...
Prophylaxis
...rophylaxis
...ecommends prophylaxis with posacon...
...oriconazole, ( S , M)705...
...ngin ( W , L)705...
...ing prolonged neutropenia for those who ar...
...ophylaxis with caspofungin is also probably...
...phylaxis with itraconazole is effective, but the...
...d not be co-administered with other...
...s. Host Disease (GVH...
...he IDSA recommends prophylaxis with posacona...
...ylaxis with other mold-active azoles...
...with itraconazole is limited by tolerabil...
...commends continuation of antifungal prophylaxis...
...ng Transpla...
...ends antifungal prophylaxis with either a syst...
Systemic voriconazole or itraconazole is...
...DSA recommends reinitiating antifungal pr...
...olid Organ Transplant...
...mends prophylactic strategies in solid org...
Diagnosis
Diagno...
...til molecular tools are more widely used in clin...
...n the area continues, the IDSA recommends that...
...lactomannan (GM) and (1→3)-β-D-gluc...
...rum and bronchoalveolar lavage (BAL...
...recommended for routine blood screen...
...T recommended for screening in solid organ trans...
...r (1→3)-β-D-glucan are recommended for...
...diographic Diagnosis...
...IDSA recommends performing a chest computed tomogr...
...of contrast during a chest CT scan for a suspici...
...st is recommended when a nodule or a mass is clo...
...ests a follow-up chest CT-scan to assess the...
...choscopy...
...mends performing a bronchoscopy with BAL...
...ant comorbidities such as severe hypoxemia, bleed...
...d of BAL is low for peripheral nodular lesions, so...
...mends the use of a standardized BAL...
Treatment
...atment...
...ifungal Agents for Aspergillos...
...photericin B (AmB)
...holate and its lipid derivatives are appropri...
...olized formulations of AmB may be considered as...
...nocandins
...s are effective in salvage therapy (e...
...azoles...
...preferred agents for treatment and prevention of I...
...ents receiving triazole-based therapy for IA,...
...te amount of data for itraconazole, vori...
...es are needed to address whether TDM is h...
...uld obtain serum trough drug levels for azole an...
...ation Therapy...
...ns of polyenes or azoles with echinocandins sug...
...tibility Testin...
...fungal susceptibility testing of isolates recov...
...Therapy for Invasive Disease...
...lmonary Aspergillosis (IPA)...
...A recommends primary treatment with v...
...ation of antifungal therapy in patient...
...ternative therapies include liposomal AmB,...
...nazole, ( S , M)705...
or other lipid formulations of AmB....
...ation antifungal therapy with voriconazole and...
...therapy with an echinocandin is NOT reco...
...inocandins (micafungin or caspofungin) can be us...
...commends that treatment of IPA be continued fo...
...th successfully treated IPA who require subsequen...
Invasive Aspergillosis...
...doses of, or eliminating altogether, immu...
...ting factors (CSFs) may be considered in neutro...
...anulocyte transfusions can be considered fo...
...inant interferon-γ is recommended as prophylax...
...y for aspergillosis should be considered for loc...
...an absolute contraindication to additional ch...
...t when to proceed with additional chemother...
...or Progressive Disease...
...recommends an individualized approach that take...
...the context of salvage therapy, an...
...ients currently receiving an antifungal and...
...r salvage therapy, agents include l...
...arkers to Assess Respo...
...ial monitoring of serum GM can be used...
...lucan has not been extensively studied in...
...ric Aspergillosi...
...ergillosis in children uses the same recommend...
...d Nontransplant Recipients...
...tic forms of tracheobronchial aspergill...
...t includes bronchoscopic removal of mucoid impa...
...active triazole agents are recommended...
...c granulomatosis is treated in the same fashion...
...of TBA are treated with a mold-active triazole...
...IDSA also recommends minimization or r...
...nsplant recipients, the IDSA recommend...
...rapulmonary Aspergillosis...
CNS
...e IDSA recommends voriconazole as pr...
...formulations of AmB are reserved for tho...
...ndophthalm...
...ends that Aspergillus endophthalmitis be tre...
...eratit...
...ommends that clinicians treat Aspergillus keratit...
...anasal Sinuse...
...recommends that both surgery and either syst...
...carditis, Pericarditis, and Myoca...
...s endocarditis, the IDSA recommends early surg...
...riconazole or a lipid formulation of AmB i...
...rgical replacement of an infected valve, lifelong...
...itis and Septic Arthritis...
...l intervention is recommended, where f...
...aneous...
...nce cutaneous lesions may reflect disseminat...
...ergillosis in burns or massive soft tissue wounds...
...ritonitis...
...ends prompt peritoneal dialysis catheter removal...
...Gastrointestinal, and Hepatic...
...SA suggests voriconazole and surgical consul...
...sts antifungal therapy with voriconazole...
Rena...
...IDSA suggests a combined approach of medical an...
...Infections...
...oninvasive Aspergillus otitis exter...
...ecommends that clinicians treat IA of the ea...
...nchitis in the Non-transplant Populatio...
...A suggests the diagnosis of Aspergill...
...ests treatment with oral itraconazole or vorico...
...hrough Infection...
...gests an individualized approach tha...
...pirical and Pre-emptive Strategies...
...cal antifungal therapy is recommended for high-ris...
...ntifungal options include a lipid formulat...
...inocandin (caspofungin or micafung...
...nazole. ( S , M)705...
...cal antifungal therapy is recommended for h...
...l antifungal therapy is NOT recommended for pati...
...f serum or BAL fungal biomarkers such as GM...
...y initiation of antifungal therapy in...
...nt of suspected or documented brea...
...nt recipients not on anti-mold prophyl...
...r lung transplantation and in the absenc...
...and Saprophytic Syndromes...
...CCPA requires: ( S , M) 3 months of chroni...
...s an individualized approach that t...
...hronic Cavitary Pulmonary Aspergillosis (CCPA)
...agnosis of CCPA requires: ( S , M) 3 mont...
...e: Sputum Aspergillus PCR testing is more sensitiv...
...ts with CCPA without pulmonary symp...
...CPA and either pulmonary or general symptoms or...
...itraconazole and voriconazole are the preferred...
...a useful third-line agent for those with ad...
...ay be managed with oral tranexamic acid, (...
...onchial artery embolization ( S...
...ifungal therapy to prevent recurrence. (...
...g these measures may require surgical...
intravenous micafungin, ( W...
...ofungin, ( W , L)705...
...hotericin B ( W ,...
...gical resection is an option for some patien...
...progressive disease, long term, even lif...
...rgilloma...
...patients with a single aspergilloma and no pro...
...ients with symptoms, especially signif...
...perative antifungal therapy is not routine...
Allergic Syndromes
...onchopulmonary Aspergillosis...
...Aspergillus IgE and total IgE are recomm...
...A suggests treating symptomatic asthmatic patients...
...tic fibrosis (CF) patients with freq...
...pergillus Rhinosinusitis...
...e IDSA recommends establishing the d...
...mmends polypectomy and sinus washout as the opti...
...IDSA recommends the use of topical nasal stero...
...IDSA suggests oral antifungal therapy using...
...ary of Recommendations for the Treatment of Aspe...
...al Scenarios Where Antifungal Therapeutic...
.... Commonly Encountered Drug-Drug Interactions Du...