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
...ogy and Risk Factors...
...allogeneic HSCT recipients should b...
...utions can be reasonably applied to other hi...
...ls in which a protected environment is...
...commends reasonable precautions to red...
...kemia and transplant centers should pe...
Prophylaxis
Prophylax...
...recommends prophylaxis with posaconazole, (...
...conazole, ( S , M)705
...ungin ( W , L)70...
...ring prolonged neutropenia for those who are...
...th caspofungin is also probably effective. ( W...
...laxis with itraconazole is effective, but the...
...d not be co-administered with other agents kn...
...aft vs. Host Disease (GVH...
...ommends prophylaxis with posaconazole fo...
...phylaxis with other mold-active azoles is also eff...
...ylaxis with itraconazole is limited by toler...
...nds continuation of antifungal prop...
...Transplant...
...mends antifungal prophylaxis with either a...
...ystemic voriconazole or itraconazole is s...
...mends reinitiating antifungal prophylaxis...
...Solid Organ Transplant...
...mends prophylactic strategies in solid...
Diagnosis
Diagno...
...molecular tools are more widely used in...
...the area continues, the IDSA recom...
...(GM) and (1→3)-β-D-glucan...
...m and bronchoalveolar lavage (BAL) GM is re...
...is NOT recommended for routine blood screening...
...mended for screening in solid orga...
...for (1→3)-β-D-glucan are recomme...
...aphic Diagnosis...
...SA recommends performing a chest comp...
...utine use of contrast during a chest CT sc...
...is recommended when a nodule or a mass is cl...
The IDSA suggests a follow-up chest CT-scan to...
...choscopy...
...ends performing a bronchoscopy with BAL in patient...
...comorbidities such as severe hypo...
...ld of BAL is low for peripheral nodular lesions,...
...mmends the use of a standardized BAL proce...
Treatment
...reatment...
...ifungal Agents for Aspergillo...
Amphotericin B (A...
...ate and its lipid derivatives are appropriate o...
Aerosolized formulations of AmB may be...
...nocandins...
...ns are effective in salvage therapy...
Triazol...
...preferred agents for treatment and preventio...
...tients receiving triazole-based therapy f...
...mount of data for itraconazole, vor...
...are needed to address whether TDM is hel...
...nicians should obtain serum trough drug le...
...nation Therap...
...polyenes or azoles with echinocandins suggest ad...
...ceptibility Tes...
...outine antifungal susceptibility testing of is...
...ended Therapy for Invasive D...
Invasive Pulmonary Aspergi...
...commends primary treatment with voriconazo...
...iation of antifungal therapy in patients...
...ternative therapies include liposomal A...
...onazole, ( S , M)705...
...other lipid formulations of AmB. ( W , L)7...
...antifungal therapy with voriconazole and a...
...herapy with an echinocandin is NOT...
...icafungin or caspofungin) can be used in setti...
...SA recommends that treatment of IPA be...
...ts with successfully treated IPA who requ...
Invasive Aspergillosi...
...s of, or eliminating altogether, immunosuppressi...
...imulating factors (CSFs) may be consi...
...nulocyte transfusions can be considere...
...ombinant interferon-γ is recommended as...
...y for aspergillosis should be considered f...
...n absolute contraindication to additional chem...
...about when to proceed with additional ch...
...ctory or Progressive Disea...
...ommends an individualized approach that t...
...text of salvage therapy, an additional ant...
...n patients currently receiving an antifungal and...
...r salvage therapy, agents include lipid...
...kers to Assess Response...
...l monitoring of serum GM can be used in the app...
...ucan has not been extensively studied i...
...atric Aspergillos...
...nt of aspergillosis in children uses th...
...nsplant and Nontransplant R...
...tic forms of tracheobronchial aspergillosis (T...
...udes bronchoscopic removal of mucoi...
...ld-active triazole agents are recommended...
Bronchocentric granulomatosis is treated in the sa...
...f TBA are treated with a mold-active tr...
...DSA also recommends minimization or...
...lung transplant recipients, the IDSA recommend...
...pulmonary Aspergill...
CNS
...ends voriconazole as primary therap...
...d formulations of AmB are reserved for t...
...hthalmitis...
...commends that Aspergillus endophtha...
Kerati...
...mends that clinicians treat Aspergillus keratitis...
Paranasal Sinus...
...he IDSA recommends that both surgery...
Endocarditis, Pericarditis, and Myocardi...
...gillus endocarditis, the IDSA recommend...
...onazole or a lipid formulation of AmB is recom...
...owing surgical replacement of an infected...
...teomyelitis and Septic Arthritis
...ervention is recommended, where feasible, f...
...utaneou...
...aneous lesions may reflect dissemin...
In cases of aspergillosis in burns or massi...
...ritonitis...
...e IDSA recommends prompt peritoneal...
Esophageal, Gastrointestinal, and Hep...
...ggests voriconazole and surgical con...
...DSA suggests antifungal therapy with vorico...
Renal
...DSA suggests a combined approach of medic...
Ear Infecti...
...e Aspergillus otitis externa, also call...
...mends that clinicians treat IA of...
...n the Non-transplant Population
The IDSA suggests the diagnosis of A...
...suggests treatment with oral itraconaz...
...eakthrough Infection...
The IDSA suggests an individualized approach tha...
Empirical and Pre-emptive Strate...
...ngal therapy is recommended for high-risk...
...ns include a lipid formulation of AmB, ( S ,...
...n echinocandin (caspofungin or micafungin), (...
...riconazole. ( S , M)705
...ntifungal therapy is recommended for high-risk pat...
...ifungal therapy is NOT recommended for patien...
...use of serum or BAL fungal biomarkers such as...
...initiation of antifungal therapy in pat...
Management of suspected or documented breakthroug...
...ung transplant recipients not on anti-...
...after lung transplantation and in the absence of...
...and Saprophytic Syndro...
...CCPA requires: ( S , M) 3 months of chronic...
...gests an individualized approach that t...
...vitary Pulmonary Aspergillosis (CCPA)...
The diagnosis of CCPA requires: ( S , M) 3 mont...
...te: Sputum Aspergillus PCR testing is...
...ients with CCPA without pulmonary symptoms,...
...with CCPA and either pulmonary or general symptoms...
...aconazole and voriconazole are the preferr...
...saconazole is a useful third-line agent for those...
...sis may be managed with oral tranexami...
...al artery embolization ( S , M)705...
...therapy to prevent recurrence. ( S , L)705...
...ling these measures may require sur...
...us micafungin, ( W , L)705...
...fungin, ( W , L)705...
...icin B ( W , L)705...
...al resection is an option for some patients with l...
...ogressive disease, long term, even...
...pergillom...
...patients with a single aspergilloma and no progre...
...ents with symptoms, especially significan...
...tive antifungal therapy is not routinely requ...
...ergic Syndro...
...nchopulmonary Aspergillosis...
...gillus IgE and total IgE are recommended to estab...
...ests treating symptomatic asthmatic patient...
...is (CF) patients with frequent exacer...
...Aspergillus Rhinosinusitis...
...recommends establishing the diagnosis of...
...recommends polypectomy and sinus washo...
...he IDSA recommends the use of topical nasal...
...uggests oral antifungal therapy us...
...of Recommendations for the Treatment of As...
...ble 2. Clinical Scenarios Where Antifungal Thera...
...nly Encountered Drug-Drug Interactions During Tr...