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
...ed allogeneic HSCT recipients should be placed i...
...ons can be reasonably applied to ot...
...in which a protected environment is not avail...
...ecommends reasonable precautions to reduce...
...eukemia and transplant centers should...
Prophylaxis
...Prophylaxis...
...A recommends prophylaxis with posaconazol...
...iconazole, ( S , M)...
...fungin ( W , L)70...
...ring prolonged neutropenia for tho...
...laxis with caspofungin is also probably ef...
...h itraconazole is effective, but thera...
...ld not be co-administered with other agent...
...Graft vs. H...
The IDSA recommends prophylaxis with...
...ith other mold-active azoles is also effec...
...ophylaxis with itraconazole is limited...
...recommends continuation of antifung...
...Lung Transplant...
The IDSA recommends antifungal prophylax...
...riconazole or itraconazole is suggested...
The IDSA recommends reinitiating antifung...
...Non-lung Solid Org...
...e IDSA recommends prophylactic strateg...
Diagnosis
...Diagnos...
...ecular tools are more widely used in...
...s research in the area continues, the I...
...Galactomannan (GM)...
...m and bronchoalveolar lavage (BAL) GM is...
...M is NOT recommended for routine blood screening...
...NOT recommended for screening in solid organ tr...
...s for (1→3)-β-D-glucan are recommend...
...Radiographi...
...ecommends performing a chest computed...
...of contrast during a chest CT scan for a suspici...
...mmended when a nodule or a mass is close t...
...DSA suggests a follow-up chest CT-scan to assess...
...Bronchoscopy...
...ecommends performing a bronchoscopy with BAL in...
...cant comorbidities such as severe hypoxemia,...
The yield of BAL is low for peripheral...
...DSA recommends the use of a standa...
Treatment
...Tr...
...Antifungal Agen...
...eoxycholate and its lipid derivatives are appropr...
...ed formulations of AmB may be considered...
...Echinocan...
...ocandins are effective in salvage therapy (eithe...
...Triazoles...
...referred agents for treatment and prevention of I...
...eiving triazole-based therapy for I...
...moderate amount of data for itracon...
...studies are needed to address whether TD...
...should obtain serum trough drug levels for...
...Combination Therap...
...ations of polyenes or azoles with echinocandin...
...Suscep...
Routine antifungal susceptibility test...
...Recommended Ther...
...Invas...
...mmends primary treatment with voriconazole. (...
...on of antifungal therapy in patients with...
...lternative therapies include liposom...
...conazole, ( S , M)70...
...r other lipid formulations of AmB. ( W , L)7...
...tifungal therapy with voriconazole and an...
...ry therapy with an echinocandin is NOT recomm...
...ndins (micafungin or caspofungin) can be used...
...DSA recommends that treatment of IPA be continued...
...h successfully treated IPA who require subsequen...
...In...
...ses of, or eliminating altogether, immunosupp...
...ony stimulating factors (CSFs) may...
...sfusions can be considered for neutropenic pat...
...inant interferon-γ is recommended as prophylaxis...
...spergillosis should be considered for localized...
...an absolute contraindication to add...
...ions about when to proceed with additional...
...Refractory or Progress...
...nds an individualized approach that take...
...ext of salvage therapy, an additional...
...atients currently receiving an antifungal a...
...herapy, agents include lipid formulations of AmB,...
...Bioma...
...nitoring of serum GM can be used in the appropriat...
...-D-glucan has not been extensively studied in IA t...
...Pediatric Aspergil...
Treatment of aspergillosis in children uses the...
...Transplant and...
...rophytic forms of tracheobronchial aspergillos...
...atment includes bronchoscopic removal of muc...
...ve triazole agents are recommended for immu...
...ocentric granulomatosis is treated i...
...nvasive forms of TBA are treated wit...
...recommends minimization or reversal of underlying...
...lung transplant recipients, the IDSA recommend...
...Extrapulmonary Aspe...
...ommends voriconazole as primary therap...
...formulations of AmB are reserved fo...
Endoph...
...IDSA recommends that Aspergillus endophthalm...
...Keratitis...
...ends that clinicians treat Aspergillus ke...
...Paranasal Sinu...
...e IDSA recommends that both surgery and...
...Endocarditis, Perica...
...endocarditis, the IDSA recommends ea...
...conazole or a lipid formulation of AmB...
Following surgical replacement of an infected val...
...Osteomye...
...gical intervention is recommended, where feasible,...
...Cutaneous...
...nce cutaneous lesions may reflect disseminated...
...rgillosis in burns or massive soft tissue wou...
...Peritonit...
...SA recommends prompt peritoneal dial...
...Esop...
...suggests voriconazole and surgical consultation i...
...suggests antifungal therapy with vorico...
...Renal
...IDSA suggests a combined approach of medical...
...vasive Aspergillus otitis externa, also called...
The IDSA recommends that clinicians trea...
...Bronchitis in th...
...DSA suggests the diagnosis of Aspergillus bronc...
...DSA suggests treatment with oral itraconazole...
...Break...
...IDSA suggests an individualized approach t...
...Empirical and Pre-em...
...ngal therapy is recommended for high-risk patients...
...ions include a lipid formulation of AmB, ( S...
...echinocandin (caspofungin or micaf...
...voriconazole. ( S , M)705
...mpirical antifungal therapy is recommended fo...
...rical antifungal therapy is NOT reco...
...erum or BAL fungal biomarkers such as GM or (1...
...y initiation of antifungal therapy in pa...
...suspected or documented breakthrough IPA...
...ung transplant recipients not on anti-mold pro...
...er lung transplantation and in the absence of re...
...Chronic a...
...s of CCPA requires: ( S , M) 3 mo...
...s an individualized approach that takes int...
...Chronic Cavi...
...nosis of CCPA requires: ( S , M) 3 mo...
...um Aspergillus PCR testing is more sensitive th...
...ents with CCPA without pulmonary symptoms, weight...
...atients with CCPA and either pulmonary or...
...itraconazole and voriconazole are...
...saconazole is a useful third-line agent for those...
...ay be managed with oral tranexamic...
...l artery embolization ( S , M)705...
...therapy to prevent recurrence. ( S , L)705...
...g these measures may require surgic...
...s micafungin, ( W , L)705...
...ngin, ( W , L)705...
...hotericin B ( W , L)705...
...ical resection is an option for some patient...
...th progressive disease, long term, even life-long...
...Aspergillom...
...ic patients with a single aspergilloma and no pro...
...nts with symptoms, especially significant hemo...
...st-operative antifungal therapy is not rout...
...Allergi...
...Allergic Bro...
...ted Aspergillus IgE and total IgE are recom...
...ggests treating symptomatic asthmatic...
...is (CF) patients with frequent exacerbations and/o...
...Allergi...
...he IDSA recommends establishing the...
...commends polypectomy and sinus washout as the o...
...mends the use of topical nasal steroids to redu...
The IDSA suggests oral antifungal therapy using mo...
...mmary of Recommendations for the Tr...
...e 2. Clinical Scenarios Where Antifungal The...
...able 3. Commonly Encountered Drug-Drug Interac...