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
...Epidemiology and Risk Facto...
...ized allogeneic HSCT recipients should be placed...
...ons can be reasonably applied to other hig...
...s in which a protected environment is not availa...
...recommends reasonable precautions to reduce mold...
...ansplant centers should perform regular surve...
Prophylaxis
Prophylax...
...DSA recommends prophylaxis with posaconaz...
...riconazole, ( S , M)705...
...icafungin ( W , L)70...
...prolonged neutropenia for those who are a...
...h caspofungin is also probably effec...
...h itraconazole is effective, but therapy may...
...should not be co-administered with ot...
...Graft vs....
...mmends prophylaxis with posaconazole for alloge...
...hylaxis with other mold-active azoles is also eff...
...itraconazole is limited by tolerabili...
...recommends continuation of antifungal pro...
...Lung Tra...
...SA recommends antifungal prophylaxis w...
...nazole or itraconazole is suggested over...
...ecommends reinitiating antifungal prophylaxis for...
...Non-lung Soli...
...ecommends prophylactic strategies in solid o...
Diagnosis
...molecular tools are more widely used in clini...
...s research in the area continues, the IDSA recomme...
...Galactomannan (G...
...oalveolar lavage (BAL) GM is recommend...
...s NOT recommended for routine bloo...
...NOT recommended for screening in solid organ tr...
...assays for (1→3)-β-D-glucan are r...
...Radiographic Diagnosi...
...mmends performing a chest computed tomographic (...
...outine use of contrast during a chest CT sca...
...mmended when a nodule or a mass is...
...ts a follow-up chest CT-scan to assess the respo...
...Bronchoscopy...
...IDSA recommends performing a bronchoscopy with...
...ignificant comorbidities such as sever...
The yield of BAL is low for periphe...
...IDSA recommends the use of a standardized BAL proc...
Treatment
...Treatme...
...Antifungal Agents f...
...cholate and its lipid derivatives are approp...
...d formulations of AmB may be conside...
...Echinocand...
...ocandins are effective in salvage therapy (ei...
...Triazoles
...es are preferred agents for treatment and preven...
For patients receiving triazole-base...
...moderate amount of data for itraconazole...
...er studies are needed to address whe...
...should obtain serum trough drug levels...
...Combination Ther...
...ons of polyenes or azoles with echi...
Susceptibi...
...utine antifungal susceptibility testing of i...
...Reco...
...Invasiv...
...mmends primary treatment with voriconazole. ( S ,...
...y initiation of antifungal therapy i...
...ternative therapies include liposomal AmB, (...
...azole, ( S , M)705...
...r other lipid formulations of AmB. ( W...
...on antifungal therapy with voriconazole and an e...
...with an echinocandin is NOT recommended. ( S , M)7...
Echinocandins (micafungin or caspofungin) c...
...recommends that treatment of IPA be continued f...
...tients with successfully treated IPA who requ...
...Invasive Asp...
Reducing doses of, or eliminating al...
...ulating factors (CSFs) may be considered...
...yte transfusions can be considered for ne...
...combinant interferon-γ is recomme...
...for aspergillosis should be conside...
...is not an absolute contraindication to additional...
...ons about when to proceed with addition...
...he IDSA recommends an individualized appr...
...f salvage therapy, an additional antifungal...
...n patients currently receiving an antif...
...therapy, agents include lipid formulations...
...Bio...
...ring of serum GM can be used in the appropriate...
...-glucan has not been extensively studied in IA...
...Pedia...
...reatment of aspergillosis in children us...
...Transpla...
...rms of tracheobronchial aspergillosis...
...udes bronchoscopic removal of mucoid impaction. (,...
...e triazole agents are recommended for immunocompro...
...hocentric granulomatosis is treated in the same f...
...forms of TBA are treated with a mold-active...
...also recommends minimization or rev...
...lung transplant recipients, the I...
...Extrapulmonary Aspe...
...C...
...ommends voriconazole as primary therapy...
...tions of AmB are reserved for those intolerant...
...Endophthalmitis...
...recommends that Aspergillus endophthalmitis...
...Keratitis...
...mends that clinicians treat Aspergillus...
...Paranasal...
...A recommends that both surgery and either syst...
...Endocarditis,...
...pergillus endocarditis, the IDSA recommends e...
...nazole or a lipid formulation of Am...
...owing surgical replacement of an infected valve...
...Osteomye...
...tervention is recommended, where feasible,...
...Cutaneo...
...e cutaneous lesions may reflect dissem...
...f aspergillosis in burns or massive soft tissue...
...Peritonitis...
...commends prompt peritoneal dialysis cat...
...Esophageal, Gastro...
...sts voriconazole and surgical consul...
...s antifungal therapy with voriconazole or a...
...R...
...A suggests a combined approach of med...
...Ear Infections...
...ninvasive Aspergillus otitis exter...
...commends that clinicians treat IA of the ear with...
...Bronchitis in the Non-trans...
...gests the diagnosis of Aspergillus bron...
...suggests treatment with oral itraconazole or vo...
...Breakthrough...
...ggests an individualized approach tha...
...Empir...
...cal antifungal therapy is recommended for...
...ions include a lipid formulation of AmB, (...
...candin (caspofungin or micafungin),...
...conazole. ( S , M)705
...ntifungal therapy is recommended for h...
...ungal therapy is NOT recommended for...
...serum or BAL fungal biomarkers such a...
...rly initiation of antifungal therapy in patients w...
...agement of suspected or documented breakthroug...
...nt recipients not on anti-mold prophylaxis, the I...
...after lung transplantation and in...
...Chroni...
...agnosis of CCPA requires: ( S , M)...
...ests an individualized approach that takes into...
...Chronic Cavitary Pul...
...CCPA requires: ( S , M) 3 months...
...te: Sputum Aspergillus PCR testing is more...
...atients with CCPA without pulmonary sy...
...atients with CCPA and either pulmona...
...aconazole and voriconazole are the prefe...
...le is a useful third-line agent for those w...
...is may be managed with oral tranexa...
...artery embolization ( S , M)705...
...apy to prevent recurrence. ( S , L)705...
...nts failing these measures may require surgica...
...micafungin, ( W , L)705...
...pofungin, ( W , L...
amphotericin B ( W , L)705
...resection is an option for some patient...
...those with progressive disease, long term, even l...
...A...
...tomatic patients with a single aspergillom...
...mptoms, especially significant hemoptysis, wit...
Peri/post-operative antifungal therapy...
...Allergic Syn...
...Allergic Bronchop...
...ated Aspergillus IgE and total IgE are r...
...sts treating symptomatic asthmatic patients wit...
...brosis (CF) patients with frequent exacerbati...
...Allergic Aspe...
...mends establishing the diagnosis of aller...
...ommends polypectomy and sinus washout as t...
...IDSA recommends the use of topical nasal...
...SA suggests oral antifungal therap...
...1. Summary of Recommendations for the Treatm...
...e 2. Clinical Scenarios Where Antifun...
...mmonly Encountered Drug-Drug Interact...