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
...pidemiology and Risk Factor...
...pitalized allogeneic HSCT recipients should be...
These precautions can be reasonably ap...
...tals in which a protected environment is...
...A recommends reasonable precaution...
...kemia and transplant centers should perform reg...
Prophylaxis
...ophylaxi...
...ecommends prophylaxis with posaconazole, ( S , H...
...zole, ( S , M)705...
...ungin ( W , L)705
...rolonged neutropenia for those who are at...
...axis with caspofungin is also probably...
...xis with itraconazole is effective,...
...oles should not be co-administered with othe...
...s. Host Disease (GVHD)
...ends prophylaxis with posaconazole for allogene...
...hylaxis with other mold-active azoles is als...
...with itraconazole is limited by tole...
...ommends continuation of antifungal prophy...
Lung Transplan...
...DSA recommends antifungal prophylaxis with eithe...
...nazole or itraconazole is suggested over i...
...mmends reinitiating antifungal prop...
...lung Solid Organ Transplant
...recommends prophylactic strategies i...
Diagnosis
...iagnosi...
Until molecular tools are more widely used in cli...
...arch in the area continues, the IDSA recommen...
...n (GM) and (1→3)-β-D-glucan...
...um and bronchoalveolar lavage (BAL) GM is reco...
...commended for routine blood screening in p...
...M is NOT recommended for screening in solid o...
...assays for (1→3)-β-D-glucan are recom...
...aphic Diagnosis...
...e IDSA recommends performing a chest...
...of contrast during a chest CT scan for a...
...ast is recommended when a nodule or a mass i...
...IDSA suggests a follow-up chest CT-scan...
...hoscopy...
...mends performing a bronchoscopy with...
...nificant comorbidities such as severe hypoxemia,...
...L is low for peripheral nodular lesions, so that...
...recommends the use of a standardized BAL pro...
Treatment
Treatmen...
...Agents for Aspergillosis...
Amphotericin B (AmB...
...deoxycholate and its lipid deriva...
...ormulations of AmB may be considered as...
...chinocandi...
...s are effective in salvage therapy (either alon...
Triazo...
Triazoles are preferred agents for tre...
...patients receiving triazole-based therapy for IA...
...ate amount of data for itraconazole,...
...urther studies are needed to address whether TDM...
...cians should obtain serum trough drug levels for...
...ation Therapy...
...f polyenes or azoles with echinocandi...
...sceptibility Testing
...ifungal susceptibility testing of isolates recover...
...nded Therapy for Invasive Dis...
...asive Pulmonary Aspergillosis (IPA)...
...ends primary treatment with voriconazole. ( S ,...
...tion of antifungal therapy in patien...
...ive therapies include liposomal AmB, ( S , M)705...
...onazole, ( S , M)705...
...lipid formulations of AmB. ( W , L)705...
...tion antifungal therapy with voriconazole and...
...py with an echinocandin is NOT recommended. ( S...
...chinocandins (micafungin or caspofungin...
...ends that treatment of IPA be contin...
...ith successfully treated IPA who require subsequ...
Invasive Aspergillosis...
Reducing doses of, or eliminating al...
...ony stimulating factors (CSFs) may be con...
...nulocyte transfusions can be considered for n...
...erferon-γ is recommended as prophylaxis...
...rgery for aspergillosis should be consi...
...n absolute contraindication to additional chemothe...
...when to proceed with additional ch...
Refractory or Progressive Di...
...DSA recommends an individualized approach th...
...f salvage therapy, an additional antifung...
...nts currently receiving an antifungal and ex...
...or salvage therapy, agents include lipid formulat...
...omarkers to Assess Res...
...g of serum GM can be used in the appropri...
...-glucan has not been extensively s...
...atric Aspergillo...
...ment of aspergillosis in children uses the...
...ant and Nontransplant Recipients...
...forms of tracheobronchial aspergillosis (TBA) d...
...cludes bronchoscopic removal of mucoid impac...
...ve triazole agents are recommended for im...
Bronchocentric granulomatosis is treated i...
...sive forms of TBA are treated with a mold-ac...
...o recommends minimization or reversal of underlyi...
...ransplant recipients, the IDSA recommends treatme...
...apulmonary Aspergillosis...
...NS
The IDSA recommends voriconazole as primary t...
...ipid formulations of AmB are reserved for thos...
...phthalmitis...
...SA recommends that Aspergillus endophth...
...ratitis...
The IDSA recommends that clinicians treat Aspe...
...ranasal Sinuse...
...ecommends that both surgery and either sys...
...rditis, Pericarditis, and Myocarditis...
...gillus endocarditis, the IDSA recommends early...
Voriconazole or a lipid formulation of AmB...
...lowing surgical replacement of an infected valve,...
...elitis and Septic Arthritis
...l intervention is recommended, where...
...taneous
...us lesions may reflect disseminated i...
...rgillosis in burns or massive soft tissue wo...
...itonitis...
...e IDSA recommends prompt peritoneal dialysis cat...
...sophageal, Gastrointestinal, and He...
...ts voriconazole and surgical consultation i...
...suggests antifungal therapy with voriconazol...
...enal...
...gests a combined approach of medical and urolog...
...Infections...
...spergillus otitis externa, also call...
...e IDSA recommends that clinicians treat IA of the...
...nchitis in the Non-transplant Population...
...ggests the diagnosis of Aspergillus bronchitis i...
...A suggests treatment with oral itraconazole or...
...hrough Infection
...he IDSA suggests an individualized approach...
...l and Pre-emptive Strategie...
...ngal therapy is recommended for hi...
...ptions include a lipid formulation of Am...
...andin (caspofungin or micafungin), ( S , H)705...
...oriconazole. ( S , M)705...
...antifungal therapy is recommended for hig...
...l antifungal therapy is NOT recommend...
...se of serum or BAL fungal biomarkers such as GM or...
...tiation of antifungal therapy in patients...
Management of suspected or documented breakthroug...
...g transplant recipients not on anti-mold prophyl...
...x months after lung transplantation and in...
...Saprophytic Syndromes...
...sis of CCPA requires: ( S , M) 3 months...
...he IDSA suggests an individualized approach that t...
...hronic Cavitary Pulmonary Aspergillosi...
...nosis of CCPA requires: ( S , M) 3 months of ch...
...e: Sputum Aspergillus PCR testing is more sensitiv...
...ts with CCPA without pulmonary symptoms, we...
...ents with CCPA and either pulmonary or genera...
...ral itraconazole and voriconazole are the p...
...is a useful third-line agent for those with adver...
...may be managed with oral tranexamic...
...artery embolization ( S , M...
...gal therapy to prevent recurrence. ( S , L)705...
...failing these measures may require surgical rese...
...avenous micafungin, ( W , L)705...
...pofungin, ( W , L)705
...otericin B ( W , L...
...gical resection is an option for some patients...
...n those with progressive disease, long term,...
...ergilloma
...tic patients with a single aspergilloma an...
...with symptoms, especially significant hemop...
...t-operative antifungal therapy is not r...
...ic Syndromes...
...llergic Bronchopulmonary Aspe...
...ted Aspergillus IgE and total IgE are recommen...
...he IDSA suggests treating symptomat...
...tic fibrosis (CF) patients with frequent exacerb...
...lergic Aspergillus Rhinosinusitis...
...recommends establishing the diagno...
...he IDSA recommends polypectomy and sinus washou...
...e IDSA recommends the use of topical nasal s...
The IDSA suggests oral antifungal thera...
...ry of Recommendations for the Treatment...
...l Scenarios Where Antifungal Therap...
...Commonly Encountered Drug-Drug Interactions...