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 F...
...d allogeneic HSCT recipients should be placed in...
...tions can be reasonably applied to other h...
...tals in which a protected environment is not...
...ecommends reasonable precautions t...
...eukemia and transplant centers should perfor...
Prophylaxis
...ophylaxi...
...e IDSA recommends prophylaxis with posaconazole,...
voriconazole, ( S , M)...
...icafungin ( W ,...
...d neutropenia for those who are at high risk f...
...ith caspofungin is also probably effect...
...rophylaxis with itraconazole is effective, but t...
...should not be co-administered with other age...
Graft vs. Host Disease (GVH...
...he IDSA recommends prophylaxis with posaconazo...
...ylaxis with other mold-active azoles is...
...ophylaxis with itraconazole is limit...
...recommends continuation of antifungal...
...ung Transplant...
...he IDSA recommends antifungal prophyla...
...mic voriconazole or itraconazole is sugges...
The IDSA recommends reinitiating antif...
...ng Solid Organ Transplant...
...SA recommends prophylactic strategies in solid org...
Diagnosis
...iagnosis
...tools are more widely used in clinical laborato...
...research in the area continues, the IDSA recommen...
...mannan (GM) and (1→3)-β-D-glucan...
...erum and bronchoalveolar lavage (BAL...
...OT recommended for routine blood screening in pati...
...OT recommended for screening in solid organ...
...erum assays for (1→3)-β-D-glucan are re...
...diographic Diagnosis...
...DSA recommends performing a chest comp...
...use of contrast during a chest CT scan for a...
...t is recommended when a nodule or a mass i...
...he IDSA suggests a follow-up chest CT-sc...
Bronchoscopy...
...mends performing a bronchoscopy with BAL in...
...comorbidities such as severe hypoxemia, bleedi...
...is low for peripheral nodular lesions, so that pe...
...e IDSA recommends the use of a standardized BA...
Treatment
...atment...
...l Agents for Aspergillosis...
...otericin B (AmB)
...holate and its lipid derivatives are approp...
...lized formulations of AmB may be considered...
Echinocandi...
...ocandins are effective in salvage t...
...azoles...
Triazoles are preferred agents for treatment and p...
...patients receiving triazole-based ther...
...unt of data for itraconazole, voricona...
...rther studies are needed to address wheth...
...ld obtain serum trough drug levels f...
...mbination Therapy...
...inations of polyenes or azoles with echinoc...
...ibility Testing...
...fungal susceptibility testing of isolates recovere...
...nded Therapy for Invasive Disea...
...vasive Pulmonary Aspergillosis (IPA)...
...IDSA recommends primary treatment with...
...n of antifungal therapy in patients with str...
Alternative therapies include liposomal AmB,...
...nazole, ( S , M)705
...er lipid formulations of AmB. ( W , L...
...tion antifungal therapy with voriconazol...
Primary therapy with an echinocandin i...
...hinocandins (micafungin or caspofungin) can...
...ends that treatment of IPA be contin...
...h successfully treated IPA who require subseque...
...ve Aspergillosis (IA)...
...of, or eliminating altogether, immunosu...
...ony stimulating factors (CSFs) may...
...anulocyte transfusions can be consid...
...mbinant interferon-γ is recommend...
...pergillosis should be considered for...
...is not an absolute contraindication...
...sions about when to proceed with additional ch...
...ory or Progressive Disease...
...ecommends an individualized approa...
...e context of salvage therapy, an additi...
...currently receiving an antifungal and exhibiting a...
...e therapy, agents include lipid formul...
...arkers to Assess Respo...
...al monitoring of serum GM can be use...
...→3)-β-D-glucan has not been extensiv...
...ic Aspergillosis...
Treatment of aspergillosis in children...
...ransplant and Nontransplant Recipi...
...forms of tracheobronchial aspergillosis (TBA...
...cludes bronchoscopic removal of mucoid impactio...
Mold-active triazole agents are recommended fo...
...c granulomatosis is treated in the same f...
Invasive forms of TBA are treated wi...
...recommends minimization or reversal of underlyin...
...g transplant recipients, the IDSA recommends tr...
...apulmonary Aspergillos...
CN...
...e IDSA recommends voriconazole as pr...
...ulations of AmB are reserved for those int...
...ndophthalmitis
...mends that Aspergillus endophthalmitis be tre...
Keratiti...
...IDSA recommends that clinicians t...
...aranasal Sinu...
...mmends that both surgery and either systemic vo...
...ndocarditis, Pericarditis, and Myocar...
...ndocarditis, the IDSA recommends early...
...r a lipid formulation of AmB is recomme...
...gical replacement of an infected valve, l...
...myelitis and Septic Arthri...
...ntion is recommended, where feasible, for manag...
...utaneous
...lesions may reflect disseminated inf...
...aspergillosis in burns or massive soft ti...
Peritoniti...
...IDSA recommends prompt peritoneal dialysi...
...l, Gastrointestinal, and Hepatic...
...sts voriconazole and surgical consul...
...s antifungal therapy with voriconazole or a li...
...enal...
...suggests a combined approach of medical and...
...Infections...
...pergillus otitis externa, also cal...
...e IDSA recommends that clinicians treat...
...is in the Non-transplant Population...
...suggests the diagnosis of Aspergillus bronchitis...
...gests treatment with oral itraconazol...
...through Infection
...he IDSA suggests an individualized approach that t...
...and Pre-emptive Strategies...
...ntifungal therapy is recommended for h...
...ungal options include a lipid formulation o...
...hinocandin (caspofungin or micafungin),...
...oriconazole. ( S ,...
...l antifungal therapy is recommended for hi...
...fungal therapy is NOT recommended for patients wh...
...erum or BAL fungal biomarkers such as GM or...
...of antifungal therapy in patients w...
...anagement of suspected or documented br...
...ng transplant recipients not on anti...
...s after lung transplantation and in the abse...
...c and Saprophytic Syndromes...
...he diagnosis of CCPA requires: ( S , M)...
...DSA suggests an individualized approach that...
...Cavitary Pulmonary Aspergillosis (CCPA)...
...s of CCPA requires: ( S , M) 3 months of...
...Aspergillus PCR testing is more sensitive than c...
...with CCPA without pulmonary sympt...
...ith CCPA and either pulmonary or general sym...
...azole and voriconazole are the preferred oral...
...nazole is a useful third-line agent for those w...
...moptysis may be managed with oral tranex...
...ery embolization ( S , M)705...
...therapy to prevent recurrence. ( S , L)705...
...iling these measures may require surgical resect...
...s micafungin, ( W , L)705...
...spofungin, ( W ,...
...photericin B ( W , L)7...
...urgical resection is an option for some patient...
...h progressive disease, long term, even life-long...
...rgilloma...
...matic patients with a single asper...
...s with symptoms, especially significant hemoptysis...
...ri/post-operative antifungal thera...
...ic Syndromes...
...ronchopulmonary Aspergillosis...
...rgillus IgE and total IgE are reco...
...he IDSA suggests treating symptomatic ast...
...cystic fibrosis (CF) patients with frequent exace...
...ergic Aspergillus Rhinosin...
...e IDSA recommends establishing the diagnosis...
...commends polypectomy and sinus washout as the o...
...mends the use of topical nasal stero...
...ts oral antifungal therapy using mold-active t...
...y of Recommendations for the Treat...
...nical Scenarios Where Antifungal Therapeutic Drug...
...Commonly Encountered Drug-Drug Interactio...