Key Points
ÎÎAspergillus spp infection is a major cause of morbidity and mortality in
immunocompromised patients
ÎÎInvasive aspergillosis (IA) involves the lower respiratory tract, sinuses, and
skin (less commonly) as portals of entry
ÎÎLevels of certainty for diagnosis of IA:
>> Proven – requires histopathological documentation of infection and culture from
a normally sterile site
>> Probable – requires fulfillment of criteria in 3 categories: host factors (eg,
immune status), clinical manifestation (signs, symptoms, radiological features)
and microbiological evidence (including nonculture-based surrogates [eg,
galactomannan and 1,3D-beta glucan])
Diagnosis
ÎÎCulture confirmation of IA to confirm diagnosis and rule out other infections
>> Bronchoalveolar lavage (BAL), transthoracic percutaneous needle aspirate, or
video-assisted thoracoscopic biopsy are standard procedures for diagnosing
invasive pulmonary aspergillosis
>> Material obtained plated for growth of Aspergillus spp
ÎÎComputed tomography (CT) scan – halo sign and air-crescent sign are often
present in neutropenic patients, with a halo sign present early in the course of
infection
ÎÎGalactomannan enzyme immunoassay for nonculture-based diagnosis and
therapeutic monitoring
>> May facilitate early diagnosis and treatment when combined with CT scans
>> Detection of galactomannan in BAL fluid may increase sensitivity of that
procedure
Antifungal Treatments for IA (Tables 1 and 2)
ÎÎDrugs with in vitro, in vivo, and clinical activity against Aspergillus spp:
>> Deoxycholate amphotericin B (D-AMB); lipid formulations of AMB (LFAB) –
amphotericin B lipid complex (ABLC), liposomal AMB (L-AMB), amphotericin
B colloidal dispersion (ABCD)
>> Antifungal triazoles – voriconazole, itraconazole, posaconazole
>> Echinocandins – caspofungin, micafungin, anidulafungin
>> Voriconazole and D-AMB only agents licensed in United States for primary
treatment of IA
▶ Voriconazole demonstrated superiority over D-AMB in primary treatment of IA
▶ Recommended as primary treatment of IA in most patients
