Key Points
1
Î Aspergillus species continue to be an important cause of life-
threatening infection in immunocompromised patients. This at-risk
population is comprised of patients with prolonged neutropenia,
allogeneic hematopoietic stem cell transplant (HSCT), solid-organ
transplantation (SOT), inherited or acquired immunodeficiencies,
corticosteroid use, and others.
Î Additionally, chronic and allergic syndromes due to Aspergillus are
recognized to affect an even greater number of additional patients.
Î 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
Î Hospitalized allogeneic HSCT recipients should be placed in a
protected environment to reduce mold exposure (S-L).
Î These precautions can be reasonably applied to other highly
immunocompromised patients at increased risk for invasive
aspergillosis (IA), such as patients receiving induction/re-induction
regimens for acute leukemia (S-L).
Î In hospitals in which a protected environment is not available, the
IDSA recommends admission to a private room, no connection to
construction sites, and not allowing plants or cut flowers to be brought
into the patient's room (S-L).
Î The IDSA recommends reasonable precautions to reduce mold
exposure among outpatients at high risk for IA, including avoidance
of gardening, spreading mulch (compost) or close exposure to
construction or renovation (S-L).
Î Leukemia and transplant centers should perform regular surveillance
of cases of invasive mold infection. An increase in incidence over
baseline or the occurrence of invasive mold infections in patients who
are not at high risk for such infections should prompt evaluation for a
hospital source (S-L).
