American Thoracic Society Quick-Reference GUIDELINES Apps
Issue link: https://eguideline.guidelinecentral.com/i/1164819
Diagnosis Table 2. Recommendations Suspected condition Recommendation Invasive fungal disease In patients with severe immune compromise, such as those with neutropenia, hematologic malignancy or recipients of hematologic stem cell or solid organ transplants presenting with unexplained lung infiltrates suspected of invasive fungal disease, the ATS recommends the use of serum GM testing. (Strong recommendation, high quality evidence) In patients suspected of invasive fungal diseases, including those with a negative serum GM, but strong risk factors for invasive aspergillosis, or positive serum GM but confounding factors for false positive GM results (ex. those patients undergoing chemotherapy or at risk for mucositis where cross-reactive epitopes from other fungi or bacteria can penetrate the intestinal mucosa causing positivity of the test), the ATS recommends bronchoalveolar lavage (BAL) testing with GM. (Strong recommendation, high quality evidence) Invasive pulmonary aspergillosis In patients with severe immune compromise, such as those with hematologic malignancy or recipients of hematologic stem cell or solid organ transplants, who are suspected of having IPA, the ATS recommends the use of blood or serum Aspergillus PCR testing. (Strong recommendation, high quality evidence) In patients with severe immune compromise, such as those with hematologic malignancy or recipients of hematologic stem cell or solid organ transplants, who are suspected of having IPA, the ATS recommends the inclusion of Aspergillus PCR on BAL testing as part of the evaluation. (Strong recommendation, high quality evidence) In patients with severe immune compromise, such as those with hematologic malignancy or recipients of hematologic stem cell or solid organ transplants, who are strongly suspected of having IPA but in whom PCR testing for Aspergillus is negative, the ATS suggests consideration of biopsy and/or additional testing with or without additional PCR or galactomannan testing. (Conditional recommendation, low quality evidence)