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Aspergillosis 2016

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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).

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