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Cutaneous
Î As cutaneous lesions may reflect disseminated infection, the IDSA
recommends treatment with voriconazole in addition to evaluation for
a primary focus of infection (S-L).
Î In cases of aspergillosis in burns or massive soft tissue wounds,
surgical debridement is recommended, in addition to antifungal
therapy (S-M).
Peritonitis
Î The IDSA recommends prompt peritoneal dialysis catheter removal
accompanied by systemic antifungal therapy with voriconazole (S-L).
Esophageal, Gastrointestinal, and Hepatic
Î The IDSA suggests voriconazole and surgical consultation in attempts
to prevent complications of hemorrhage, perforation, obstruction or
infarction (W-L).
Î The IDSA suggests antifungal therapy with voriconazole or a lipid
formulation of AmB as initial therapy for hepatic aspergillosis (W-L).
• For extrahepatic or perihepatic biliary obstruction, or localized lesions that are
refractory to medical therapy, surgical intervention should be considered.
Renal
Î The IDSA suggests a combined approach of medical and urologic
management for renal aspergillosis (W-L).
• Obstruction of one or both ureters should be managed with decompression if
possible and local instillation of AmB deoxycholate.
• Parenchymal disease is best treated with voriconazole.
Ear Infections
Î Noninvasive Aspergillus otitis externa, also called otomycosis, is
treated by thorough mechanical cleansing of the external auditory
canal followed by topical antifungals or boric acid (S-M).
Î The IDSA recommends that clinicians treat IA of the ear with a
prolonged course of systemic voriconazole, usually combined with
surgery (S-L).
Bronchitis in the Non-transplant Population
Î The IDSA suggests the diagnosis of Aspergillus bronchitis in non-
transplant patients be confirmed by detection of Aspergillus spp. in
respiratory secretions, usually sputum, with both PCR and GM on
respiratory samples being much more sensitive than culture (W-L).
Î The IDSA suggests treatment with oral itraconazole or voriconazole
with therapeutic drug monitoring (W-L).
