Diagnosis
4
Î GM is NOT recommended for screening in solid organ transplant
recipients or patients with chronic granulomatous disease (CGD)
(S-H).
Î Serum assays for (1→3)-β-D-glucan are recommended for diagnosing
IA in high risk patients (hematologic malignancy, allogeneic HSCT),
but are not specific for Aspergillus (S-M).
Radiographic Diagnosis
Î The IDSA recommends performing a chest computed tomographic
(CT) scan whenever there is a clinical suspicion of invasive pulmonary
aspergillosis (IPA) regardless of chest radiograph results (S-H).
Î Routine use of contrast during a chest CT scan for a suspicion of IPA is
NOT recommended (S-M). Contrast is recommended when a nodule or
a mass is close to a large vessel (S-M).
Î The IDSA suggests a follow-up chest CT-scan to assess the response
of IPA to treatment after a minimum of two weeks of treatment; earlier
assessment is indicated if the patient clinically deteriorates (W-L).
• When a nodule is close to a large vessel, more frequent monitoring may be
required (W-L).
Bronchoscopy
Î The IDSA recommends performing a bronchoscopy with BAL in
patients with a suspicion of IPA (S-M).
• Significant comorbidities such as severe hypoxemia, bleeding, and platelet
transfusion-refractory thrombocytopenia may preclude BAL.
• The yield of BAL is low for peripheral nodular lesions, so that percutaneous or
endobronchial lung biopsy should be considered.
• The IDSA recommends the use of a standardized BAL procedure and sending the
BAL sample for routine culture and cytolog y as well as non-culture-based methods
(e.g., GM) (S-M).
