8
Biomarkers to Assess Response
Î Serial monitoring of serum GM can be used in the appropriate patient
subpopulations (hematologic malignancy, HSCT) who have an elevated
GM at baseline to monitor disease progression, therapeutic response,
and predict outcome (S-M).
Î (1→3)-β-D-glucan has not been extensively studied in IA to predict
outcome (W-L).
Pediatric Aspergillosis
Î Treatment of aspergillosis in children uses the same recommended
therapies as in adult patients. However, the dosing is different and for
some antifungals is unknown (S-H).
Transplant and Nontransplant Recipients
Î Saprophytic forms of tracheobronchial aspergillosis (TBA) do
NOT require antifungal treatment except for symptomatic or
immunosuppressed patients (S-M).
• Treatment includes bronchoscopic removal of mucoid impaction.
• Mold-active triazole agents are recommended for immunocompromised patients
in whom the possibility of invasive disease cannot be eliminated (S-M).
Î Bronchocentric granulomatosis is treated in the same fashion as
allergic bronchopulmonary aspergillosis (ABPA) (S-L).
Î Invasive forms of TBA are treated with a mold-active triazole or
intravenous lipid formulations of AmB (S-M).
• The IDSA also recommends minimization or reversal of underlying
immunosuppression when feasible, and bronchoscopic debridement of airway
lesions in selected cases (S-L).
Î In lung transplant recipients, the IDSA recommends treatment with a
systemic anti-mold antifungal for TBA, including saprophytic forms.
The IDSA also recommends adjunctive inhaled AmB in the setting of
TBA associated with anastomotic endobronchial ischemia or ischemic
reperfusion injury due to airway ischemia associated with lung
transplantation (S-M).
• Duration of antifungal therapy is at least 3 months or until TBA is completely
resolved, whichever is longer.
